The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves

Wuerfel, Tobias; Schmitz, Christoph; Jokinen, L.L.J.

doi:10.3390/biomedicines10051084

Cited by 21 publications

(17 citation statements)

References 232 publications

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“…Additionally, it may also alleviate pain through hyperstimulation analgesia [ 32 ]. Applying ESWT stimulates the proliferation, migration, and differentiation of stem cells, fibroblasts, tenocytes, bone cells, and their precursors [ 33 – 35 ]. To understand the effects shown in this study, studies that show the direct influence of periosteal stimulation on orthotopic bone regeneration and the reduction of osteoclast activity through the inhibition of pro-osteoclastogenic factors could be considered.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Focused Extracorporeal Shock Wave Therapy and Ultrasound Therapy in the Treatment of Calcar Calcanei: A Randomized Study

Topalović

Nešić

Mitrović

et al. 2023

BioMed Research International

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The prospective, simple randomized study assesses the effect of focused extracorporeal shock wave therapy (f-ESWT) on pain intensity and calcification size compared to the application of ultrasound physical therapy in treating patients with calcar calcanei. A total of 124 patients diagnosed with calcar calcanei were consecutively included in the study. The patients were divided into two groups: the experimental group ( n = 62 ), which included the patients treated with f-ECWT, and the control group ( n = 62 ), consisting of patients treated with the standard ultrasound therapy method. The experimental group’s patients received ten therapy applications spaced seven days apart. The patients in the control group had ten ultrasound treatments on ten consecutive days over two weeks. All patients in both groups were tested using the Visual Analog Scale (VAS) to measure pain intensity before the beginning and at the end of treatment. The size of the calcification was assessed in all patients. The study hypothesizes that f-ESWT reduces the pain and the size of the calcification. Pain intensity reduction was registered in all patients. The calcification size in patients in the experimental group was reduced from the initial range of 2 mm–15 mm, to a content of 0.0 mm–6.2 mm. The calcification size in the control group ranged from 1.2 to 7.5 mm, without any change. None of the patients experienced any adverse reactions to the therapy. Patients treated with standard ultrasound therapy did not have a statistically significant reduction in the calcification size. In contrast, the patients in the experimental group treated with f-ESWT showed a substantial decrease in the calcification size.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Focused Extracorporeal Shock Wave Therapy and Ultrasound Therapy in the Treatment of Calcar Calcanei: A Randomized Study

Topalović

Nešić

Mitrović

et al. 2023

BioMed Research International

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“…ESWT is a non-pharmacological and non-surgical 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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Kaub

Schmitz

2022

Biomedicines

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There is increasing interest in the application of near-infrared (NIR) laser light for the treatment of various musculoskeletal disorders. The present study thoroughly examined the physical characteristics of laser beams from two different laser therapy devices that are commercially available for the treatment of musculoskeletal disorders. Then, these laser beams were used to measure the penetration depth in various biological tissues from different animal species. The key result of the present study was the finding that for all investigated tissues, most of the initial light energy was lost in the first one to two millimeters, more than 90% of the light energy was absorbed within the first ten millimeters, and there was hardly any light energy left after 15–20 mm of tissue. Furthermore, the investigated laser therapy devices fundamentally differed in several laser beam parameters that can have an influence on how light is transmitted through tissue. Overall, the present study showed that a laser therapy device that is supposed to reach deep layers of tissue for treatments of musculoskeletal disorders should operate with a wavelength between 800 nm and 905 nm, a top-hat beam profile, and it should emit very short pulses with a large peak power.

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“…The initial use of ESWs in medicine was in kidney stone fragmentation, but their application was quickly expanded to a variety of pathologies of the musculoskeletal system, such as the treatment of non-unions, tendinopathies, and soft tissue disorders [ 2 , 3 , 4 ]. A recent systematic review [ 5 ] revealed 100 studies that addressed the effects of ESWs on bone and cartilage tissue [ 6 , 7 , 8 ], 39 studies about the effects of ESWs on tenocytes or scar tissue [ 9 , 10 , 11 ], and 42 studies on muscle and nerve tissue [ 12 , 13 , 14 ]. No studies are present about the effects of ESWs on fascial tissues, nor if myofascial pain is considered a promising indication for their use [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although ESWs are already widely used in clinical practice, the mechanism of action underlying their biological activities is still not fully understood. A wide variety of effects at the molecular and cellular levels have been described to date, whereby the effects of ESWs differ in each case from the tissue treated [ 5 , 18 , 19 , 20 , 21 , 22 ]. From the review conducted by Wuerfel [ 5 ], it appears that the more demonstrated effects of ESWs are the increase of cell proliferations of both progenitor and differentiated cells, the ability to mimic the effect of capsaicin by reducing substance-P concentration and of botulinum toxin by destroying endplates in the neuromuscular junction, and the modulation of the releases of various cytokines and collagen type I fibers.…”

Section: Introductionmentioning

confidence: 99%

“…A wide variety of effects at the molecular and cellular levels have been described to date, whereby the effects of ESWs differ in each case from the tissue treated [ 5 , 18 , 19 , 20 , 21 , 22 ]. From the review conducted by Wuerfel [ 5 ], it appears that the more demonstrated effects of ESWs are the increase of cell proliferations of both progenitor and differentiated cells, the ability to mimic the effect of capsaicin by reducing substance-P concentration and of botulinum toxin by destroying endplates in the neuromuscular junction, and the modulation of the releases of various cytokines and collagen type I fibers. From this review, it is clear that different tissues respond to the same mechanical stimulus in different ways, and consequently it is not correct to automatically translate the data of the research on tenocytes and skin fibroblasts to fascial tissue.…”

Section: Introductionmentioning

confidence: 99%

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Immediate Effects of Extracorporeal Shock Wave Therapy in Fascial Fibroblasts: An In Vitro Study

et al. 2022

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Extracorporeal shock waves (ESWs) are used in the treatment of soft tissue injuries, but their role in the treatment of myofascial pain has not yet been demonstrated. The aim of this study was to investigate changes in cell biology of fibroblasts derived from deep/muscular fascia following treatment with ESWs. Primary fascial fibroblasts were collected from small samples of human fascia lata of the thigh of three volunteer patients (two men, one woman) during orthopedic surgery, and put in culture. These cells were exposed to 100 impulses of 0.05 mJ/mm2 with a frequency of 2.5 Hz, using 3D-printed support. This study demonstrated for the first time that ESWs can lead to in vitro production of hyaluronan-rich vesicles immediately after the treatment. At 1, 4, and 24 h after treatment, Alcian blue and Toluidine blue staining; immunocytochemistry to detect hyaluronic acid binding protein (HABP), collagen I, and collagen III; and transmission electron microscopy demonstrated that these vesicles are rich in hyaluronan and collagen I and III. The diameter of these vesicles was assessed, highlighting a small size at 1 h after ESW treatment, whereas at 4 and 24 h, they had an increase in the size. Particularly evident was the release of hyaluronan-rich vesicles, collagen-I, and collagen-III starting at 1 h, with an increase at 4 h and maintenance by 24 h. These in vitro data indicate that fascial cells respond to ESW treatment by regulating and remodeling the formation of extracellular matrix.

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The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves

Cited by 21 publications

References 232 publications

The Efficacy of Focused Extracorporeal Shock Wave Therapy and Ultrasound Therapy in the Treatment of Calcar Calcanei: A Randomized Study

The Efficacy of Focused Extracorporeal Shock Wave Therapy and Ultrasound Therapy in the Treatment of Calcar Calcanei: A Randomized Study

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

Immediate Effects of Extracorporeal Shock Wave Therapy in Fascial Fibroblasts: An In Vitro Study

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