The use of shock waves as a non-invasive therapy has been conceived in the '70s and first employed to remove kidney stones. The use in the orthopaedic field began only in the '90s to face arthrosis and tendons calcifications. Nowadays its use has been extended in the treatment of many other disorders such as fibrosis, muscle contractures and all the pathologies of the musculoskeletal apparatus in general. 

Shock waves are sound pressure waves made by specific generators, projected on the interested area and suggested in the case of tendinitis, periarthritis, ulcers, scleroderma, strains and pulled muscle, bones necrosis, plantar fasciitis, osteitis pubis and skin necrosis.

Shock waves' effects

There are two different kinds of effect, direct and indirect:

• Direct effect: caused by the transformation of the waves into kinetic energy that through the density of the interested area (muscle, bones, fat), produce a reflex and transmission reaction.
• Indirect effect: defined as cavitation phenomena; you can think of it as a pressure that brings to the creation of little gas bubbles hit a second time by another wave that causes their implosion; these bubbles then manage to go through tissues favouring the vascularity.

Between direct and indirect effect, the most relevant are:

• Osteoinductive action: it stimulates osteoblastic activity and collagen production
• Analgesic effect: releasing endorphins it reduces the pain 
• Angiogenic effect: it increases capillaries' oxygenation and at a later stage the capillarization
• Anti-inflammatory effect: reduction of the pain stimulus of the interested area
• Hyperemic effect: reduction of muscle tensions and strains