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Stosswellentherapie_knobloch_msn 03_2013_en

// Medical technology // Therapy

Shock wave therapy was first used in the 1980s for
contactless fragmentation of kidney stones. In the
1990s, orthopaedists started to incorporate this
therapy modality into their practice, initially for the
treatment of bone non-union or delayed union and
tendon problems.
Radial and focused shock wave therapy
Shock waves are high-energy sound waves created
when jet fighters break the sound barrier, for
instance. In physical terms, one speaks of a shock
wave when the pressure changes abruptly within an
extremely short distance (less than one forth of the
pulse length). Typical features of shock waves are:
steep pressure rise within 10 ns and at ambient pressure up to 100 MPa; followed by a negative pressure tensile wave component up to 10 MPa.
The following shock wave therapy modalities
should be distinguished because they differ in their
effectiveness, in the equipment costs and with
respect to their classification in the medical fee

Radial shock wave therapy – pressure waves
Radial shock waves are produced mechanically by
means of compressed air. Using a pistol-shaped
handpiece, a projectile is accelerated to a speed of
several metres per second until it strikes an impact
body. The projectile transmits its kinetic energy to
the impact body which then passes it on to the
coupled tissue. The energy produced with this
ballistic method of pressure wave generation is not
equivalent to the energy level and physical
characteristics of focused shock waves.
Shock wave therapy

Focused shock wave therapy
Contrary to radial pressure wave generation,
focused shock wave systems use electrohydraulic, piezoelectric or electromagnetic generators to Professor Karsten Knobloch, M.D.
produce the shock waves. The energy flux density SportPraxis Prof. Dr. med. Karsten Knobloch, Hannover/Germany (sports medicine practice)
of focused shock waves is ten times higher than that of radial shock waves, which means that a significantly higher amount of energy can be Technological progress in extracorporeal shock wave therapy during the last few years has significantly enhanced treatment options for top-class athletes. As early as in 2008, a field report by Professor Lohrer on the use of shock wave therapy at the Frankfurt Olympic Training Centre was published in this journal (medicalsports network 03.08). The report also covered the use of shock waves in the treatment of athletes during Olympic Shock wave therapy of tendon injuries
competitions such as the Sydney Olympic Games. The US Food and Drug Administration approved shock wave therapy for the treatment of plantar medicalsports network 03.13
fasciitis and lateral epicondylitis in 2000 and 2002, 03.13 medicalsports network
English translation of original contribution in German »Stoβwellentherapie – Anwendungsmöglichkeiten im Spitzensport«, in: medicalsports network 03.2013 / / Medical technology // Therapy
respectively. In the treatment of calcific replacement surgery in cases of bilateral four patients considered both methods to effective than the 0.1 mJ/mm² energy flux Pseudarthrosis, shin splints and
Osgood-Schlatter syndrome
reduce pain and improve function scores. densities of up to 0.4 mJ/mm² and 1500 – 2000 shocks per session. In the treatment patients with medial shin splints provided of Achilles tendon disorders, shock wave better pain reduction and a higher rate of therapy is able to provide sustained pain resumption of sports than in the control relief after an average of four treatments. KARSTEN KNOBLOCH
// Studies in medicine at Georg-August-University of
Shock wave therapy in the treatment of
and jumpers is frequently affected by an bone bruises and stress fractures
Stress reactions of the bone or even stress // 2007: Habilitation (postdoctoral lecturing qualification)
fractures involving cortical interruption ossification centre of the patellar tendon. // 2009: Head of the outpatient interdisciplinary surgery
athletes prepare for the new season. Bone bruises, too, cause MRI signal alteration resulted in a significant improvement in // 2010: Adjunct professor for plastic surgery at the MHH
Being a non-invasive treatment modality, // 2010: Fel ow of the American Col ege of Surgeons
opportunities in the management of stress Conclusion
// 2012: Opening of own sports medicine practice in
bruises. In fact, in a case series of ten and bone diseases, shock wave therapy is athletes with metatarsal or tibial stress thus enabling athletes to resume sports. A resulted in rapid healing, enabling the cannot be excluded. A list of references can be obtained from the author. Shock wave therapy in the treatment of
bone necrosis
In the treatment of aseptic bone necrosis // professor.knobloch@sportpraxis-
with 2400 shocks per session at an energy flux density of 0.5 mJ/mm² is able to halt the progression of the disease after four treatment sessions, especially when performed in the early and intermediate stages of the pathology (ARCO stages I and II). Shock wave therapy obviously stimulates NO and other pro-angiogenic and pro-osteogenic mediators. In a direct comparison between hip endoprosthesis implantation and shock wave therapy, 13 out of 17 patients considered shock wave Fig. 1: Focused shock wave therapy for
piriformis syndrome treatment
medicalsports network 03.13
English translation of original contribution in German »Stoβwellentherapie – Anwendungsmöglichkeiten im Spitzensport«, in: medicalsports network 03.2013


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