Focused Shockwave Therapy Research Articles

Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction.

BackgroundLow-intensity shockwave therapy (SWT) is an emerging treatment for erectile dysfunction (ED). Devices used for SWT include focused shockwave therapy (fSWT) or radial wave therapy (rWT), which differ in how the waves are generated, their tissue penetration, and the shape of their pressure waves. Most studies of SWT for ED to date have utilized fSWT. Although widely used, the efficacy of rWT for ED is unknown. Our objective is to compare the efficacy of rWT and fSWT for ED at our institution.MethodsA retrospective chart review was performed to identify all men with ED treated by fSWT or rWT. Men with history suggesting non-vasculogenic ED were excluded. All men received 6 consecutive weekly treatments. The fSWT group received 3,000 shocks per treatment at 0.09 mJ/mm2. The rWT group received 10,000 shocks per treatment at 90 mJ and 15 Hz. Pre-treatment and 6-week post-treatment Sexual Health Inventory in Men (SHIM) scores were measured. Treatment response was categorized on a scale of 1–3 (1 if no improvement, 2 if erections sufficient for intercourse with phosphodiesterase 5 inhibitors (PDE5i), or 3 if sufficient erections without PDE5i). Primary endpoint was self-reported improvement score of 2 or greater.ResultsA total of 48 men were included: 24 treated by fSWT and 24 by rWT. There were no significant differences in age, duration of ED, pre-treatment PDE5i use, or pre-treatment SHIM scores between the groups. Following treatment with rWT, the mean SHIM score improved from 9.3 to 16.1 (P<0.001). The mean SHIM following fSWT improved from 9.3 to 15.5 (P<0.001). The mean improvement in SHIM score did not differ between rWT (6.8) and fSWT (6.2) (P=0.42). 54% of men treated by fSWT experienced a significant clinical improvement (≥ grade 2 response) compared to 75% in the rWT group (P=0.42). There were no reported side effects with either device.ConclusionsIn our patient population, both fSWT and rWT were moderately effective treatments for arteriogenic ED with no observable difference in efficacy between the two modalities.

A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

IntroductionIn physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period.Material and methodsThe patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion.ResultsAt 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05).ConclusionsFocused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

The effectiveness of extracorporeal focused shockwave therapy in the treatment of plantar fasciitis

Plantar fasciitis is a common pathological condition affecting hind foot. The etiology of this disorder is not fully known, but is most probable multi-factorial in nature. Extracorporeal shock wave therapy (ESWT) is a non-invasive procedure that includes delivering shock waves to the traumatic region with the goal of decreasing pain and encouraging soft tissue healing. Extracorporeal shock wave therapy of pain syndrome on the background of plantar fasciitis allows to get a good result in 50% of cases with full restoration of the foot function, professional and daily activity of the patient.

Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials

BackgroundExtracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations.MethodsWe performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM).ResultsWe included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT.ConclusionsThe ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.

B-mode Ultrasound-guided Focused-shock Wave Therapy Accompanied by Atorvastatin-loaded Microbubbles Administration Improve Endothelial Dysfunction

B-mode Ultrasound-guided Focused-shock Wave Therapy Accompanied by Atorvastatin-loaded Microbubbles Administration Improve Endothelial Dysfunction

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy.

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy.Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment.Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC).Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05).Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

Focused Shockwave Therapy &amp; Low Level Laser Therapy In Patella Tendinopathy Among German Soccer Players

Focused Shockwave Therapy &amp; Low Level Laser Therapy In Patella Tendinopathy Among German Soccer Players

Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study.

To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. Randomized controlled trial. Sports medicine departments of a university hospital and a general hospital in the Netherlands. Fifty-two physically active male and female participants with a clinical diagnosis of PT (mean age: 28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30). Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home. The Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment. No significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks -4.8; 95% confidence interval, -12.7 to 3.0, P = 0.150). This study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.

Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases.

Coccydynia can lead to significant functional disability and worsening of quality of life if not properly managed. In this study, we aim to assess the outcomes of extracorporeal shock wave therapy in patients with coccydynia. A prospective case series study was carried out from January to December 2015. Twenty-three patients, mean age of 38.3±12.1 (range 18-64), were included. The majority were females (13; 56.5%), had pain for at least 6weeks (17; 73.9%) and had trauma to the sacrococcygeal region (17; 73.9%). They had three sessions (one session per week for three consecutive weeks) of focused shock wave therapy directed to the maximal point of coccygeal tenderness. Numerical pain scale and Oswestry disability index were used to assess outcome. Six (26.1%) patients did not complete the follow-up because of no, or minimal, improvement of their pain. After 6months of follow-up, the median numerical pain scale significantly decreased from 7.0±4.0 to 2.0±2.0 among the 17 patients with coccydynia (p<0.001). The median Oswestry disability index improved from 24.0±9.0 before therapy to 8.0±9.0 at final follow-up (p<0.001). Before treatment, 12 (70.6%) patients had moderate-to-severe disability. In contrast, no patients had severe disability and only one (5.9%) patient had moderate disability at final follow-up (p<0.001). Extracorporeal shock wave therapy had favorable outcomes in treating coccydynia. The majority of patients had partial relief of their pain and disability following this therapy.

An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur.

The experiment was designed to evaluate and compare the efficacy of focused shockwave and radial shockwave in symptomatic heel spur treatment. Postural balance tests were used to ensure the objectivity of evaluations. Forty three patients with symptomatic heel spur were divided into two comparative groups that received respectively focused shockwave therapy (the FSWT group; 2000 impulses, 4 Hz, 0.4 mJ/mm2) and radial shockwave therapy (the RSWT group; 2000 impulses, 8 Hz, 5 bars + 2000 impulses, 8 Hz, 2.5 bars). Each patient received 5 treatments at weekly intervals. Before therapy started and 1, 3, 6 and 12 weeks after it ended, the intensity of pain experienced by the patients was assessed and static balance tests were performed on a force platform. Successive measurements showed that the intensity of all kinds of pain under consideration was decreasing gradually and statistically significantly in both groups. The percentage reduction in pain intensity was similar between the groups. The standard deviation of the COP in the anterior-posterior and medial-lateral directions, 95% confidence ellipse area and COP velocity kept varying throughout the experiment, but in none of the groups changes were statistically significant. Focused shockwave therapy and radial shockwave therapy improve the well-being of patients with symptomatic heel spur significantly and comparably. Posturography cannot deliver unambiguous data for tracking changes that the two therapies induce in these patients.

Osteogenetic effect of extracorporeal shock waves in human

• This study shows efficacy of extracorporeal shock wave therapy in osteogenesis. • Focused shock wave therapy increases bone mass density in human. • Focused shock wave therapy increases bone mass concentration in human. • Focused shock wave therapy applied in heel pain is free of adverse effects.

Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study.

The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm2) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

High energy focused shock wave therapy accelerates bone healing. A blinded, prospective, randomized canine clinical trial.

To evaluate the influence of shock wave therapy (SWT) on radiographic evidence of bone healing after tibial plateau leveling osteotomy (TPLO). Healthy dogs between two to nine years of age that underwent TPLO were randomly assigned to receive either electro-hydraulic SWT (1,000 shocks) or sham treatment (SHAM). Treatment or SHAM was administered to the osteotomy site immediately postoperatively and two weeks postoperatively. Three blinded radiologists evaluated orthogonal radiographs performed eight weeks postoperatively with both a 5-point and a 10-point bone healing scale. Linear regression analysis was used to compare median healing scores between groups. Forty-two dogs (50 stifles) were included in the statistical analysis. No major complications were observed and all osteotomies healed uneventfully. The median healing scores were significantly higher at eight weeks postoperatively for the SWT group compared to the SHAM group for the 10-point (p <0.0002) and 5-point scoring systems (p <0.0001). Shock wave therapy applied immediately and two weeks postoperatively led to more advanced bone healing at the eight week time point in this study population. The results of this study support the use of electro-hydraulic SWT as a means of accelerating acute bone healing of canine osteotomies. Additional studies are needed to evaluate its use for acceleration of bone healing following fracture, or with delayed union.

Recalcitrant plantar fasciitis: Efficacy of extracorporeal focused shock wave therapy. A cohort study

Recalcitrant plantar fasciitis: Efficacy of extracorporeal focused shock wave therapy. A cohort study

No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial

The aim of the study was to compare the effectiveness of focused shockwave therapy (FSWT) and radial shockwave therapy (RSWT) for treating patellar tendinopathy. Patients were randomized into two groups. One group received three sessions of FSWT, and the other group received three sessions of RSWT. Both groups also received an eccentric training programme. Follow-up measurements took place 1, 4, 7 and 14weeks after the final shockwave treatment. The primary outcome measure was the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were pain during ADL, sports activities and the decline squat. Forty-three subjects (57 tendons) were included in the study. Twenty-one subjects (31 tendons) received FSWT, and 22 subjects (26 tendons) received RSWT. Both groups improved significantly on the VISA-P score, but there were no differences in improvement between the FSWT group (15 points on the VISA-P) and the RSWT group (9.6 points, n.s.). This was also the case for the secondary outcome measures. There were no statistically significant differences in effectiveness between FSWT and RSWT. It is therefore not possible to recommend one treatment over the other on grounds of outcome. Both groups improved significantly, although it is questionable whether this difference is clinically relevant. II.

The effects of treatment the avascular necrosis of the femoral head with extracorporeal focused shockwave therapy.

Background.Avascular necrosis of the femoral head continues to represent a major challenge for the orthopaedist and trauma surgeon. A fully effective method of treatment is yet to be introduced. After femoral head collapse, only total hip replacement can help the patient. Our study aims to assess the effects of treatment of avascular necrosis of the femoral head with extra corporeal focused shockwave therapy.Material and methods. A prospective study was carried out in patients with avascular necrosis of the femoral head, ARCO stage I-III, diagnosed by MRI imaging. Shock waves are applied under x-ray guidance. Four points are marked on the skin above the lesion. Each spot receives a dose of 1500 pulses at an energy flux density of 0.4 mJ/mm2 and a frequency of 4 Hz. Each patient undergoes 5 therapy sessions. A posturometric and stabilometric assessment is carried out before and after the therapy. Other examinations include a tensometric evaluation of the strength of the treated limb, and an assessment of pain intensity (VAS scale)and hip function (Harris hip score). Follow-up visits are scheduled at 6 weeks and 3, 6 and 12 months post-treatment.Results. Nine patients were treated with shockwave therapy at the Department of Orthopaedics and Musculoskeletal Traumatology, Medical Faculty, Medical University of Silesia, between 5 May 2011 and 1 June 2012. The patients demonstrated pain reduction and improved mobility of the treated joint (VAS score decreasing from 6.75 +/- 0.71 to 2.5 +/- 1.7; Harris hip score increasing from 55.21 +/- 15.45 to 89.21 +/- 8.26). Tensometric platform testing carried out after the treatment revealed a statistically significant difference between mean velocity of the centre of pressure (CoP) movement when walking with eyes open and closed (p<0.05) and mean CoP movement along the x (walking with eyes closed) and y (free standing with eyes closed) axes.Conclusions. 1. Extracorporeal focused shockwave therapy resulted in considerable improvement in the patients' quality of life at 6 weeks' follow-up. 2. At 6 months some patients reported intensified pain and worse hip function.

An attempt at using focused shockwave therapy to treat selected orthopedic diseases – a preliminary report

An attempt at using focused shockwave therapy to treat selected orthopedic diseases – a preliminary report

ESWT for tendinopathy: technology and clinical implications

PurposeThe general consensus that tendinopathy, at least in the chronic stage, is mainly a degenerative condition and inflammation plays a minor role has led to a shift from treatments that target inflammation towards treatment options that promote regeneration. One of these treatments is extracorporeal shockwave therapy (ESWT), a physical therapy modality that uses pressure waves to treat tendinopathy. This review was undertaken to give an overview of the literature concerning this treatment, and special attention is given to the differences between focused and radial ESWT.MethodsA narrative description of wave characteristics, generation methods and in vitro effects of ESWT is given. The literature on ESWT as a treatment for one common tendinopathy, patellar tendinopathy, was systematically reviewed.ResultsWaves that are generated for focused and radial ESWT have very different physical characteristics. It is unclear how these characteristics are related to clinical effectiveness. Studies into the biological effects of ESWT have mainly used focused shockwave therapy, showing a number of effects of shockwaves on biological tissue. The systematic review of studies into the clinical effects of ESWT for patellar tendinopathy showed conflicting evidence for its effectiveness.ConclusionPhysical characteristics of focused and radial waves differ substantially, but effect on clinical effectiveness is unclear. Whereas in vitro studies often show the effects of ESWT on tendon tissue, results of clinical studies are inconsistent. Based on the review of the literature, suggestions are given for the use of ESWT in clinical practice regarding timing and treatment parameters.Level of evidenceIV.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-012-2009-3) contains supplementary material, which is available to authorized users.

The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopathy - design of a randomised controlled trial

BackgroundPatellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy.Methods/designThe TOPSHOCK study (Tendinopathy Of Patella SHOCKwave) is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle.DiscussionThe TOPSHOCK study is the first randomised controlled trial that directly compares the effectiveness of focused shockwave therapy and radial shockwave therapy, both in combination with eccentric decline squat training, for treating patellar tendinopathy.Trial registrationTrial registration number NTR2774.

ESWT in the management of patella tendinopathy

Lecture 21Patella tendinopathy is still a potentially career ending injury if not accurately diagnosed and actively managed. Prevalence has been reported to be in the range of 7–40% in the...