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SHOCKWAVE (2) PRINCIPLES OF PRODUCTION (Shockwave energy is released at…
SHOCKWAVE
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4) DOSAGE
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Radial shockwave = non-focused shockwave because it is not reflected or redirected towards a focal point in the pts body
radial shockwave energy declines rapidly in proportion to the distance from the site of generation; radial shockwaves loose power the deeper they go into the body
E.G. convex 15mm head delivers its energy across the head radially. at 3.0 bar the axial penetration is 3.9cm
treatment depth or effective distance for therapeutic purposes could be said to be the Rayleigh wave distance (mid distance from the treatment head)
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Depth of shockwave depends on the force with which it was produced; higher input of energy = deeper shock will travel = more energy will be transmitted into the tissue
shockwaves produced are generally believed to travel out from the head of the machine in a cylindrical shape with very little energy outside the physical size of the head.
i.e. 15mm round head will produce a 15mm round shockwave which will stay the shape of the head as it enters another medium
1) HISTORY
Animal experiments leading to adverse effects on bone prompted experimental investigation on cartilage and associated soft tx (ligaments, tendons, fascia)
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the use of shockwave to treat fractures was researched in 1980's with earliest clinical work being used on delayed and non-union fractures
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SHockwave therapy is effectively a controlled explosion that enters tx, it will be reflected, refracted, transmitted and displaced like other forms of energy
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5) HEAD SIZE AND SHAPE
Radial shockwaves are produced cross the face of the shockwave head; these heads vary in shape and size
most commonly used head is 15mm across and described as convex (head reaches a peak in the center which is higher than the edges)
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7) OVERALL ENERGY
total energy density = shock head size and amount of E given to the shock and add the total number of shocks given
SHOCKWAVE
8) EFFECTS OF SHOCKWAVES
HEALING (INCREASED)
HEAD= 15-35mm
POWER= 1-2 bar
FREQUENCY= 10-16Hz
SHOCKS 1000 to 1 spot 4000 larger area
HOW OFTEN= every 7-10 days
No. OF SESSIONS 4-6
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DECREASE PAIN
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HEAD= 6-35mm
POWER= 1-2 bar
FREQUENCY= 15-30Hz
SHOCKS= 1500 one spot 4000 larger area
HOW OFTEN= every 7-10 days
No. OF SESSIONS= 3
DESTRUCTION OF TISSUE
HEAD= 15mm
POWER= 2.5 bar
FREQUENCY 4-5Hz
SHOCKS= 1000-4000
HOW OFTEN= every 5 days
No. OF SESSIONS= 1-3 more likely 6+
the destruction of cells through spalling, spall crack formation or tension; normally requires higher shock pressure and slower speeds. Although for the effect of cavitation higher speeds are most definitely favorable
HOW OFTEN: damage occurs almost instantly, perform the next session before any repair can occur, critical window for healing is 6-12 days, thus treatment for destruction should be performed every 5 days
NUMBER OF SHOCKS: 1000 shocks upwards; 2000 conventional number; figures as high as 4000 have been demonstrated
FREQUENCY: as low as 4Hz up; normal convention= 10Hz; desired result is mainly cavitation then any frequency from 5Hz will do but from 15Hz cavitation will be much better. NB increasing frequency will decrease depth
SESSIONS: 1-3 but may not lead to full resolution, average is 6 though some prominent bone spur don't go in 6
POWER: higher the pressure setting usually the better though post pt can't tolerate high settings initially. (increase for 200 shocks @ a time) anything 2.5 bar or more should have the desired effect
HEAD: 15mm head convex/concave as most structures needing destruction or not that deep. small heads can give far too much energy density to be used for this purpose and they can easily cause skin damage at high pressure.
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Definition: A large amplitude compression wave, as produced by an explosion of supersonic motion of a body in a medium