ESWT - Extracorporeal Shockwave Therapy in Orthopedics

Since the beginning of the 1990s extracorporeal shockwaves have been successfully used to treat chronic pain conditions. Extracorporeal Shockwave Therapy (ESWT) and Trigger Point Shockwave Therapy (TPST) are highly efficient, non-invasive methods of treating chronic pain in the skeletal musculature.
ESWT now has a firm place in the conservative treatment spectrum available to physicians through successful application for further indications in the treatment of acute and chronic pain of the musculoskeletal system.


The classic orthopedic indications for shockwave therapy (ESWT) are disorders of the tendon insertions, e.g. changes in the soft tissue of the rotator cuff in the shoulder, tennis or golfer’s elbow, patellar tip syndrome in the knee, or plantar fasciitis with heel pain. In sports medicine, the conditions of insertion tendinitis (enthesiopathies) are one of the standard indications for treatment with focused shockwave therapy.
Clinical studies assess the effects of ESWT in this area less on the basis of tissue destruction and more on the stimulation or activation of tissue substances which are able to play a role in the process of self-healing.


Trigger Point Shockwave Therapy (TPST) allows the penetration depth, intensity, power and pulse frequency of the shockwave pulses to be easily applied for each different indication.
The trigger points with the finely defined focus point can be detected before treatment and precisely localized. The variable penetration depth allows even triggers located deep in the musculature to be pinpointed, precisely localized and treated. This enables treatment to be maximally efficient.

The FP4 planar therapy source in the PiezoWave therapy unit significantly expands the treatment spectrum in ESWT/TPST. This unit can treat large-scale myofascial syndromes close to the surface. The combined application of the FP4 planar therapy source and the F10 G4 focused therapy source also permits therapy for many orthopedic indications.

The mechanisms of action and effects of ESWT described in the literature are as follows:

  • Neovascularization
  • Induced production of growth factors such as TGF-ß1, VEGF
  • Stimulates the proliferation of fibroblasts
  • Excitation of mesenchymal stem cell migration
  • Antibacterial effect
  • Local stimulation of circulation and suppression of proinflammatory processes