Frequently asked questions about shock wave therapy (SWT)

Side effects of shock wave therapy

SWT is generally well received by patients. Sometimes, after using the technique, short-term swelling occurs on the skin, and hematomas can form. The high professionalism of Best Clinic employees and the use of modern equipment allows us to minimize the risk of complications. Before the procedure, patients are examined by qualified specialists, their medical history and available medical documentation are studied. If there are relative contraindications, the decision on the possibility of using shock wave therapy is made by experienced clinic doctors.

How does a shock wave work?

Shock wave is an acoustic wave that delivers energy to the painful area and skeletal muscle tissue in the subacute, subchronic and chronic stages of the disease. Shock waves are characterized by a certain pulse shape and pressure, which usually ranges from 1 to 5 bar, which allows for gentle therapy, while providing a stimulating effect and triggering healing, reparative and restorative processes in biological tissues.

If we consider the treatment of heel spurs specifically, then with the help of a shock wave, calcified fibroblasts are destroyed.

Calcification most often leads to microtears and other tendon injuries. The shock waves “break” the resulting calcifications, which are subsequently removed through the body’s lymphatic system, and thus the condition of the tendons improves.

It is also important to note that UVT not only has a targeted effect on the affected areas, but also has auxiliary healing properties on the body. Thus, in the zone of exposure to waves, metabolic processes improve, significant stimulation of blood flow occurs, especially in the capillaries, which promotes faster resorption of calcium salts, areas of fibrosis and stimulates tissue restoration, which contributes to a speedy recovery of the patient.

Is shockwave therapy effective for arthritis?

Arthritis is accompanied by pain, changes in joint structures, inflammation, and movement restrictions. The shock wave blocks a painful attack, improves the quality of nutrition in damaged cells, enhances the elasticity of cartilage, promotes the resorption of inflammatory foci and the destruction of pathological bone structures. For arthritis, shockwave therapy is used to reduce pain, inflammation, expand movement patterns, and prevent relapses. The effectiveness of the procedure largely depends on the quality of the equipment used and the duration of treatment. Several sessions are required to obtain a lasting positive effect. The skill of the specialist who conducts shock wave therapy sessions also plays an important role.

So what is a “heel spur”?

Nothing more than inflammation of the fascia (hence the name plantar fasciitis), which connects the heel and metatarsal bones. Thanks to this design, our foot maintains its correct shape and smoothly absorbs when walking, softening the gait.

Reasons contributing to the appearance of “heel spurs”:

flat feet , this pathology leads to a redistribution of the load on the arch of the foot, as a result of which the plantar fascia becomes inflamed at the point of attachment to the heel. At the Pain Treatment Center of the Ram Clinic, flat feet are detected in the early stages, corrective treatment is carried out, which further promotes the correct positioning of the foot and the prevention of such diseases as “heel spurs” and other pathologies of the musculoskeletal system.
excess weight , this pathology leads to significant stress on the foot;
excessively intense physical activity received by long-distance runners, amateur tourists who practice hiking over long distances without rest and in incorrectly selected shoes;
various inflammatory, vascular, degenerative diseases of the lower extremities : deforming arthrosis, diabetic polyneuropathy, rheumatoid arthritis, etc.

All these negative phenomena lead to microscopic tears in the place where the plantar fascia attaches to the heel bone. Repeatedly repeated microtraumas of the fascia (especially the points of its attachment to the heel bone) lead to a chronic inflammatory process, which results in the appearance of a pathological bony outgrowth of the heel bone - a heel spur, which causes pain.

Symptoms of a heel spur: burning, excruciating pain in the heel, many patients describe it as “like stepping on a nail.” After rest, especially after a night's sleep, relief occurs, but the pain returns again with the next load on the lower limbs. And the intensity of pain does not depend on the stage of the disease.

If the “heel spur” is not treated, painful sensations begin to appear even with the most minimal load on the foot. A person begins to adapt when walking, involuntarily unloading the heel area, thereby overloading the forefoot. In more advanced cases, you can see how patients with this pathology literally walk on their toes. As a result of uneven load on the foot, the disease can be complicated by transverse flat feet and other problems with the ankle, knee and even hip joints.

Many patients are in no hurry to seek qualified medical help, trying to solve the problem with folk remedies, which worsens their condition and continues to injure the plantar fascia.

At the Pain Treatment Center of the RAM clinics, heel spurs are treated with the most modern method of shock wave therapy (SWT) using equipment with Dornier Aries electromagnetic emitters and a unique intelligent wave focusing system (Smart Focus) for orthopedics and traumatology.

Let's see what the advantage of this method is relative to drug blockade and surgical treatment:

drug blockade : injection of corticosteroid drugs into the affected area. This method brings relief for a short period of time. Continuous administration of such drugs is contraindicated, because leads to the leaching of calcium from bone tissue and, subsequently, to osteoporosis and even aseptic necrosis of bone tissue. But the reason remains still unresolved;
surgical treatment in the surgical department of a hospital : surgery is the most radical method of treating heel spurs. But as you know, any operation is a long process of recovery and rehabilitation, and success in such treatment is not always achieved; moreover, relapses often occur.
treatment using shock wave therapy (SWT) : by far the most effective method, according to statistics it accounts for more than 90% of successful treatment compared to other methods and has no side effects or contraindications.

What exactly happens in our tissues during the procedure?

Increased blood flow and local hyperemia at the site of exposure enhances the breakdown of inflammatory mediators and induces regenerative processes.
Stimulation of metabolic reactions during the passage of a shock wave is caused by a change in the membrane permeability of cells.
High and medium pressure pulses lead to changes in the polarity and direction of ion channels and contribute to a short-term expansion of intermolecular distances.
Shock wave treatment stimulates the excretion of catabolic products, activates the function of macrophages, which achieves an anti-inflammatory effect.

Cellulite - where does it come from?

First of all, we note that such a type of cellulite as gynoid lipodystrophy is a purely female problem that develops due to the physiological characteristics of the female body.

The amount of fatty fiber in women is much greater than in men, and this is easily explained. In women, the subcutaneous fat layer performs not only standard functions (providing energy, maintaining heat, protecting internal organs), but also a number of specific ones. For example, it serves as a source of energy during pregnancy, both for the woman and for the fetus, and during menopause (after the extinction of ovarian function) it functions as an endocrine organ that produces female hormones.

Any hormonal disorder can provoke a failure in the subcutaneous fat tissue of the processes of nutrition, metabolism, drainage, and removal of toxins. Adapting to new conditions, normal fat cells (adipocytes) begin to degenerate: accumulate more fat, enlarge, become overgrown with connective tissue, group and encapsulate. Most women are familiar with the external manifestation of this process - “orange peel”.

Cellulite does not go away on its own, but only gets worse over time. Pathologically overgrown connective tissue (fibrous tissue) impedes blood circulation, fluid outflow and lymph drainage. In the absence of adequate nutrition and gas exchange in adipose tissue and skin, barely noticeable cellulite of the 1st degree quickly turns into more pronounced degrees 2 and 3, and then into the 4th, the most severe, with signs of severe tissue ischemia.

How the procedure itself is carried out:

A special gel is applied to the area affected by the shock wave; a small-sized applicator is installed directly above the affected area at the desired angle, which transmits pulses of sound waves to a depth of 7 cm.

Treatment of heel spurs with shock wave therapy usually consists of 5-7 sessions of 15-20 minutes each, which are best carried out according to a scheme with breaks of 2 to 4 days. In 1 in 10 patients, there may be a temporary increase in pain approximately 6-8 hours after the procedure, but after 2-3 days the pain intensity decreases and further treatment can be carried out.

Cavity and medicine

In medicine, for the first time, cavitation and the shock waves generated by it were used for remote lithotripsy, that is, for the destruction of stones in the renal pelvis, bladder and ureters. Then cavitation began to be used for bloodless tissue dissection using an ultrasonic laser. Currently, it is actively used for cleaning and whitening teeth, including shock wave therapy.

In shock wave therapy devices, the sound amplitude ranges from 16 to 25 hertz, that is, it belongs to the category of low-frequency vibrations that the human ear can no longer hear (or barely hear). Let us remind you that the frequency of 16 Hz is the minimum frequency that the ear can hear. This is such a deep bass, it is perceived not as one sound of a certain frequency, but as a series of clicks, this is the “do” of the subcontractave. As for the frequency range of about 25 hertz, this is the “sol” of the subcontractave, but even in this case, sounds of such low frequencies are extremely rarely used in modern musical notation.

To generate impulses, modern shock wave therapy devices are used. In appearance, they can resemble a pneumatic gun, at the end of which there is a special applicator, and the energy source for creating cavitation bubbles and shock waves can be:

electric and hydraulic shock;
piezoelectric generator, which is based on oscillations excited by electric current in a quartz plate;
The most inexpensive are devices with pneumatic generation of a shock wave, when the working fluid is a portion of compressed air released under high pressure. In fact, an ordinary jackhammer, if the impact metal part that crushes asphalt is removed from it, will be no different in principle from a powerful shock wave therapy device, since the compressor also creates excess pneumatic pressure.

Infrasonic low-frequency waves, unlike ultrasound (which belongs to high-frequency waves), have a low amplitude and a long wavelength, which means that they will not be scattered in space and will act directionally. Therefore, their final, concentrated vector of impact resembles a blow.

The very first devices that worked on these principles were created in the USA back in the mid-twentieth century, and then it was believed that they could treat malignant brain tumors. It turned out that this was not the case, but it turned out that the shock wave is capable of destroying kidney stones and is used to treat nephrolithiasis, or urolithiasis. Lithotripsy machines created in the 90s are based on this principle, and they are still used in hospitals today.

Zimmer device.

Since 2005, shock wave therapy has been widely used in Europe for the treatment of diseases of the musculoskeletal system and in sports medicine. Since 2008, there has been an international association for shock wave therapy, and currently devices for this type of treatment are being improved everywhere, they are becoming more compact and at the same time more effective.

The main mechanisms of the effect of UVT on the body are improvement of blood circulation and tissue microcirculation, normalization of local metabolism, and a pronounced anti-inflammatory effect. How is its use indicated for complications of spinal osteochondrosis, that is, for protrusions and hernias?