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Shockwave

Hi,

I am researching shockwave at the moment and have come across both air compressed shockwave and also electromagnetic shockwave. Is there any difference in these two methods?

What systems do people on this forum use is there a preferred brand of machine or rather once you would stay away from?

Thanks in advance.

ove indergaard

8 months ago

Back to General Electrotherapy

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lhs90393
lhs90393

Hi I am looking to purchase an F-SWT machine for my practice and am hoping to treat a variety of conditions, I am a physio so mostly M/S conditions, but, I have spent much time in aged care and have an interest in skin conditions. Having looked at the range available in Australia I am tempted by either the Storz or the Elvation Piezoelectric devices. The defocus hand-set for the Storz is an additional$8k+GST. My 1st question is has anyone had experience using either device and if so can they give an appraisal. Secondly, is the defocus handpiece essential. Piezo is interesting but frequently the comment is focus area is too narrow/shallow therefore need U/S guidance. I am interested in photography and there are defocus lenses available in that field they allow the user to shift the depth of field from front to rear of the subject. This led me to think that when using a standard F-SWT (say Storz MP100) does moving the tissue treated beyond the nominal focus point result in a defocus effect. A bag of water is much more cost effective than an $8K handpiece needing a $1.5K service every 10^6 shocks. Opinion appreciated.

Prof Oscar Ronzio
Prof Oscar Ronzio

ove268, I saw the correlation in the website of zimmer but I don´t know how they calculated it. Please, try to ask to a manufacture of electromagnetic shock waves how did they calculate the energy. You will see... On the other hand, I agree with Cilff but we also have to consider that in some pneumatic devices the frequency is a variable that affects the energy. At the same bars, at different frequency, at the same total shoots, the applied energy will be different.

ove268
ove268

Hi Cliff,

Thanks for your thorough answer. That has clarified my thinking about the issue somewhat. thanks for taking the time to explain the dosage and bar issue, that is very important. This will help me narrow my search for a unit.

Thanks again.

Ove

Cliff Eaton
Cliff Eaton

Having read the thread I wish to make these observations: There is a Chinese Radial Shockwave (should be Radial pressure wave strictly speaking) whcih uses electromagnetic technology. I cannot find any studies to support it however. Focused shockwave, of which there is three types: Spark discharge, Piezo electric and electromagnetic. Electromagnetic provided the largest therapetic area so you can be less accurate in your application. Piezo has the smallest treatment are and should be used in conjunction with US scanning. FSWT is true shockwave and can be used both superficially and deep. The majority of the good qulaity RCTs support its use in tendinopathy management. Best results when combined with graduated loading strategies Radial shockwave or RPW provides a shear wave and has been shown to be most effective for treating myofascial pain (Gleitz (2015). However due to attenuation treatments are superficial. Depending on the manufacturers transmitter you can only get a therapeutic value down to around 5cm This brings me to the transmitters. You get what you pay for! The amount of energy (EFD) measured in mj/mm2 is dependent on the type, material and shape of the transmitter. I have spoken with 18 manufacturers and only three could give me their EFDs (Chattanooga, Storz and Swiss Dolarclast). Chattanooga and Storz use the same handpiece. For a standard tendon transmitter (R15) at maximum bar pressure they produce 0.38mj/mm2. Compare this with Swiss dolarclast at 0.18mj/mm2 for their standard handpiece (R15) de Worp et al (2013) published a paper stating that they found no difference between FSWT and RPW when it came to treating Patella tendinopathy. They concluded that based on clinical outcomes they could not recommend one over the other. Based on purely economic grounds (RPW much cheaper) they had to recommend RPW 80% of the world's therapists using Shockwave are currently using RPW. Some of those who have been enjoying the benefits are gradually upgrading their machines to focused shockwave As you need to treat the associated MTP and the tendinopathy there is a good argument to have both - purse strings allowing!! If you asked my advice I would recommend you start with RPW. When consider purchasing you must establish the best EFD NOT bar pressure or frequency, which is what most sales people want to quote Hope that helps with your decision. I use Shockwave clinically and it works so you will not be disappointed Cliff

ove268
ove268

Thank you Professor.

That was a very nice explanation of a potential issue with the technology.
The Zimmer states that they have done research to make a comparison of the mJ to bars. Where from memory it is from 60mJ to 185mJ (1-5 bars)with adjustments possible down to 10mJ increments. They do not however discuss any reliability issues, however I believe heating of the treatment applicator is an issue, which may or may not affect the consistency of application.

I do see your point of the mechanical system providing better consistency and also more relatable to the existing research base and is an important point.

Thank you for your kind reply

Last updated 8 months ago

Prof Oscar Ronzio
Prof Oscar Ronzio

Dear ove268. Yes, since a few years ago we have radial electromagnetics shockwaves. They are based on the gauss rifle, a very interesting device. The fact is that is a new technology so it doesn´t have so much publications as the conventional (pneumatic) ESWT devices. We also have to think that the dosys is not clear. What do I mean? Let´s analize it:

  • When we use a pneumatic device we can modify the Bars but this preassure is not measured in the end of the applicator, it is measured in the pump system. So, this preassure could be different from one device to another.
  • In the electromagnetics ones we can modify the energy (mJ) but not the bars, because we will not have an air-pump system.
  • There is not a good correlation between Bars and mJ (from my point of view)
  • It's not the same to apply 200 mJ in the osteotendinous union than in the middle portion of a tendon or in a muscle. We should have to consider in how many tissue the energy will be applied.
  • Some devices expres in the screen the energy in mJ/mm2 but you can change the applicator, so the form and the area will change.
  • The formulas do not express physiological effects. I´m going to use a simple but erroneuos formula to demostrate it:
    • Case 1: 2000 shoots x 50 mJ = 100.000
    • Case 2: 1000 shoots x 100 mJ = 100.000
      • Could we say that the effect will be the same? Certainly no, because we still no have the acknowledgment and studies to demonstrate it in all the posibilites that we have.

In the practice I noticed that some of this devices have "arrhythmias" (as we called it joking). This means that are not captable to sustain the same power in every impact. Of course, this problem is not present in all the devices and I didn´t use the Zimmer one but , in general, the "gun" suppliers are from China. Just in case, you should try it before.

Hope this information is usefull for you. Best, Oscar Ronzio

Last updated 8 months ago

ove268
ove268

Great thank you. Yes I understand the different mechanisms. One of the systems I'm looking at is electromagnetic but does radial and not focused. It's the Zimmer enpuls 2.0.

My ultimate concern is the efficiency, if there are no differences in clinical results then it is just a judgement call either way.

lochingai197
lochingai197

Air compressed type is called pneumatic, mainly for radial shockwave. Electromagnetic is for focused shockwave, more economical than the sparking discharge type. You can also consider piezoelectric one.

Those are all about the physical mechanism of producing the shockwaves, different in cost and efficiency, similar clinical effects besides the radial type. The clinical effects mainly depend on the intensity.

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