Extracorporeal Short Wave Therapy

The biological and molecular biological mode of action of extracorporeal show waves (ESW) is based on the con- version of mechanical stimuli into biochemical signals. Generally speaking, an energy transfer takes place, from mechanical into chemical energy.
In order for ESWT to work, the stimulus applied must produce its effect on the tar- get site – the target cell or the cell nucleus – in such a form that the corresponding targe- ted flow of information leads demonstrably to the desired biochemical changes in the cell itself.

As ESWT is used as a the- rapeutic measure, two ef- fects should be produced: specific substances within the body such as cytokines, growth factors, neurotrans- mitters, heat shock proteins and RONS (reactive oxygen nitrogen species) should be activated to incite the orga- nise to generate new tissue; and the gene expression of the cell should be affected at molecular level.

As in music, where it is pos- sible to create pieces of music that sound different using the same instruments, by changing the oscillation, tempo and rhythm in order to produce another tone, individual tissues respond dif- ferently to the frequency and amplitude of mechanical sti- mulation, as well as to the type of forces released. The cellular morphology, that is to say the sound body of the cell, appears to play a role in mechanotransduction.
In order to find the right tone for the various areas of application for ESWT, various parameters are available to set the frequency and the magnitude of the shear force to stimulate bone cells for example. These parameters could be determined by the amount of intracellular cal- cium, the release of pros- taglandin, and in molecular biology by the bone-specific protein, osteopontin.

When mechanically stimula- ting the cartilage, in additi- on to the frequency and the amplitude of the compressi- on, the duration of the stimu- lation also plays a decisive role. In this case too, the in- termittent release of Ca2+ appears to play a decisive role, since, by changing the frequency of the concentrati- on of Ca2+ in the cytoplas- mic matrix, the gene expres- sion can be controlled, as if applying a code.

In epithelial tissue, the modu- lation of the force applied is of importance. Shear forces, that among other things init- iate NO generation and the ensuing vasodilatation, are of prime importance here.

The fact that it is possible to activate mesenchymal stems cells in a targeted and con- trolled manner opens up the possibility of observing and monitoring other signalling and differentiation paths of MSC. This is not only of huge importance in the orthopae- dic and surgical field with re- gard to the therapeutic use of ESW, but is hugely beneficial for cardiovascular regenera- tion.

The modes of action sket- ched out here of extracorpo- real shock waves are certain- ly still incomplete. The list of biochemical and molecular biological effects is long. The main issues are on the one hand finding the optimal fre- quency, amplitude and du- ration of ESWT stimulation and the amount of force that has to be delivered to induce the regeneration of the vari- ous tissue structures, and on the other hand the objective documentation and visuali- sation of the molecular bio- logical changes. This latter appears to have moved ne- arer to being within our grasp thanks to the possibility of molecular magnetic reso- nance tomography (mMRT).

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