ESWT | Extracorporeal Shockwave Therapy

ESWT – Stand for Extracorporeal Shockwave Therapy, to stimulate the activation of the natural biological processes of repair.
Focalized ESWT is a non-invasive surgical procedure that uses sound waves, high acoustic waves, to stimulate healing in some physical disorders. Pressure pulses with a rising fast. These pulses generate a force that can be addressed on the body parts to be treated. No anesthesia requires. The procedure used to be performed in an out-patient setting.


From a physical point of view, the shock waves are defined as high-energy sound waves.
The ESWT technology is to care and treat bone pathologies and soft tissues as well of different nature. Encourages and stimulates mechanisms with anti-inflammatory effect or for example skin regeneration Act differently according to the pathological tissue that goes to treat (bones, soft tissue or skin).
Shock waves act differently according to the pathological tissue that goes to treat (bones, soft tissue and skin). In the soft tissues, Focalized Extracorporeal Shockwaves increasing the blood flow angiogenesis, at local level, which determines the removal of the chemical mediators involved in the inflammatory process and analgesic.
On bone tissue, act by promoting the healing process by stimulating the activity of osteoblasts, cells responsible for the formation of new bone tissue.
The biological effects are varied:

• Anti-inflammatory and analgesic effect
• Disintegration of the crystal structures pathological
• Osteoinductive action
• Iperemizzante action
• Neo antigenic action

ESWT | Clinical Applications

Therapy with shock waves was used for the first time in the eighties and was called lithotripsy. This technology has been used for treatment of kidney calculus, to eliminate kidney stones without surgery. About 20 years ago, first experiments in the orthopedic and rehabilitation field, in the last decade a rapid evolution, up to now have developed a new concept of shock waves for the aesthetic treatments and the E.D. Erectal Dysfunction pathology.
Extracorporeal Shockwave Therapy is a method of treatment for multiple pathologies. In recent years, the extracorporeal therapy focused shock waves has become a choice of therapy for a growing number of indications, however a basic distinction between therapeutic areas that use shock waves:
Urology: treatment of the kidney stones is used where high energy shock waves capable of performing a mechanical crushing of the calculations.
In all other areas of medicine which is used in the shock wave using lower energies. The basis of the therapeutic effect there is a strong angiogenesis of tissues.
Generally, therapy with shock waves is used in:

• Renal calculi in urology, I.P.P. Induratio Penis Plastica, E.D. Erectal Dysfunction
• Surgery in gallstones.
• Dentistry in support for complex systems.
• Aesthetic medicine against localized fat, cellulite and scars
• Sport medicine and physiotherapy
• Dermatology and Plastic Surgery in skin ulcers
• Orthopedics - bones
• Rheumatology and Pain Therapy
• Cardiology - non-invasive cardiac revascularization
• Veterinary- as for the human field the main use is focused on disorders in the musculoskeletal system.

Some contraindications to Extracorporeal Shockwaves Therapy:

• Acute infection of the soft tissue / bone
• Primary pernicious diseases
• Epiphysiolysis in the focal point
• Diseases of the blood clotting
• Pregnancy
• Patients with pacemakers
• Lung tissue in the focal point
• Brain, spinal cord, large nerves in the focal point (cranium, spine, ribs).

In literature, there were no real side effects, except in rare cases may occur bruises.
The actual treatment lasts between 10 and 15 minutes, and is well tolerated: the number of sessions and their frequency will vary according to the pathology to be treated. However the application of this therapy involves relatively modest time and it's done in only a few sessions. In current practice, the acoustic waves (sound) are conveyed into the tissue to be treated according to different energy levels and administration protocols that depend on the type of equipment used, the level of energy used and the number of shocks given. The energy level giving, determining the therapeutic efficacy for the type of pathology, as well as also the exposure to possible side effects in the treated tissues.
Like any therapy, the extracorporeal shockwave have specific indications and contraindications, and, therefore, the physician is the only professional who has the expertise and diagnostic prescriptive and specific training, as he may change the dosage according to tolerability of the patient and the results achieved.

ESWT | Technology and how it works

Dedicate Medical Device produces Focalized Shockwaves, to create the beneficial effect and therapy.
Its call Focused Extracorporeal Shockwave when the device can generate Shockwave exactly where is possible to adjust the depth of penetration and focus energy directly onto the pathological process, Focal Area.
The acoustic focalized waves are of very high frequency, even more than those used for ultrasonic imaging. The focalized sound waves are designed exactly at a point within the body to clear and remove a structure unwanted. The high-frequency sound waves pass easily through the soft tissues of the body, but crash in solid structures such as bones or deposits of minerals. Using basically the same technology of the ESWL, (Extracorporeal Shock Wave Lithotripsy) for fragmentation the kidney stones.
Shock Waves Pulse
The pulse shock wave is composed of a first phase of positive pressure followed by a peak of negative pressure wave (traction).
The acoustic energy is defined by means of the positive and negative pressure. The decisive parameter for the side effects such as pain or tissue damage is the component of negative pressure (tensile stress wave) of a shock wave.
Depth Penetration
The depth penetration of the shock waves is variable, on average, from 0 to 60 millimeters. Between the source, therapeutic head, and the focus is placed an interface of water or gel which has the function of transmission of the shock waves and for adjusting the depth of penetration. However, it is not recommended to use the ultrasound gel as bubbles area are formed inside blocking the passage of the focused shock waves. Therefore it is advisable to use silicone oil with high density for the interface between the source and the patient's skin.
Manner and Delivery of Shockwaves
The distinction of the shock waves technology can be classified based on physical principle used for their generation. Physical principles used in the generation of focused shock waves are: Electro-hydraulic, Electromagnetic and Piezoelectric. The fundamental difference of the pulses in the three technologies is the size of the focal length - area where the energy comes therapeutic.
Electro-hydraulic – uses a high voltage applied between two electrodes placed in the focus F1 at a distance of 1 mm and inside of an ellipsoid filled with water.
Electromagnetic - uses a flat or cylindrical coil, wrapped in a metal membrane.
Piezoelectric - uses a large number of piezoelectric crystals are mounted on the inside of a water-filled sphere placed on the concave surface of a spherical cap.
Parameters Comparison between ESWT Devices
For a correct evaluation and comparison between the different systems of Shockwave the most important parameters to consider in the acoustic field are:
Pressure, measured in MPa
Density of Energy Flow, measured in mJ / mm2
Dimensions X, Y, Z , Focal Volume
The pressure profile, from beginning to end of the shock wave, determines the characteristic times of the curve Pressure / Time (rise time, pulse duration of positive pressure, phase of negative pressure).

AGADA’ Medical Technologies | ESWT

AGADA' Focalized Shock Waves generated by an Electromagnetic generator directional through the Therapeutic Head that, in direct contact with the patient skin, to better precision of the treatment area. Also a built-in multiple levels adjustable of therapeutic energy to guarantee the maximum of flexibility and feasibility and to treat multiple pathologies.
The device supply constant and stable energy it is silent as well, allows painless treatments, no needs of anesthesia, outpatient treatments and allowing treating diseases that are often resistant to the most common therapies.

Multidisciplinary| Easy focusing| Compact size| Attractive design| Ergonomic

AGADA' medical technologies | Focalized Extracorporeal Shockwave Therapy.
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