MECHANISMS OF ACTION OF SHOCKWAVES
Radial Shockwave (RSW), sometimes referred to as Radial Pressure Wave (RPW) or Extracorporeal Activation Therapy (EPAT), is a non-invasive treatment option to aid in the activation of muscle and connective issue, facilitating pain relief. During treatment with RSW, high-energy sound waves are transmitted into the tissue propagating radially and creating a therapeutic effect on the impacted areas.
These high energy waves create a phenomenon referred to as mechanotransduction. In simple terms, it is the process of imparting brief, physical deformation to cells that lead to biochemical changes. These changes have the potential to positively impact pain and tissue repair. 1 In some instances, the negative pressure created during the tensile phase of a shockwave creates cavitation bubbles within cells. 2 If intense enough, it can lead to disruption of damaged cells which is why shockwave can be classified as a proinflammatory modality. Disruption of cells can lead to cell death (apoptosis) which triggers a low-level inflammatory response that benefits the process of removal and replacement of damaged tissue. This is another way that shockwave therapy can uniquely assist in treating chronic soft tissue problems.
Radial shockwave energy delivery is modified by the following:
• The volume of shocks provided. Most studies, and Chattanooga, recommend 2000 pulses per location when treating tendon dysfunction. Trigger points may require fewer shocks. Patient biofeedback will dictate length and intensity of treatment over an area. • The rate at which the shocks are provided (Hz). Some patients will subjectively prefer higher frequency treatments. Treating at higher rates will also shorten treatment times. • The bar pressure of the machine which dictates the intensity of the radial pressure wave. Deeper tissue dysfunction requires higher bar settings in most cases. • The applicator used. Softer materials transmit less energy and are useful for superficial tissues/ sensitive areas. Harder metals (steel and titanium) are used to treat deeper tissues as they transmit more energy into the tissue. Examples of different applicators are listed on page 5.
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