high energy shock waves


Summary: High-amplitude compression waves, across which density, pressure, and particle velocity change drastically. The mechanical force from these shock waves can be used for mechanically disrupting tissues and deposits.

Top Publications

  1. Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, W├Ârtler K, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290:2573-80 pubmed
    ..Furthermore, high-energy ESWT appeared to be superior to low-energy ESWT. ..
  2. Hyer C, Vancourt R, Block A. Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 2005;44:137-43 pubmed
    ..0002). Twenty-five of 30 patients reported some degree of improvement, with 5 experiencing no change. These early results indicate ultrasound-guided ESWT may be a useful tool in the treatment armamentarium for chronic plantar fasciitis...
  3. Kato K, Fujimura M, Nakagawa A, Saito A, Ohki T, Takayama K, et al. Pressure-dependent effect of shock waves on rat brain: induction of neuronal apoptosis mediated by a caspase-dependent pathway. J Neurosurg. 2007;106:667-76 pubmed
    ..This is the first report in which the pressure-dependent effect of shock wave on the histological characteristics of brain tissue is demonstrated. ..
  4. Ogden J, Alvarez R, Marlow M. Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle Int. 2002;23:301-8 pubmed
  5. Martini L, Fini M, Giavaresi G, Torricelli P, de Pretto M, Rimondini L, et al. Primary osteoblasts response to shock wave therapy using different parameters. Artif Cells Blood Substit Immobil Biotechnol. 2003;31:449-66 pubmed
    ..The current study has demonstrated that one of the most important aspects to be considered is not the total number of impulses used but the energy level of the shock waves, thus confirming that ESWT has a dose-dependent effect on cells. ..
  6. Frairia R, Catalano M, Fortunati N, Fazzari A, Raineri M, Berta L. High energy shock waves (HESW) enhance paclitaxel cytotoxicity in MCF-7 cells. Breast Cancer Res Treat. 2003;81:11-9 pubmed
    b>High energy shock waves (HESW) produced by a piezoelectric generator were studied for their effect on human breast cancer cell (MCF-7) viability and sensitivity to paclitaxel...
  7. Mariotto S, Cavalieri E, Amelio E, Ciampa A, de Prati A, Marlinghaus E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide. 2005;12:89-96 pubmed
  8. Rompe J, Furia J, Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am. 2008;90:52-61 pubmed publisher
  9. Wang L, Qin L, Lu H, Cheung W, Yang H, Wong W, et al. Extracorporeal shock wave therapy in treatment of delayed bone-tendon healing. Am J Sports Med. 2008;36:340-7 pubmed
    ..These results provide a foundation for future clinical studies toward establishment of clinical indication for treatment of delayed bone-to-tendon junction healing. ..

More Information


  1. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288:1364-72 pubmed
    ..Extracorporeal shock wave therapy (ESWT) is increasingly used for plantar fasciitis, but limited evidence supports its use...
  2. Wilbert D. A comparative review of extracorporeal shock wave generation. BJU Int. 2002;90:507-11 pubmed
    ..Under clinical conditions other variables, e.g. the stone-free rate or the percentage of complications, are used to describe the efficacy and safety of a lithotripter. ..
  3. Roukis T, Weil L, Borrelli A. Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy. J Foot Ankle Surg. 2002;41:166-72 pubmed
  4. Canaparo R, Serpe L, Catalano M, Bosco O, Zara G, Berta L, et al. High energy shock waves (HESW) for sonodynamic therapy: effects on HT-29 human colon cancer cells. Anticancer Res. 2006;26:3337-42 pubmed
    Whether high energy shock waves (HESW), generated by a piezoelectric generator, were able to activate a sonosensitizer, 5-aminolevulinic acid (ALA) and induce inhibition of cell growth in HT-29 human colorectal cancer cells was ..
  5. Liang H, Wang T, Chen W, Hou S. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clin Orthop Relat Res. 2007;460:219-25 pubmed
    ..High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate. ..
  6. Gerdesmeyer L, von Eiff C, Horn C, Henne M, Roessner M, Diehl P, et al. Antibacterial effects of extracorporeal shock waves. Ultrasound Med Biol. 2005;31:115-9 pubmed
    ..ESWT proved to exert significant antibacterial effect in an energy-dependent manner. Certain types of difficult-to-treat infections could offer new applications for ESWT. ..
  7. Nishida T, Shimokawa H, Oi K, Tatewaki H, Uwatoku T, Abe K, et al. Extracorporeal cardiac shock wave therapy markedly ameliorates ischemia-induced myocardial dysfunction in pigs in vivo. Circulation. 2004;110:3055-61 pubmed
    ..These results suggest that extracorporeal cardiac SW therapy is an effective and noninvasive therapeutic strategy for ischemic heart disease. ..
  8. Orhan Z, Ozturan K, Guven A, Cam K. The effect of extracorporeal shock waves on a rat model of injury to tendo Achillis. A histological and biomechanical study. J Bone Joint Surg Br. 2004;86:613-8 pubmed
    ..03). A significantly greater force was required to rupture the tendon in the study group (p = 0.028). Our findings suggest a basis for clinical trials using ESWT. ..
  9. Theodore G, Buch M, Amendola A, Bachmann C, Fleming L, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. 2004;25:290-7 pubmed
    ..Twelve-month data were not collected for the Control Group as they were unblinded at 3 months and offered treatment. ESWT represents a safe treatment option for chronic proximal plantar fasciitis. ..
  10. Ogden J, Alvarez R, Levitt R, Johnson J, Marlow M. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. 2004;86-A:2216-28 pubmed
    ..No patient was made worse by the procedure. The application of electrohydraulic high-energy shock waves to the heel is a safe and effective noninvasive method to treat chronic plantar fasciitis, lasting up to and beyond one year. ..
  11. van Leeuwen M, Zwerver J, van den Akker Scheek I. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature. Br J Sports Med. 2009;43:163-8 pubmed publisher
    ..Based on current knowledge it is impossible to recommend a specific treatment protocol. Further basic and clinical research into the working mechanism and effectiveness of ESWT for patellar tendinopathy are necessary. ..
  12. Chen Y, Wang C, Yang K, Kuo Y, Huang H, Huang Y, et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. J Orthop Res. 2004;22:854-61 pubmed
    ..Together, low-energy shock wave effectively promoted tendon healing. TGF-beta1 and IGF-I played important roles in mediating ESW-stimulated cell proliferation and tissue regeneration of tendon. ..
  13. Speed C, Nichols D, Richards C, Humphreys H, Wies J, Burnet S, et al. Extracorporeal shock wave therapy for lateral epicondylitis--a double blind randomised controlled trial. J Orthop Res. 2002;20:895-8 pubmed
    ..There appears to be a significant placebo effect of moderate dose ESWT in subjects with lateral epicondylitis but there is no evidence of added benefit of treatment when compared to sham therapy. ..
  14. Wang F, Wang C, Huang H, Chung H, Chen R, Yang K. Physical shock wave mediates membrane hyperpolarization and Ras activation for osteogenesis in human bone marrow stromal cells. Biochem Biophys Res Commun. 2001;287:648-55 pubmed
  15. Koshiyama K, Kodama T, Yano T, Fujikawa S. Structural change in lipid bilayers and water penetration induced by shock waves: molecular dynamics simulations. Biophys J. 2006;91:2198-205 pubmed
    ..The penetration of water molecules is enhanced by the shock wave impulse and this qualitatively agrees with a recent experimental result. ..
  16. Speed C, Nichols D, Wies J, Humphreys H, Richards C, Burnet S, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. 2003;21:937-40 pubmed
    ..Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited...
  17. Wang C, Chen H, Huang T. Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study. Foot Ankle Int. 2002;23:204-7 pubmed
    ..The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fasciitis. ..
  18. Chao Y, Tsuang Y, Sun J, Chen L, Chiang Y, Wang C, et al. Effects of shock waves on tenocyte proliferation and extracellular matrix metabolism. Ultrasound Med Biol. 2008;34:841-52 pubmed publisher
    ..The associated tenocyte proliferation is mediated by early up-regulation of PCNA and TGF-beta1 gene expression, endogenous NO release and synthesis and TGF-beta1 protein and then collagen synthesis. ..
  19. Pishchalnikov Y, Sapozhnikov O, Bailey M, Williams J, Cleveland R, Colonius T, et al. Cavitation bubble cluster activity in the breakage of kidney stones by lithotripter shockwaves. J Endourol. 2003;17:435-46 pubmed
    ..Collapse of the distal cluster caused minimal damage. Cavitation-mediated damage to stones is attributable, not to the action of solitary bubbles, but to the growth and collapse of bubble clusters. ..
  20. Varga R, Zeman S. Decomposition of some polynitro arenes initiated by heat and shock Part I. 2,4,6-Trinitrotoluene. J Hazard Mater. 2006;132:165-70 pubmed
    ..It has been stated that the chemical micro-mechanism of the primary fragmentations of shock-exposed TNT molecules and/or its detonation transformation should be the same as in the case of its low-temperature thermal decomposition. ..
  21. Madersbacher S, Marberger M. High-energy shockwaves and extracorporeal high-intensity focused ultrasound. J Endourol. 2003;17:667-72 pubmed
    ..This technique is currently not in routine clinical use. Theoretically, in parallel with HIFU, any organ accessible to conventional diagnostic ultrasound examination is a potential target for this kind of therapy. ..
  22. Rompe J. "Extracorporeal shock wave therapy for plantar fasciitis--a double blind randomised controlled trial" by C.A. Speed et al., J Orthop Res 2003;21:937-40. J Orthop Res. 2004;22:1362-4; author reply 1366 pubmed
  23. McDonald B. Stability of self-similar plane shocks with Hertzian nonlinearity. J Acoust Soc Am. 2006;120:3503-8 pubmed
    ..For an initial wave profile increasing in the direction of propagation, it is shown that where the quadratic nonlinearity coefficient diverges, the slope of the wave goes to zero. ..
  24. Pettrone F, McCall B. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am. 2005;87:1297-304 pubmed
    ..0001). These results demonstrate that low-dose shock wave therapy without anesthetic is a safe and effective treatment for chronic lateral epicondylitis. ..
  25. Horn C, Mengele K, Gerdesmeyer L, Gradinger R, Gollwitzer H. The effect of antibacterial acting extracorporeal shockwaves on bacterial cell integrity. Med Sci Monit. 2009;15:BR364-9 pubmed
    ..Other mechanisms, such as intracellular effects, might be involved in bacterial killing after ESWs and still must be elucidated. ..
  26. Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86:672-82 pubmed
  27. Qian Z, Jin F, Lu T, Kishimoto K, Hirose S. Effect of initial stress on Love waves in a piezoelectric structure carrying a functionally graded material layer. Ultrasonics. 2010;50:84-90 pubmed publisher
    ..The results reported here are meaningful for the design of surface acoustic wave (SAW) devices with high performance. ..
  28. Ciampa A, de Prati A, Amelio E, Cavalieri E, Persichini T, Colasanti M, et al. Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett. 2005;579:6839-45 pubmed
    ..The present report suggests a possible molecular mechanism of the anti-inflammatory action of ESW treatment. ..
  29. Ohtori S, Inoue G, Mannoji C, Saisu T, Mitsuhashi S, Wada Y, et al. Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neurosci Lett. 2001;315:57-60 pubmed
    ..5 or CGRP. Reinnervation of the epidermis occurred 2 weeks after treatment. These data show that relief of pain after shock wave application to the skin results from rapid degeneration of the intracutaneous nerve fibres. ..
  30. Ringer S, Lischer C, Ueltschi G. Assessment of scintigraphic and thermographic changes after focused extracorporeal shock wave therapy on the origin of the suspensory ligament and the fourth metatarsal bone in horses without lameness. Am J Vet Res. 2005;66:1836-42 pubmed
    ..Results of this study indicate that at currently used ESWT settings, no damage to the bone or bone-tendon junction should occur. ..
  31. Gorbunov N, McFaul S, Januszkiewicz A, Atkins J. Pro-inflammatory alterations and status of blood plasma iron in a model of blast-induced lung trauma. Int J Immunopathol Pharmacol. 2005;18:547-56 pubmed
    ..We conclude that EPR monitoring of blood (Fe3+)TRF can be a useful approach for assessment of systemic pro-inflammatory alterations due to SW-induced lung injury. ..
  32. Ito K, Shimokawa H. [Extracorporeal cardiac shock wave therapy for angina pectoris]. Nihon Rinsho. 2008;66:2019-26 pubmed
    ..Importantly, no procedural complications or adverse effects were noted. These results indicate that our extracorporeal cardiac SW therapy is an effective and non-invasive treatment for ischemic heart disease. ..
  33. Lebrun C. Shock-wave treatment for chronic lateral epicondylitis in recreational tennis players. Clin J Sport Med. 2005;15:198-9 pubmed
  34. Liu M, Guo X, Kuang S, Wang S, Rong G. [Application of extracorporeal shock-wave therapy (ESWT) in delayed unions and non-unions]. Beijing Da Xue Xue Bao Yi Xue Ban. 2004;36:327-9 pubmed
    ..With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined. ..
  35. Wang C, Yang K, Wang F, Hsu C, Chen H. Shock wave treatment shows dose-dependent enhancement of bone mass and bone strength after fracture of the femur. Bone. 2004;34:225-30 pubmed
    ..015) and modulus of elasticity (P = 0.011) than the low-energy and control groups. Overall, the effect of shock wave treatment on bone mass and bone strength appears to be dose dependent in acute fracture healing in rabbits. ..
  36. Canaparo R, Serpe L, Zara G, Chiarle R, Berta L, Frairia R. High energy shock waves (HESW) increase paclitaxel efficacy in a syngeneic model of breast cancer. Technol Cancer Res Treat. 2008;7:117-24 pubmed
    The combined effect of high energy shock waves (HESW), generated by a piezoelectric device, and paclitaxel on Mat B-III rat breast cancer cells in vitro and in an in vivo animal model is presented...
  37. Lee T, Huang H, Yang Y, Hung K, Cheng C, Chang N, et al. Vulnerability of the spinal cord to injury from extracorporeal shock waves in rabbits. J Clin Neurosci. 2007;14:873-8 pubmed
    ..ESWT produced varying degrees of microscopic changes of the treated cords, but no neurological symptoms. The neuronal injury was dose-dependent and mild in the low-energy group. ..
  38. Meirer R, Brunner A, Deibl M, Oehlbauer M, Piza Katzer H, Kamelger F. Shock wave therapy reduces necrotic flap zones and induces VEGF expression in animal epigastric skin flap model. J Reconstr Microsurg. 2007;23:231-6 pubmed
    ..1). However, for expression of basic fibroblast growth factor, no difference was found between the two groups. The authors conclude that the success of the shock wave treatment may partly be due to modulation of growth factor expression. ..
  39. Chooi Y, Penafort R. Extra-corporeal shock-wave therapy in the treatment of non-unions. Med J Malaysia. 2004;59:674-7 pubmed
    ..The two successful cases experienced remarkable results of union at an average of 22 weeks after ESWT. The remaining three had disappointing results. A description of the study and a note on the essential issues are presented. ..
  40. Trompetto C, Avanzino L, Bove M, Marinelli L, Molfetta L, Trentini R, et al. External shock waves therapy in dystonia: preliminary results. Eur J Neurol. 2009;16:517-21 pubmed publisher
    ..Extracorporeal shock wave therapy is probably an effective and safe treatment for upper limb dystonia, particularly for the secondary forms. Larger randomized studies are needed to confirm these preliminary results. ..
  41. Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiol. 2007;36:803-11 pubmed
    ..Herein we discuss the indications, mechanism of therapeutic effect, efficacy of treatment, and complications after ESWT application. ..
  42. Furia J. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med. 2006;34:733-40 pubmed
    ..Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Local field block anesthesia may decrease the effectiveness of this procedure. ..
  43. Clutter J, Stahl M. Hydrocode simulations of air and water shocks for facility vulnerability assessments. J Hazard Mater. 2004;106:7-16 pubmed
    ..Simulations for a variety of air and water shock scenarios are presented to validate the computational models used in the hydrocode and highlight the phenomenological issues. ..
  44. Rompe J. Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med. 2003;31:1049-50; author reply 1050 pubmed
  45. Perez M, Weiner R, Gilley J. Extracorporeal shock wave therapy for plantar fasciitis. Clin Podiatr Med Surg. 2003;20:323-34 pubmed
    ..In conclusion, ESWT has proved to be a viable treatment option for the intervention of chronic recalcitrant plantar fasciitis. ..
  46. Bulut O, Eroglu M, Ozturk H, Tezeren G, Bulut S, Koptagel E. Extracorporeal shock wave treatment for defective nonunion of the radius: a rabbit model. J Orthop Surg (Hong Kong). 2006;14:133-7 pubmed
    ..020). Histology confirmed that the bone-healing process was faster in the treated side. ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation. ..
  47. Malay D, Pressman M, Assili A, Kline J, York S, Buren B, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. 2006;45:196-210 pubmed
    ..001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment...
  48. Landorf K, Menz H, Radford J. Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis. J Am Podiatr Med Assoc. 2006;96:269-70; author reply 271-2 pubmed
  49. McClure S, Sonea I, Evans R, Yaeger M. Evaluation of analgesia resulting from extracorporeal shock wave therapy and radial pressure wave therapy in the limbs of horses and sheep. Am J Vet Res. 2005;66:1702-8 pubmed
    ..A small cutaneous analgesic effect may exist at the treatment site for approximately 3 days after ESWT or RPWT in horses. ..
  50. Gorbunov N, McFaul S, Van Albert S, Morrissette C, Zaucha G, Nath J. Assessment of inflammatory response and sequestration of blood iron transferrin complexes in a rat model of lung injury resulting from exposure to low-frequency shock waves. Crit Care Med. 2004;32:1028-34 pubmed
  51. Mariotto S, de Prati A, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem. 2009;16:2366-72 pubmed
  52. Greenstein A, Sofer M, Lidawi G, Matzkin H. Does shock wave lithotripsy of renal stones cause cardiac muscle injury? A troponin I-based study. Urology. 2003;61:902-5 pubmed
    ..Troponin I plasma levels were not elevated after this procedure and, therefore, remain suitable for evaluation of patients complaining of chest pain after SWL. ..
  53. Notarnicola A, Moretti L, Tafuri S, Panella A, Filipponi M, Casalino A, et al. Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee. Ultrasound Med Biol. 2010;36:874-9 pubmed publisher
    ..The therapeutic effects of SW were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of SW therapy in the management of CRPS. ..