shockwave therapy Flashcards
what is a shockwave?
a large amplitude compression wave produced by supersonic motion of a body in a medium
what range of frequency can shockwave therapy have?
0-20MHz
what are the 2 types of shockwave?
-radial shock wave
-focussed shock wave
what are the 2 phases a shockwave has?
-a positive phase that produces shear stress (mechanical effect)
-the negative phase generates agitation and gas bubbles at high speeds, generating a second wave of shockwave
which phase could be likely to cause tissue damage?
negative phase - the cavitation generated (changes in pressure of liquid form small cavities & bubbles)
describe some properties of focussed shockwave therapy
-these shockwaves are stronger
-the beam is focused
-the energy density increases as you go deeper into the tissue
-concentrated on a point of tissue
describe some properties of radial shock wave therapy
-less intense than focussed
-the beam is divergent - ie it spreads out from it source and covers large areas
-the energy density diminishes as you go deeper into the tissues
describe the differences in pressure, pulse duration, pressure field, penetration depth and effect of focussed vs radial ESWT
how do radial shockwave applicators work?
-radial shockwaves are generated by accelerating a projectile, using compressed air through a tube on the end of which an applicator is placed
-the projectile hits the applicator and the applicator transmits the generated pressure wave into the body
in order to minimise reflection of the wave into the air, what should we use during treatment?
a coupling gel - US gel to the shockwave transducer to minimise reflection
what are examples of physiological effects of shockwave therapy?
-neovascularisation - formation of new blood vessels (role in healing)
-formation of endothelial NO
-release of anti-inflammatory cytokines
-increased fibroblast and tenocyte proliferation (healing)
-analgesia to provide a transient pain relief
what are therapeutic effects of shock wave therapy?
-tissue regeneration
-destruction of calcifications
-pain relief
what kind of clinical conditions can you use shockwave therapy for?
-tendinopathies eg Achilles, patellar, tennis elbow, gluteal
-plantar fasciitis
-myofascial pain
what are examples of contraindications for using shockwave therapy?
-pregnancy
-acute injuries
-infection
-over open wound
-bleeding disorders
-systemic infection
-septic infection of joints
-recent steroid injection
-acute inflammation
-tendon rupture/partial tear
what are the shockwave parameters?
-application pressure
-frequency
-pulse counter
-energy flux density (EFD) (mj/mm)
what is energy flux density?
amount of energy that flows through a given area per unit time
what value of EFD should be avoided in shock wave therapy?
above 0.50mJ/mm
how long should shockwave therapy treatment be?
up to 10 minutes
what frequency should be used for shock wave therapy?
-4-10Hz
how many impulses should be used for shockwave therapy for tendinopathies?
1000-2000
describe the principles of application of shockwave therapy
-explanation of procedure
-check contra-indications
-examination of skin
-instructions and warnings
-remove metal and jewellery
-dont need to test sensation
-mark area
-turn on machine
-set parameters
-apply gel to the treatment area
-place applicator on treatment area
-move treatment head within treatment area to prevent cavitation
what are examples of some adverse effects of shockwave therapy?
-high energy shockwaves (much higher than used in therapy) have been shown to have detrimental effects in soft tissues
-minor skin irritation
-pain - avoid taking NSAIDS post Rx
-headaches/migraines
-redness
-bruising
