Shockwave is an acoustic wave which carries high energy to sore spots and myoskeletal tissues with subacute, subchronic and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissues.
Shockwaves are characterized by jump change in pressure, high amplitude, and non-periodicity.
The kinetic energy of the projectile, created by compressed air, is transferred to the transmitter at the end of the applicator and further into the tissue.
New Blood Vessel Formation
Nutrient blood flow is necessary to start and maintain the repair processes of the damaged tissue structure. The application of acoustic waves creates capillary micro ruptures in tendon and bone. Due to micro ruptures, the expression of growth factors such as eNOS, VEGF, PCNS, and BMP is significantly increased.
As a result of these processes arterioles are remodeled, stimulated to grow, and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone.
Reversal of Chronic Inflammation
Chronic inflammation occurs when the inflammatory response is not entirely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the critical components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.
The production of chemokines and cytokines follows mast cell activation. These pro-inflammatory compounds first enhance the inflammatory process, and in the next step, help restore normal healing and regenerative processes.
Stimulation of Collagen Production
The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.
Dissolution of Calcified Fibroblasts
Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The lymphatic system then removes the granular particles of calcium.
Dispersion of Pain Mediator “Substance P”
Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines and other nociceptive metabolites also help inhibit the development of inflammatory oedema. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief.
Release of Trigger Points
Trigger points are the principal cause of pain in the back, neck, shoulder, and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis.” The postulated mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.
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