What is shockwave therapy and how does it work?
Above (Left to Right): Focused lithotripsy shockwave hand device, Radial lithotripsy shockwave device, and Ultrasound guidance device
About the technology and its history in Queensland
The first lithotripsy shockwave Unit set up in Queensland was in Brisbane at Holy Spirit hospital, Wickham terrace, in October 1990 and was the first machine used to treat kidney stones in the State, treating patients from all over QLD including Townsville, Cairns, Rockhampton, Gold Coast, and Toowoomba.
The original machine from the early 1980s was called the HM1 (Human Model 1) and comprised a huge water bath. The Dornier MFL 5000 replaced the need for using a water bath and used a very large spark plug and water cushion for delivery. We now use a parabolic reflector which is even more efficient.
Then the Dornier Epos Ultra followed -- and was specifically designed for use in orthopaedic conditions with a much shorter focal length compared to the kidney machine -- to enable exact focusing on very small tendons.
Extra-corporeal Shockwave Therapy (ESWT) works using acoustic waves of high pressure amplitudes with high rise times of a few nanoseconds and a frequency spectrum ranging from the audible to the far ultrasonic level.
Shockwaves result from the intense changes in pressure -- in less controlled and larger areas you see shockwaves during explosions, supersonic aircraft flying, or lightning causing thunder. These intense changes in pressure produce strong waves of compression and tensile forces that can travel through any elastic medium such as water, or certain solid substances.
There are several ways to generate shockwaves. Our current machine uses a parabolic reflector to generate the shockwave.
The results of the technology
During treatment, the 4 key points are:
Shockwave therapy is a non-invasive treatment - no surgery, no anaesthesia, no fuss
Pain reduction begins by inhibiting the nociceptors - the pain sensing nerves
Collagen production is upregulated - helping muscles, tendons and soft tissue to heal and repair themselves
New blood vessel are formed in the area - meaning more oxygen and nutrients are available to help repair injuries
Radial or Focused - Depending on the Condition
Soundwaves do not travel well through air. Shockwaves can be produced over a broad energy range from low to high energy so you can again tailor your treatment for different conditions.
Focused shockwaves are released at 180 shocks/min and from 0.01 mj energy to 0.5 mj energy per shockwave.
Radial shockwaves are produced with a pressure of between 1 and 4 Bar.
The therapy head is either coupled to the patients body via a water cushion or using oil/gel for transfer of energy from the hand piece, and coupling is also done via gel.
The EMSE (Electromagnetic Shockwave Emitter) works on a similar principal to a loud speaker. A capacitor is charged to high voltage of several kilovolts. After charging this energy is available for a high-energy discharge of short duration.
The energy is deflected towards the wave propagating medium (water) causing a shockwave. The intensity is proportional to the current pulse and is propagated at the speed of sound. At the end of its first path in the water a plane shock wave occurs. This is then focused using a convex acoustic lens to produce great and steep pressure amplitudes over a limited volume to the area of inflammation.
Our Storz Duolith SD1 module allows us to exactly set the depth of maximum energy -- from 0 cm on the skin surface down to 12.5 cm deep in larger muscles and joints -- giving us the ability to treat all manner of patients and conditions effectively.
The tools of the trade
Facts About Lithotripsy
Proven science behind real effects
The Focused lithotripsy shockwave hand device
You may notice this device has a wider end than the radial (unfocused) device. It's all a matter of shockwaves and acoustics - as outlined above the broader and rounder shape actually helps angle all the force of the shockwave to a narrow point. The final point can be finely adjusted so the area of greatest energy and impact -- where shockwaves converge can be several centimetres below the skin surface.
This is how lithotripsy shockwave therapy can precisely deliver beneficial energy and effects within the body -- without any surgery or scalpels.
The Radial lithotripsy shockwave hand device
and Ultrasound mapper
The longer tool on the left is the radial (unfocused) device and the flat-headed tool on the right is the ultrasound. The ultrasound provides the ability to 'see' within the body -- it uses the echoes of pulses send into the body to create a map of what's underneath the skin (same principle as submarine sonar).
QLS uses the ultrasound device in combination with either, occasionally both, focused and radial hand devices, to precisely deliver lithotripsy shockwaves to the areas of the body that are the underlying cause of the condition being treated.
Occasionally we will use a combination of Focused and Radial treatment where there is more volume to treat.
All of the hand devices above are connected to the same command unit that allows visualisation of the ultrasound mapping, and tuning of the shockwave hand tools' strength, spread and depth. Conductive gel is used to maximise effect of the shockwave path.