Dr Candice Dugmore Chiropractor
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Address: 169 Fordyce Road, Walmer
Port Elizabeth, 6070
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Email: drcandi13@gmail.com

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Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) is considered to be the leading evidence based multidisciplinary tool in the conservative management of subacute and chronic conditions relating to the musculoskeletal system. Shockwave therapy is a multidisciplinary device used in orthopaedics, physiotherapy, sports medicine, urology and veterinary medicine. Shock wave therapy is a noninvasive method that uses pressure waves to treat various musculoskeletal conditions. High-energy acoustic waves (shock waves) deliver a mechanical force to the body’s tissues. Its main assets are fast pain relief and mobility restoration. Together with being a non-surgical therapy with no need for painkillers makes it an ideal therapy to speed up recovery and cure various indications causing acute, subacute or chronic pain.

Medical effects:

Acoustic waves with high energy peak used in Shockwave therapy interact with tissue causing overall medical effects of accelerated tissue repair and cell growth, analgesia and mobility restoration. All the processes mentioned in this section are typically employed simultaneously and are used to treat chronic, sub-acute and acute (advanced users only) conditions.

New Blood Vessel Formation:

Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary microruptures in tendon and bone. Due to microruptures the expression of growth factors such as eNOS, VEGF, PCNS and BMP is significantly increased.

As a result of these processes arterioles are remodeled, stimulated to grow and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone. 

Reversal of Chronic Inflammation:

Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.

Mast cell activation is followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step help restore normal healing and regenerative processes. 

Stimulation of Collagen production:

The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged musculoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.

Dissolution of Calcific Fibroblasts:

Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The granular particles of calcium are then removed by the lymphatic system.

Dispersion of Pain mediator “Substance P”:

Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines and other nociceptive metabolites also helps inhibit development of inflammatory oedema. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief. 

Release of trigger points:

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis”. The assumed mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.