Extracorporeal Shockwave Therapy (ESWT)
Discover why we regularly recommend shockwave therapy as an adjunct to stem cell therapies and regenerative medicine.
The role of ESWT as adjunctive therapy to stem cell treatments
Extracorporeal shockwave therapy (ESWT) is the application of acoustic sound waves in human tissues, which is well established as a safe treatment modality with musculo-skeletal (MSK), urology and cardiology applications.
These waves are mechanical and not electrical and work by speeding up the healing process by increasing blood circulation and metabolism. It is commonly used for chronic tendinopathies, bone stress injuries and degenerative conditions in MSK.
Shockwave Therapy is an excellent stand-alone treatment and is also an excellent adjunct to Stem Cell Therapy. These sound waves are believed to prepare the tissue post stem cell aspiration by activating the cells, ‘warming them up’ and post stem cell therapy to further enhance the delivery of treatments.
The physician will recommend a course of treatments in an outpatient setting, delivered by a physio or other MSK specialists.
Mechanism of Shockwave Therapy
A key mechanism of shockwave is mechano-transduction, where the mechanical energy is converted into chemical energy in the extracellular matrix (ECM). It is a biological pathway to which many cell types (including stem cells) sense and process the mechanical information from the extra-cellular environment.
These biomechanical forces are converted in biochemical responses, thus influencing some fundamental cell functions such as migration, proliferation, differentiation and apoptosis (TFG-Beta1).
ESWT also induces nitric oxide release which promotes vasodilation and neovascularisation.
“Shockwave therapy aids stem cell proliferation. When you combine ESWT with stem cell it promotes the healing process.”
Benoy Matthew - Specialist Physiotherapist & ESWT Expert
Adipose Tissue Stem Cells for Therapy
Human adipose stem cells have been researched as regenerative medicine in various diseases with promising results. Adipose tissue stem cells (ASCs), known as multipotent stem cells, are most commonly used in clinical applications in recent years. Adipose tissues (AT) have the advantage in the harvesting, isolation, and expansion of ASCs, especially an abundant amount of stem cells compared to bone marrow.
ESWT Pre-procedure (Injection & Extraction)
In a study by Priglinger in 2017, ESWT was performed on freshly obtained human adipose tissue and isolated adipose tissue cells. ESWT on adipose tissue enhanced the cellular ATP content and modified the expression of single mesenchymal and vascular marker, and thus potentially provides a more regenerative cell population.
Because the effectiveness of autologous cell therapy is dependent on the therapeutic potency of the patient’s cells, shockwave technology is thought to raise the number of patients eligible for autologous cell transplantation.
ESWT Post-procedure Multimodal Treatment
Following injection with stem cells, it is recommended to have further treatment with radial and focus shockwave followed by high-quality rehabilitation to restore function. Shockwave therapy promotes tenocyte proliferation which results in tendon regeneration and remodelling.
It is important that the influence of new tendon cells to cope with the increased demands following stem cells is promoted with a graduated strengthening programme.
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Dietz-Laursonn et al (2016). In-vitro cell treatment with focused shockwaves—influence of the experimental setup on the sound field and biological reaction. Journal of therapeutic ultrasound, 4(1), p.10.
Hatanaka et al (2016). Molecular mechanisms of the angiogenic effects of low-energy shockwave therapy: roles of mechanotransduction. American Journal of Physiology-Cell Physiology, 311(3), pp.C378-C385.