This means the depth at which the highest amount of energy applied can be varied. The area of most energy is referred to as the energy flux area. The effect of changing the frequency of shockwave therapy know as the pulse rate frequency or PRF for short may be more than just for comfort.
Lower frequencies hz are often described as feeling more painful. Authors have suggested using higher frequencies at the beginning of treatment to familiarise or acclimatise the patient to the sensation then work down to the desired frequency in stages e. However, it must be noted that although increasing frequency increased the number of cavitations it did not increase the size of those cavitations; only pressure energy delivery per mm can do that.
Increasing frequency affects the depth of wave penetration as lower frequency waves travel further than higher frequency waves. As can be seen below high frequency waves travel less distance below are depictions of different wave frequencies on a gold film, adapted from Telford, Geldart and Sheriff, Lower frequency waves travel further. Much lower frequency waves travel distance much more easily. So increasing frequency can be used to decrease treatment depth whilst maintaining shock energy you can create stronger effects at lower depths by increasing both the frequency and the power.
This is referred to as total energy density. Recently manufacturers have suggested that shock wave at very high frequencies can overcome the effects of the golgi tendon organs and hence make a muscle relax more. However, as far back as Gregory and Proske described a firing rate of per second for the golgi tendon organs which would mean a machine would have to have a shock rate higher than this for this principle to be true. Although most people focus on the human studies the animal studies may be more intriguing as there are no psychological factors involved with animal treatment processes there is no placebo effect.
Although the settings of the machines vary for each type of effect required, a description of these settings can be seen here , each shock wave will have some of each of these effects around each wave i.
An example of this can be seen in the positive part of the radial shockwave below:. Imagine the red is the area of energy that will create damage.
This area goes from the bottom of the shock to the top as a column damaging everything in it's way. Around this column is an area of less energy, seen in green, which would be of a dosage able to create healing. There would also be an area, shown in blue, of much less energy able to decrease pain. There is also an area where the wave force would decrease above the area of damage the energy can't continue forever which in turn would have healing or pain relieving effects.
It needs to be remembered that the effects happen at high to low energy levels i. The actual effects of radial shockwave can be seen in the sections below:. Biological effects of radial shockwave can be seen here. Tissue effects of radial shockwave can be seen here. Focused shockwave or high energy section for information only - this web site is dedicated to radial shockwave :. High energy shockwave has been shown to have detrimental effects on soft tissues.
It normally requires some form of local analgesia to tolerate the treatment although there have been studies demonstrating that the use of local analgesia can be a negative factor to the outcome of shockwave.
High energy shockwave is unlikely to ever be used in the therapy setting where most clinicians have low energy shockwave machines. Focused shockwaves are directed by reflection at target zones into a patient's body Sturtevant, Focused ESW is created from a wide arc so that at the site of actual wave generation the amount of energy dispersed is minimal.
This limits damage at the skin and to underlying soft tissues. The focusing mechanism directs each shock to a defined point within the body. This concentrates the energy at this point to an extremely high level.
The location within the body is adjusted by altering the energy output voltage of the machine or by adjusting the focusing mechanism Sturtevant, In static ESW machines diagnostic imaging is most commonly used to exactly localise the point of energy concentration and hence where the damage will be.
Fluroscopy, xray or ultrasound are usually used. Focused shockwaves are generated by initiating a pressure wave, normally within fluid, and there are 3 different ways to do this currently. Although all 3 mechanisms create different wave forms and hence energy characteristics they all seem to be sufficient to destroy human tissue Sturtevant, All content is for entertainment purposes only , it is NOT intended as medical advice.
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