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!