• Extracorporeal Shockwave Therapy (ESWT) is an example of technological evolution that opens the possibility for a non-invasive therapeutic modality. Validated for use in the health care sector, it is indicated for the treatment of musculoskeletal disorders, aesthetic conditions (cellulitis, toning and fat reduction), diabetic neuropathy, and urogenital conditions (erectile dysfunction, non-bacterial prostatitis, pelvic pain syndrome).

    History: ESWT technology appeared in WWII, when submarines were attacked by bombs and remained intact, but the sailors on board presented serious trauma with visceral and pulmonary lesions without external lesions. These lesions were attributed to the shock waves, which went through the submarine walls and propagated among the sailors bodies. In everyday life, shock waves can be perceived when there is thunder, which occurs due to the intense heating and the rapid expansion of the air surrounding a lightening flash.

    The use of ESWT for therapy had its beginning in the early 70’s with Extracorporeal Lithotripsy, and then became a golden standard for the the treatment of gallstones, renal calculi, ureteral calculi, and vesical calculi. During the lithotripsy for the treatment of lower ureteral calculi, physicians observed that some patients presented an increase in bone density in the pelvic region. Based on this observation they began to use equipment designed for lithotripsy for the treatment of orthopedic dysfunctions, originating a new technology that allowed the grading of depth and intensity with which shock waves penetrate biological tissues.

    In 1997, in Vienna, Austria, the European Society for Musculoskeletal Shockwave was founded, with the objective of promoting the research and development of therapy in Europe. In Brazil, the use of shock waves as an orthopedic therapy started in 1998. In 2001, ESWT was approved by the FDA for treatment of chronic plantar fascitis in the USA. The possibility of use of ESWT in aesthetic treatments emerged from the observations of surgical results, when women suffering from muscle disorders, after receiving hip prosthesis and shock wave therapy, reported enhancement in mobility and decrease pain, as well as an improvement in their skin and body contour, suggesting there was a decrease in body circumference in the treated area. Subsequent studies have confirmed that there is a reduction of fat, improved collagen and fibroblast formation, and enhanced muscle mass with shockwave treatments.

    Characteristics: ESWT is characterized by a high-pressure pulse (80 MPa) in a time interval of extremely short duration (nanoseconds), which produces mechanical pressure waves that promotes cavitation in liquid medium (gas bubbles in fluid medium) and increase in the local temperature. These shock waves propagate in the target tissue, generating essential mechanisms of action such as mechanical impact in the tissues and formation of microbubbles and microvessicle release, which favors the achievement of therapeutic objectives for tissue healing and regeneration.

    For therapeutic purposes, there are four types of shock wave generators: Electrohydraulic systems, Piezoelectric systems, Electromagnetic systems, and Pneumatic systems – with the latter two being the most frequently used and studied in rehabilitation and aesthetics.

    The electomagnetic generator system consists of two coils that generate a magnetic field when electric current is run through- the action causes a projectile, situated inside the applicator head to move rapidly and collide with the tip of the applicator. The collision of the projectile, transfers energy to the tip of the applicator, which then transfers mechanical energy waves into the treatment area. In the pneumatic generator, the projectile is displaced toward the tip by compressed air- so essentially an air gun apparatus.

    ESWT equipment can be built to emits two types of waves – classified as Focal waves (that diverge over the target area and are more intense and deeper acting for both local and systemic effects), or Radial waves (less intense and more superficial used for tendon repair) directed at the target tissue. Equipment may offer the two types of waves, or only one of the types depending on the needed application. ESWT energy can be classified as low, medium, and high, reaching different structures and depths, such as fascia, fat, nerves, muscles, tendon, and bones.

    ‘Flashwave’ technology presents the latest advancement in shockwave therapy. The system is a piezoelectric system – in which a spark is created across a gap junction between electrodes and the energy is transferred as a waveform into a liquid in the head, which can be coupled with ultrasound gel to be transferred into the tissues of the body. the gap junction can be adjusted to modify the energy intensity of the flashwave so that the energy emitted can be modified/adjusted to the needs and tolerance of the client. The ‘Flashwave’ technology has bee shown to produce 10 times more energy per flash than another leading shockwave device. the energy comes as a peak wave with ripples that are able to be projected in both a radial and a focused pattern as desired for treatment. Waves are sent up to 10 cms into the tissues – and in clinical trials this system provides significant enhancement of therapeutic effects in comparison to older systems.

    Research Studies: There are now many shock wave studies in the areas of orthopedics, aesthetics, urology, diabetes, and neurology. The general consensus is that it stimulates metabolic changes in muscles stem cells enhancement, dissipation of fat and cellulite, reset or restoration of bioresonance, biocellular communication, and growth of blood vessels. It therefore has application in musculoskeletal medicine, aesthetic medicine, urology, and diabetes. Clinical studies have shown promising results athletic optimization, wound healing, and in diminishing the proprioceptive disorders such as Parkinson’s disease and elderly gait and balance issues.

    Characteristics: Flashwaves are longitudinal waves that can travel through the body at supersonic velocity, carrying the energy of the flash which created them. It is cutting edge medical technology, researched and developed by German engineers and medical professionals.  Flashwave initiates communication with and among cells, activating an intrinsic repair program with the tissue. This revolutionary cellular communication is the key to Flash wave’s unique medical efficacy without any relevant side effects. In comparison to other regenerative approaches ‘Flashwave’ is reliable, reproducible, and easy to apply system which doesn’t seem to require a long and complicated set of treatments.

    In Summary: Flashwave system is the latest innovation of shockwave treatment and offers a non-invasive treatment which significantly increases the range of therapeutic options available for a wide number of conditions. It is safe and due to its unique mechanism of action is a great new treatment option for a number of previously difficult-to-treat condition.