Explaining Extracorporeal Shockwave Therapy (ESWT) Historical use of shockwaves in medicine. The intuition of a housewife who encouraged her husband to investigate the use of shockwaves for biomedical application eventuated into the development of the kidney stone lithotripter, the world s first minimally invasive surgery. This introduced extracorporeal shock waves (ESW) into medicine and to date remains the gold standard for the eradication of kidney stones. Characteristics of a shock wave ESW are acoustic pressure pulses that transmit energy from a generator source, presented as a single positive peak pressure pulse with a rapid peak rise time of up to 100MPa, followed by a pressure decrease within nanoseconds (Figure 1). Figure 1. Physical properties of medical shockwaves. A radial pulse or wave does not have this characteristic and therefore is NOT a shockwave device. Methods of generating a shock wave (Figure 2). There are only 3 ways to generate a medical shock wave. Shockwave therapy in medicine evolved from Urology, the two most popular devices to date for kidney stone lithotripsy are the spark gap or electrohydraulic, and electromagnetic type devices. Radial waves (Dolorclast) are not shock wave devices, they are radial pulse. They have never been used in kidney stone lithotripsy.
Where is shockwave therapy used today? Shockwave therapy is used widely in sports and orthopaedic medicine, but have continued to expand into cardiology, complex pain syndromes, vascular application, anti-microbial and neurological syndromes (Amelio & Manganotti, 2010; Angehrn, 2008; Cacchio, et al, 2009; Chanderau et al., 2011; Craig et al., 2012; Craig & Miller, 2010; Craig & Walker, 2012; D Agostino, et al., 2011; Furia, 2006; Furia, 2008; Gerdesmeyer et al., 2005; Moretti et al 2008; Moretti et al, 2009; Notarnicola et al., 2010; Ogden et al., 2004; Romeo et al., 2011; Schaden et al., 2007; Taki et al., 2007; Tinazzi, 2010; Trompetto et al., 2009; Yardi, et al., 2010; Vasyuk, et al, 2010; Wang, 2007; Weil et al, 2002; Zelle, 2010). *Only more recent and relevant material cited. There are over 1000 publications on shockwave therapy in multiple journals since 2001 2012, making shockwave therapy possibly one of the most researched medical intervention ever. The types of devices use in these disciplines are the electro-hydraulic and electro-magnetic devices. The piezo-electric and radial type (Dolorclast) devices are not used in cardiology, neurology, complex pain syndromes and vascular applications. The Essen-Mayo clinic in Germany, the world s premier cardiology centre uses the electro-hydraulic CardioSpec device. ESWT in New Zealand In 2000 Bruce Twaddle (Orthopaedic Surgeon) and I were the first to assess all these technologies over an 18 month period. We decided on the electrohydraulic device because it provided the best outcomes, period!! Today we are the most experienced providers of shockwave therapy in New Zealand and continue to conduct cutting edge research in medical shockwave therapy with institutions and researchers in internationally. We had the vision in 2000 that shock wave therapy would prove to be highly effective, and 12 years on shockwave therapy is gaining popularity and expanding across medical disciplines (unlike most technologies that quickly become redundant). Our motivation has always been the enhancement of human science and wellbeing through developing and investigating safe, effective and drug free rehabilitation.
Twelve years on (2012), those who were skeptical of shock wave therapy even those who were opponents to this treatment modality, now realize that this is actually the best and safest treatment option for many chronic sporting injuries and syndromes, and some have decided to provide this therapy. However; they are not using the same technology as us. Some provider are using radial-wave devices and calling it shockwave therapy. This is because the radial wave devices are a cheaper alternative. To set the record straight, we have both the electro-hydraulic and radial-wave devices. This is simply because we are truly the shockwave centre of excellence in New Zealand and felt that we needed to have the completed range of shockwave devices in order to provide unbiased and appropriate therapy. Our case series using shockwave therapy for chronic musculoskeletal injuries have exceeded over 1500 cases with a success rate of over 85%. We have no doubts as to the effectiveness of this treatment for sports and occupation injuries. Most of us who are the pioneers of this treatment have now moved onto other areas of ground breaking research such as in; neurology, vascular disease, complex pain syndromes and developmental research. Our Research We were the first in the world to use shock wave therapy to reverse nerve insensitivity in a diabetic foot (Craig et al, 2012), and are pioneers in the use of shock waves in non-cancer pain syndromes of the extremity (Craig & Walker, 2012). We continue to develop and expand frontiers in rehabilitative medicine using shock waves and have been successful in utilizing shockwaves for muscle dystonia and spasticity in Cerebral Palsy (CP) and Charcot-Marie-Tooth (CMT) Disease patients, once again leading and pioneering use of shock wave therapy. We are presently in the process of presenting a hypothesis with European investigators on the reversal of Type 1 diabetes mellitus and are developing a treatment protocol to reverse this disorder, and reduce or eliminate insulin dependence using shockwaves (Craig, D Agostino, Poratt & Walker, Pending Publication). Finally for any treatment to be effective, the correct philosophy and technology must be selected and operated by an experienced and caring professional. We wish you health & wellbeing always.
Images of Electro-hydraulic Shockwave Devices: Images of Radial Pulse / Wave Devices:
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