Main Article Content
Abstract
An emerging non-invasive treatment modality to manage pain related to several Musculo-Skeletal Disorders (MSD) is termed Extracorporeal Shock Wave Therapy (ESWT). As per the research, it can be effective for tendinitis, plantar fasciitis, and calcific shoulder pain. Acoustic waves (SWs), which carry energy and propagate through tissues, are emitted by ESWT. SWs trigger both interstitial and extracellular reactions, leading to a range of beneficial effects, including pain relief, enhanced vascularization, protein biosynthesis, cell proliferation, neuroprotection, chondroprotection, and the breakdown of calcium deposits in Musculo-Skeletal (MS) structures. Thus, this explores the principles, types, machine construction, application methods, dosage, mechanisms, physiological effects, therapeutic benefits, indications, contraindications, dangers, and clinical relevance of ESWT.
Keywords
Therapeutic Benefits
Extracorporeal Shock
Article Details
How to Cite
A Comprehensive Review On The Mechanisms, Therapeutic Benefits, And Clinical Use Of Extracorporeal Shock Wave Therapy. (2025). International Journal of Research in Pharmacology & Pharmacotherapeutics, 14(3), 471-484. https://ijrpp.com/ijrpp/article/view/722
How to Cite
A Comprehensive Review On The Mechanisms, Therapeutic Benefits, And Clinical Use Of Extracorporeal Shock Wave Therapy. (2025). International Journal of Research in Pharmacology & Pharmacotherapeutics, 14(3), 471-484. https://ijrpp.com/ijrpp/article/view/722
References
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References
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2. De la Corte-Rodríguez H, Román-Belmonte JM, Rodríguez-Damiani BA, Vázquez-Sasot A, Rodríguez-Merchán EC. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthc. 2023;11(21):1–17.
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13. Bar-Kochba E, Iwaskiw AS, Dunn JM, Ott KA, Harrigan TP, Demetropoulos CK. The dynamic response of human lungs due to underwater shock wave exposure. PLoS One [Internet]. 2024;19(5):1–18. Available from: http://dx.doi.org/10.1371/journal.pone.0303325
14. Opara J, Dymarek R, Sopel M, Paprocka-Borowicz M. Extracorporeal Shock Wave Therapy (eSWT) in Spinal Cord Injury—A Narrative Review. J Clin Med. 2024;13:1–13.
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16. Caliogna L, Medetti M, Bina V, Brancato AM, Castelli A, Jannelli E, et al. Pulsed electromagnetic fields in bone healing: Molecular pathways and clinical applications. Int J Mol Sci. 2021;22(14):1–17.
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21. Reilly JM, Bluman E, Tenforde AS. Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review. PM R [Internet]. 2018;10(12):1385–403. Available from: https://doi.org/10.1016/j.pmrj.2018.05.007
22. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Jt Surg - Am Vol. 2018;100(3):251–63.
23. Gerdesmeyer L, Mittermayr R, Fuerst M, Al Muderis M, Thiele R, Saxena A, et al. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy. Int J Surg [Internet]. 2015;24:154–9. Available from: http://dx.doi.org/10.1016/j.ijsu.2015.07.718
24. Auersperg V, Trieb K. Extracorporeal shock wave therapy: an update. EFORT Open Rev. 2020;5(10):584–92.
25. D’Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg [Internet]. 2015;24:147–53. Available from: http://dx.doi.org/10.1016/j.ijsu.2015.11.030
26. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res [Internet]. 2012;7(1):1–8. Available from: http://www.josr-online.com/content/7/1/11
27. Schmitz C, Császár NBM, Milz S, Schieker M, Maffulli N, Rompe JD, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database. Br Med Bull. 2015;116(1):115–38.
28. Schaden W, Mittermayr R, Haffner N, Smolen D, Gerdesmeyer L, Wang CJ. Extracorporeal shockwave therapy (ESWT) - First choice treatment of fracture non-unions? Int J Surg [Internet]. 2015;24:179–83. Available from: http://dx.doi.org/10.1016/j.ijsu.2015.10.003
29. López-Marín LM, Rivera AL, Fernández F, Loske AM. Shock wave-induced permeabilization of mammalian cells. Phys Life Rev [Internet]. 2018;26:1–38. Available from: https://doi.org/10.1016/j.plrev.2018.03.001
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34. Liang SM, Chow KH, Manousakas I, Pu YR, Chang CC. Design and fabrication of a shock wave generator for musculoskeletal disorders. Biomed Eng - Appl Basis Commun. 2006;18(1):24–9.
35. Nazim SM. Advancements in Shock Wave Lithotripsy: Pushing Boundaries with Innovative Technology and Techniques. Intech [Internet]. 2016;1–21. Available from: https://www.intechopen.com/books/advanced-biometric-technologies/liveness-detection-in-biometrics
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37. Trebinjac S, Mujić-Skikić E, Ninković M, Karaiković E. Extracorporeal shock wave therapy in orthopaedic diseases. Bosn J Basic Med Sci. 2005;5(2):27–32.
38. Ko NY, Chang CN, Cheng CH, Yu HK, Hu GC. Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis—Randomized Controlled Study. Int J Environ Res Public Health. 2022;19(15):1–11.
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42. Periasamy M, Venkatramani H, Shanmuganathan RS. Management of chronic Achilles tendon injuries-review of current protocols and surgical options. Indian J Plast Surg. 2019;52(1):109–16.
43. Król P, Łojewski B, Król T, Kuszewski M, Stania M. Focused shock wave and ultrasound therapies in the treatment of lateral epicondylitis - a randomized control trial. Sci Rep. 2024;14(1):1–11.
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54. Coghill RC. Individual differences in the subjective experience of pain: New insights into mechanisms and models. Headache. 2010;50(9):1531–5.
55. Yang SM, Chen YH, Lu YL, Wu CH, Chen WS, Lin MT. The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial. J Neuroeng Rehabil. 2024;21(1):1–11.
56. Reardon G, Dandu B, Shao Y, Visell Y. Shear shock waves mediate haptic holography via focused ultrasound. Sci Adv. 2023;9(9):1–21.
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60. Liao C De, Xie GM, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: A meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2018;19(1):1–26.
61. Poenaru D, Ojoga F, Cinteza D. Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger. A Systematic Review. J Clin Med. 2022;11(2):1–14.
62. Ko J, Cho S Bin. Clinical Efficacy and Safety of Low-Energy Extracorporeal Shock Wave Therapy for Various Conditions of Deep Dermal and Subdermal Fibrosis. Ski Res Technol. 2024;30(10):1–8.
63. Elhawary H, Baradaran A, Abi-Rafeh J, Vorstenbosch J, Xu L, Efanov JI. Bone Healing and Inflammation: Principles of Fracture and Repair. Semin Plast Surg. 2021;35(3):198–203.
64. Shao H, Zhang S, Chen J, Wen A, Wu Z, Huang M, et al. Radial extracorporeal shockwave therapy reduces pain and promotes proximal tendon healing after rotator cuff repair: Randomized clinical trial. Ann Phys Rehabil Med [Internet]. 2023;66(4):1–7. Available from: https://doi.org/10.1016/j.rehab.2023.101730
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30. Farooq U. The discovery of third pole between a pair of like poles of an iron-core solenoid and a permanent magnet. Res Gate. 2019;1–15.
31. Sekhar BC, Dhanalakshmi B, Rao BS, Ramesh S, Prasad KV, Rao PSVS, et al. Piezoelectricity and Its Applications. Intech [Internet]. 2016;1–19. Available from: https://www.intechopen.com/books/advanced-biometric-technologies/liveness-detection-in-biometrics
32. van der Worp H, van den Akker-Scheek I, van Schie H, Zwerver J. ESWT for tendinopathy: Technology and clinical implications. Knee Surgery, Sport Traumatol Arthrosc. 2013;21(6):1451–8.
33. Roerdink RL, Dietvorst M, Zwaard B V.D., van der Worp H, Zwerver J. Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review. Int J Surg [Internet]. 2017;46:133–45. Available from: https://doi.org/10.1016/j.ijsu.2017.08.587
34. Liang SM, Chow KH, Manousakas I, Pu YR, Chang CC. Design and fabrication of a shock wave generator for musculoskeletal disorders. Biomed Eng - Appl Basis Commun. 2006;18(1):24–9.
35. Nazim SM. Advancements in Shock Wave Lithotripsy: Pushing Boundaries with Innovative Technology and Techniques. Intech [Internet]. 2016;1–21. Available from: https://www.intechopen.com/books/advanced-biometric-technologies/liveness-detection-in-biometrics
36. Crevenna R, Mickel M, Schuhfried O, Gesslbauer C, Zdravkovic A, Keilani M. Focused Extracorporeal Shockwave Therapy in Physical Medicine and Rehabilitation. Curr Phys Med Rehabil Reports. 2021;9(1):1–10.
37. Trebinjac S, Mujić-Skikić E, Ninković M, Karaiković E. Extracorporeal shock wave therapy in orthopaedic diseases. Bosn J Basic Med Sci. 2005;5(2):27–32.
38. Ko NY, Chang CN, Cheng CH, Yu HK, Hu GC. Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis—Randomized Controlled Study. Int J Environ Res Public Health. 2022;19(15):1–11.
39. Gefen A, Creehan S, Black J. Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review. Int Wound J. 2020;17(5):1405–23.
40. Amir M. Saleh, ELNaggar EMK, Sayed AS El, Abdallah SA. Effect of extracorporeal shockwave on gait parameters in patients with plantar fascitis: a randomized controlled trial. Bull Fac Phys Ther [Internet]. 2024;29:1–15. Available from: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02681586/full
41. Rojas J, Familiari F, Bitzer A, Srikumaran U, Papalia R, McFarland EG. Patient positioning in shoulder arthroscopy: Which is best? Joints. 2019;7(2):46–55.
42. Periasamy M, Venkatramani H, Shanmuganathan RS. Management of chronic Achilles tendon injuries-review of current protocols and surgical options. Indian J Plast Surg. 2019;52(1):109–16.
43. Król P, Łojewski B, Król T, Kuszewski M, Stania M. Focused shock wave and ultrasound therapies in the treatment of lateral epicondylitis - a randomized control trial. Sci Rep. 2024;14(1):1–11.
44. Rathod VT. A review of acoustic impedance matching techniques for piezoelectric sensors and transducers. Sensors (Switzerland). 2020;20(14):1–65.
45. National Research Council. Musculoskeletal Disorders and the Workplace. Musculoskeletal Disorders and the Workplace. 2001. 1–511 p.
46. Sharma V, Gupta Y, Kumar BVM, Prakash U. Friction Stir Processing Strategies for Uniform Distribution of Reinforcement in a Surface Composite. Mater Manuf Process [Internet]. 2016;31(10):1384–92. Available from: http://dx.doi.org/10.1080/10426914.2015.1103869
47. Cocco G, Ricci V, Villani M, Delli Pizzi A, Izzi J, Mastandrea M, et al. Ultrasound imaging of bone fractures. Insights Imaging [Internet]. 2022;13(1):1–12. Available from: https://doi.org/10.1186/s13244-022-01335-z
48. Jacomelli M, Demarzo SE, Cardoso PFG, Palomino ALM, Figueiredo VR. Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions. J Bras Pneumol. 2016;42(4):248–53.
49. Prevet H, Collins I. Labelled chemical probes for demonstrating direct target engagement in living systems. Future Med Chem. 2019;11(10):1195–224.
50. Tiainen T, Viitala R. Robust optimization of multi-probe roundness measurement probe angles. Measurement [Internet]. 2021;168:1–7. Available from: https://doi.org/10.1016/j.measurement.2020.108146
51. Poenaru D, Sandulescu MI, Cinteza D. Biological effects of extracorporeal shockwave therapy in tendons: A systematic review. Biomed Reports. 2023;18(2):1–12.
52. Poggi C, Palavecino M. Ultrasound principles and instrumentation. Surg Open Sci [Internet]. 2024;18:123–8. Available from: https://doi.org/10.1016/j.sopen.2024.02.005
53. Cheung T, Ho YS, Yeung JWF, Leung SF, Fong KNK, Fong T, et al. Effects of Transcranial Pulse Stimulation (TPS) on Young Adults With Symptom of Depression: A Pilot Randomised Controlled Trial Protocol. Front Neurol. 2022;13:1–14.
54. Coghill RC. Individual differences in the subjective experience of pain: New insights into mechanisms and models. Headache. 2010;50(9):1531–5.
55. Yang SM, Chen YH, Lu YL, Wu CH, Chen WS, Lin MT. The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial. J Neuroeng Rehabil. 2024;21(1):1–11.
56. Reardon G, Dandu B, Shao Y, Visell Y. Shear shock waves mediate haptic holography via focused ultrasound. Sci Adv. 2023;9(9):1–21.
57. Yam MF, Loh YC, Tan CS, Adam SK, Manan NA, Basir R. General pathways of pain sensation and the major neurotransmitters involved in pain regulation. Int J Mol Sci. 2018;19(8):1–23.
58. Patel N, Jankovic J, Hallett M. Sensory aspects of movement disorders. Lancet Neurol. 2014;13(1):1–27.
59. Cabanas-Valdés R, Serra-Llobet P, Rodriguez-Rubio PR, López-de–Celis C, Llauró-Fores M, Calvo-Sanz J. The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis. Clin Rehabil. 2020;34(9):1–16.
60. Liao C De, Xie GM, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: A meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2018;19(1):1–26.
61. Poenaru D, Ojoga F, Cinteza D. Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger. A Systematic Review. J Clin Med. 2022;11(2):1–14.
62. Ko J, Cho S Bin. Clinical Efficacy and Safety of Low-Energy Extracorporeal Shock Wave Therapy for Various Conditions of Deep Dermal and Subdermal Fibrosis. Ski Res Technol. 2024;30(10):1–8.
63. Elhawary H, Baradaran A, Abi-Rafeh J, Vorstenbosch J, Xu L, Efanov JI. Bone Healing and Inflammation: Principles of Fracture and Repair. Semin Plast Surg. 2021;35(3):198–203.
64. Shao H, Zhang S, Chen J, Wen A, Wu Z, Huang M, et al. Radial extracorporeal shockwave therapy reduces pain and promotes proximal tendon healing after rotator cuff repair: Randomized clinical trial. Ann Phys Rehabil Med [Internet]. 2023;66(4):1–7. Available from: https://doi.org/10.1016/j.rehab.2023.101730
65. Lee JH, Kim EJ. A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity. Med. 2023;59(5):1–13.
66. Cheng JH, Wang CJ. Biological mechanism of shockwave in bone. Int J Surg [Internet]. 2015;24:143–6. Available from: http://dx.doi.org/10.1016/j.ijsu.2015.06.059
67. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1):33–7.
68. Jung JW, Kim HS, Yang JH, Hoon Lee K, Park SB. Extracorporeal shock wave therapy treatment of painful hematoma in the calf: A case report. World J Clin Cases. 2020;8(24):6511–6.
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