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Focused Extracorporeal Shockwave Therapy (fESWT)

The Extracorporeal Shockwave Therapy (ESWT) is a non-invasive physical treatment modality that belongs to the field of mechanotherapy, the application of mechanical forces. Initially it was implemented in medicine in the field of urology, for the destruction of kidney stones, but over the last 25 years it has been developed for musculoskeletal indications also. During the 1990s and the early 2000s, research results suggested that fESWT could be used as a therapeutic tool.

The use of fESWT has been demonstrated to reduce pain and promote healing in bone, tendon, ligament and fascia in patients with musculoskeletal disorders; and to reduce spasticity in patients with neurological disorders.

The Focused Extracorporeal Shockwave Therapy is a specific type of Extracorporeal Shock Wave Therapy where the shockwaves are delivered to a specific point deep within the tissue. This allows a more targeted treatment of a particular area compared to a more diffuse Radial Shockwave delivery method; essentially, Focused Shockwave Therapy offers greater depth penetration and precision compared to Radial Shockwave Therapy.

The shockwaves used are short sound pulses that can penetrate water and soft tissue, which are generated outside the body (»extracorporeally«) in the handpiece of the device and transmitted into the patient’s body by means of ultrasound gel, where they have a targeted effect on the painful areas.

Radial Shockwave Therapy is the most common type of shockwave therapy, although Focused Shockwave Therapy is growing in popularity due to the treatment options, depth and precision it can offer acute cases.

Shockwave therapy devices are considered “noisy,” often described as making a noticeable “tapping” or “clicking” sound, similar to compressed air, and can be uncomfortable for some patients. Fortunately, our Focused Shockwave Therapy device, Ulforce, is more silent compared to other devices on the market, which makes the sessions less uncomfortable.

Key differences between Radial and Focused ESWT

  • Precise targeting:

Unlike Radial ESWT, Focused ESWT can deliver shockwaves to a smaller, more precise area within the tissue, which can enhance treatment efficacy for specific conditions like tendonitis or plantar fasciitis

  • Treatment depth:

Focused ESWT can reach deeper tissue due to its focused nature, while Radial ESWT affects superficial tissues.

  • Difference in pain levels:

The vibrating nature of the Radial ESWT and the extra skin stimulation, generally make the treatment more uncomfortableFocused ESWT, on the other hand, is deemed as “painless”, which allows it to be used in more acute cases.

  • Number of sessions needed:

The number of sessions, as with any other treatment, depends on the individual circumstances. Typically, Radial ESWT requires around 3-10 sessions, meanwhile Focused ESWT requires much less, usually between 3-5 sessions depending on the severity of the conditions and individual response.

  • Mechanism of action:

The focused shockwaves stimulate the body’s natural healing process by triggering cellular activity, promoting blood flow, and potentially reducing pain through a mechanism called “hyperstimulation analgesia”. 

  • Clinical applications:

Focused ESWT is commonly used to treat musculoskeletal pain conditions like tennis elbow, Achilles tendinitis, plantar fasciitis, repetitive strain injury, shin splits, hamstring issues, joint conditions causing long-term pain and certain types of bone injuries

Advantages of Focused ESWT

1. Pain relief:

Shock wave therapy is known for its ability to relieve pain.

The high-energy sound waves penetrate deep into the tissue, reducing inflammation and providing rapid pain relief.

2. Stimulation of blood circulation:

The application of shock waves improves blood circulation. This is particularly beneficial for the healing of tissues and can accelerate regeneration.

3. Acceleration of the healing process:

By increasing the body’s own regenerative capacity and improving metabolism, shock wave therapy can allow damaged tissue to regenerate and heal, leading to a faster recovery.

4. Non-invasive treatment:

As a non-invasive treatment method, shock wave therapy offers a gentle alternative to invasive procedures. It does not require surgery, reduces the risk of complications and shortens recovery time.

5. Versatile application options:

Shock wave therapy can be used for a variety of conditions, including heel spur, tennis elbow, shoulder pain and muscle tension, making it a versatile treatment option.

How does shock wave treatment work?

At the beginning of the session, the therapist applies an ultrasound gel to the area to be treated, so that the shock waves can be introduced into the body without energy loss. Then light pressure is applied and the device is moved across the damaged areas that require treatment, using a hand-held device. The shock waves are now transmitted into the body. Depending on the type of device and the condition treated, around 1500 to 2000 shock waves are delivered.

Potential Side effects

  • Pain
  • Local inflammation
  • Bruising
  • Paraesthesia
  • Erythema
  • Fascia/Tendon rupture or soft tissue damage

These potential side effects are said to resolve quickly, within a week prior to the following treatment session.

Contraindications to ESWT

  • Pregnancy
  • Over major blood vessels and nerves
  • Pacemakers or other implanted devices
  • Open wounds
  • Joint replacements
  • Epiphysis
  • Blood clotting disorders including thrombosis
  • Infection
  • Cancerous tissues
  • A compromised mental status of the patient and/or the inability to cooperate.