The efficiency of Extracorporeal Shockwave Therapy in musculoskeletal disorders treatment Essay

Extracorporeal Shockwave Therapy (ESWT) is a non invasive method that uses pressure waves to treat various musculoskeletal disorders including plantar fasciitis, lateral epicondylitis and shoulder tendinitis. Extracorporeal Shockwave Therapy is a longitudinal acoustic wave, travelling with ultrasonic speed in the water of the body tissue, which is a single pressure pulse with a short needle-like positive spike of less than one microsecond with lower amplitude (272). Shockwave Therapy is known to exert cavitation effects and have recently been demonstrated to induce localized impulses on cell membranes that resemble shear stress (272, 273). The rational of this treatment is the stimulation of tissue healing, reduction of calcification and inhibition of pain receptors or denervation to achieve pain relief (274,275). ESWT treatment is process by applying a probe on the skin after a gel is applied to help conduct the shock waves. The physical energy of shockwaves is converted into favorable biological effect on bones and soft tissue (276). Several clinical trial and animal studies have shown that ESWT enhanced wound healing through stimulation of numerous endogenous growth factors, promotes neovascularization , enhanced recruitment of endothelial progenitor cells, induced angiogenesis, improved tissue perfusion, enhances cell proliferation, stimulates extracellular matrix and decreases apoptosis (277-280). ESWT also induced the production of nitric oxide, VEGF, and several wound healing relevant genes (281-285). Animal studies show that shock wave therapy suppresses pro-inflammatory cytokines and chemokines, and reduced infiltration of leukocytes and macrophages (281,283). A prospective, randomized, controlled study was carried out among patients with DFU and compared the efficacy of wound healing among ESWT treatment group and standard treatment (debridement, off-loading, and infection treatment). After 20 weeks of follow up healing was evaluated by measuring the rate of epithelialisation. Complete wound healing was observed in 53% of ESTW patients compared to 33% patients treated with standard care. It is also demonstrated that days of complete healing was found to be 61 and 82 days respectively in ESWT and standard care patients (286). Saggini et al (287) shows that ESWT treatment shows 50 % of lower extremity chronic ulcers wound got completely healed and another 50 % of study patients wound were not healed but significant decrease of wound size, and increased formation of granulation tissue was observed compared to standard dressing (control). Further ESWT treated group shows reduced ulcer pain (288,289). In one long-term effectiveness study of ESWT in diabetic and non-diabetic foot ulcers, ESWT treatment was found to be effective in both the study groups. But the therapeutic effectiveness of ESWT was found to be gradually declined after 1 year (290). Further, Mehtap Aykac et al. (291) carried out a case study in 65 years old diabetic patients with DFU treated ESWT. ESWT was applied every other day for a total of 9 sessions with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. Follow-up visit at 3 months shows a significant reduction in perceived pain and a decrease in the wound size and depth were observed.