Shock waves can have various biological effects depending on their energy level. Low-energy shock waves are used for cell regeneration and wound healing, while high-energy shock waves are used for lithotripsy and breaking bone non-unions. Shock waves can stimulate microcirculation, cell metabolism, and release of substances like nitric oxide and substance P. They may also have analgesic, antibacterial and anti-inflammatory effects through stimulation of growth factors and stem cells. Focused shock waves are used in urology for conditions like Peyronie's disease and erectile dysfunction, while radial shock waves target areas like tendinopathies and trigger points. Treatment involves multiple sessions with focused or radial shock waves at varying energy levels

1. Effects of shock waves

2. 0.2 0.4 0.6 0.8 1.0
low-energy high-energy
Energy flux density
(mJ/mm2)
Cell regeneration (R-SW/F-SW)
Lithotripsy
Non-unions (F-SW)
2.0 3.0 4.0
Pain Therapy (R-SW/F-SW)
Wound healing (F-SW)
ESWL
From ESWT to ESWL – All about the right energy

3.  Stimulation of microcirculation (blood, lymph) and metabolism (nitrous oxide, vasodilation,
reduction of oxidative stress)
 Mechanotransduction – cell matrix stimulation
 Increase of cell wall permeability (Cell metabolism)
 Release of substance P
 Antibacterial and anti-inflammatory effect
 Stimulation of growth factors (neogenesis of vessels, bone, collagen)
 Stimulation of stem cells (cell proliferation, transport and differentiation, skin rejuvenation)
 Analgesia effect (inhibition of nociceptive fibres – gate mechanism, endorfines and serotonine
release, acceleration of substance P washout)
Biological effects of shock waves

4. Apply ESWT – Pain is NOT perceived
 Large myelinated A-delta fiber:
carries quick, intense-pain
messages
 Small, unmyelinated C fiber:
transmits throbbing, chronic pain
 Non-nociceptive A-beta fiber:
does not transmit pain stimuli
Gate open
Gate closed
Pain Management: Gate-Control Theory – Ronald Melzack (1960s)
Pain is perceived
 The gate control theory asserts
that signals transmitted by the
A-delta and C pain fibers can be
thwarted by the stimulation
with SHOCK WAVES of the non-
nociceptive A-beta fibers and
thus inhibit an individual's
perception of pain

5. Focused and radial application and transmitters
F-SW
R-SW

6. Use of the focused handpiece (F-SW) with different stand-offs

7. 2013 – Radial shock transmitter portfolio

8.  Muscle and connective tissue
relaxation, elimination of adhesions
 Improved microcirculation
 Improved neuromuscular performance
 Revitalisation
 Pneumatic generated vibration pulses
Vibration heads of V-ACTOR® handpiece
Mechanism of action of vibration therapy with the V-ACTOR®

9. ESWT – Orthopedics
Combined/radial
treatment
Achillodynia
Plantar fasciitis
Metatarsalgia
Tibial stress syndrome
Patellar tendinitis
Trochanteric tendinopathy
Calcific tendinitis
Radial/ulnar epicondylitis
Trigger points
AWT® – Aesthetics
Combined/radial
treatment
Anti-cellulite treatment
Body shaping
Tissue tightening
Scar and wrinkle
smoothing
Skin elasticity
improvement
Connective tissue
tightening
Treatment of pregnancy
stretch marks
Treatment of skin
irregularity after liposuction
ESWT – Dermatology
Focused treatment
Non-healing wounds
Diabetic gangrene
Ulcera (diabetic)
Ulcera (non-diabetic)
Skin burns
ESWT – Urology
Focused treatment
IPP (Induratio penis
plastica) »Peyronie’s
disease«
CPPS (Chronic pelvic
pain syndrome)
ED (Erectile dysfunction)
Shock wave – Indications

10. Step 1: F-SW
Stand-off: 0, I or II
Parameters: 1 – 8 Hz; 0.01 – 0.35 mJ/mm²
Number of shocks: 500 – 200
Step 2: R-SW
Transmitter: D20-S, D20-T
Parameters: 15 – 21 Hz; 1.0 – 3.5 bar
Number of shocks: 2000 – 4000
Step 3: V-ACTOR®
Parameters: 25 – 35 Hz; 2.0 – 3.0 bar
Number of shocks: 5000 – 10000
ESWT/Orthopaedics – Treatment steps of combined therapy

11. ESWT/Orthopaedics – Treatment steps of radial shock wave therapy
Step 1: R-SW
Transmitter: F15, R15, DI15, C15
Parameters: 8 – 15 Hz; 1.0 – 3.5 bar
Number of shocks: 1500 – 3500
Step 2: R-SW
Transmitter: D20-S, D20-T
Parameters: 15 – 21 Hz; 1.0 – 3.5 bar
Number of shocks: 2000 – 4000
Step 3: V-ACTOR®
Parameters: 25 – 35 Hz; 2.0 – 3.0 bar
Number of shocks: 5000 – 10000

12. AWT®/Aesthetics – Treatment steps of combined therapy
Step 1: C-ACTOR®
Stand-off: I or II
Parameters: 1 – 8 Hz; 0.56 – 1.02 mJ/mm²
Number of shocks: 500 – 3000
Step 2: D-ACTOR®
Transmitter: D20-S, D20-T
Parameters: 15 – 21 Hz; 1.5 – 4.0 bar
Number of shocks: 3000 – 4000
Step 3: V-ACTOR®
Parameters: 25 – 35 Hz; 2.0 – 3.0 bar
Number of shocks: 5000 – 10000

13. AWT®/Aesthetics – Treatment steps of radial shock wave therapy
Step 1: D-ACTOR ®
Transmitter:C15, DI15
Parameters: 15–21 Hz; 1.5 – 4.0 bar
Number of shocks: 1500 – 3500
Step 2: D-ACTOR ®
Transmitter: D20-S, D20-T
Parameters: 15 – 21 Hz; 1.0 – 3.5 bar
Number of shocks: 2000 – 4000
Step 3: V-ACTOR®
Parameters: 25 – 35 Hz; 2.0 – 3.0 bar
Number of shocks: 5000 – 10000

14. C-ACTOR®
Stand-off: I
Parameters: 6 Hz; 0.25 mJ/mm²
Number of shocks: 400 + 20/cm²
Dermatology – Treatment of focused shock wave therapy

15. CPPS ED IPP
Urology – Treatment steps of focused shock wave therapy
F-SW
Stand-off: none, II or II »anatomical«
Parameters: 6 Hz; 0.2 – 0.3 mJ/mm²
Number of shocks: 3000

16.  Coagulation disorders (haemophilia)
 Use of anticoagulants, especially Marcumar
 Thrombosis
 Tumour diseases, carcinoma patients
 Pregnancy
 Children in growth (growth plates)
 Cortisone therapy up to 6 weeks before
first ESWT treatment
 Swelling
 Reddening
 Haematomas
 Petechiae
 Pain
 Skin lesions in case of previous
cortisone therapy
ESWT – Contraindications ESWT – Side effects

17. Thank you!