Mechanism: The exact mechanism of ESWT treatment is unknown 1 , however, there are a variety of proposed mechanisms which include: promoting neovascularization at the tendon-bone junction 4 , stimulating proliferation of tenocytes 5 and stimulation of collagen synthesis via amplification of growth factor. 5-8 In addition to these proposed mechanisms regarding tissue repair, ESWT may reduce pain through a variety of mechanisms that surround the gate-control theory of pain transmission. These include: hyperstimulation of nociceptors, altered pain receptor neurotransmission, and by increasing local pain-inhibiting substances. 9-12 Treatment: Treatment is performed directly on the skin, but is non-invasive. The time alloted for a specific treatment will depend on the area and depth of the tissue being treated. This will normally fall within 2-4 minutes per area treated. Treatment frequency is normally 3-4 sessions with FSW units (1 x week) and 5-6 sessions with RPW units (treatments spaced out 5-7 days). The frequency of RPW treatments can change based on the energy levels that are utilised. Types of ESWT • Radial Pressure Waves vs Focus Shock Waves • Two technologies & two ways to generate high energy waves to tissue.
Radial pressure waves Lower energy density
Focused shock waves Higher energy density
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