Effects of Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves

Abstract

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies addressed the molecular and cellular mechanisms of action of ESWT. However, no uniform concept could be established in this matter until now. We performed a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results were as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT was described in a study does not automatically mean that this mechanism was relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.

Safety and efficacy of treating post‐burn pathological scars with extracorporeal shock wave therapy: A meta‐analysis of randomised controlled trials

“…Specifically, results of animal experiments in vivo showed that ESWT could alleviate the infiltration extent of inflammatory cells, decrease the number and density of fibroblasts, improve collagen arrangement and reduce hypertrophic index of scars in a rabbit hypertrophic scar model 41,42 . Furthermore, experiments in vitro indicated that extracorporeal shock waves can regulate proliferation, migration and differentiation of keratinocytes and fibroblasts derived from scar tissue, reduce expression of transforming growth factor beta 1 (TGF‐β1), alpha smooth muscle actin (α‐SMA), collagen‐I, fibronectin and twist‐1, which might be responsible for the anti‐scarring effect of ESWT 43–46 . In Joo's study, mechanisms of ESWT were primarily attributed to a significant increase of micro‐perfusion in the PBPS area post ESWT 20 ; the latter can be achieved with both fESWT 47 and rESWT 48 …”

“…41,42 Furthermore, experiments in vitro indicated that extracorporeal shock waves can regulate proliferation, migration and differentiation of keratinocytes and fibroblasts derived from scar tissue, reduce expression of transforming growth factor beta 1 (TGF-β1), alpha smooth muscle actin (α-SMA), collagen-I, fibronectin and twist-1, which might be responsible for the antiscarring effect of ESWT. [43][44][45][46] In Joo's study, mechanisms of ESWT were primarily attributed to a significant increase of micro-perfusion in the PBPS area post ESWT 20 ; the latter can be achieved with both fESWT 47 and rESWT. 48 No serious adverse events after treating PBPS with ESWT + CRT were reported in the studies listed in Table 2.…”

More Than Ninety Percent of the Light Energy Emitted by Near-Infrared Laser Therapy Devices Used to Treat Musculoskeletal Disorders Is Absorbed Within the First Ten Millimeters of Biological Tissue

“…ESWT is a non-pharmacological and nonsurgical treatment modality for a variety of musculoskeletal disorders [12]. The molecular and cellular mechanisms of action of extracorporeal shock waves (ESWs) on musculoskeletal tissue were addressed in more than 180 studies in the literature [13]. A key mechanism is the reduction of pain sensation and a blockade of neurogenic inflammation through the overstimulation of substance P nerve fibers [14].…”