Me: This is just even more evidence and studies which goes deeper in the research to find how relevant the ESWT method might be in allowing bones to increase in length.
From study 1…
From the introduction of the PDF paper the authors note that loading, LIPUS, and PEMF has not bee very effective by stating…” Biophysical stimuli such as mechanical vibration, ultrasound, and pulsed electromagnetic ﬁelds have been suggested as an alternative treatment, but these stimuli seem to have too little effect on bone remodeling and bone architecture 1-4. Another potentially useful biophysical intervention that has proven effective for acute fractures 5 and nonunions 6-8 is treatment with extracorporeal shock waves” This states right off the bat that ESWT may be better than the other stuff we have researched so far. The treatment did lead to some skin redness and bleeding. We see an increase in bone formation, trabecular bone volume, and other bone properties. It seems the ESWT has some form of analgesic effect so an increase in energy flux density which is gradual may actually help the pain sensitivity. the conclusion they see is…”In conclusion, a single treatment with unfocused extracorporeal shock waves can increase bone turnover and improve the cancellous and cortical bone architecture as well as the mechanical properties of the treated area. In this experimental setup, extracorporeal shock waves caused damage in the bone marrow, which resulted in hyperplasia and hypertrophy of adipocytes in the bone marrow but did not induce microfractures in the bone or periosteal damage.”
From study 2…
The researchers decided to try out applying ESW therapy as a noninvasive, inexpensive, and rapid method for stimulating cambium cell proliferation, and combining these cells with a bioactive scaffold for bone growth. The cambium cells are part of the periosteum called osteoprogenitor cells. Just one dosage of the ESWT managed to get the cambium cells and overal bone thickness to increase as well as the callus size.
From study 3…
These researchers showed that not only does ESWT cause osteogenesis but also can regenerate fibrocartilage and remodel the bone to tendon junction in joints.
From the Journal of Bone and And Joint Surgery study article link HERE…
Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone
By O.P. van der Jagt, MD, T.M. Piscaer, MD, W. Schaden, J. Li, PhD, N. Kops, H. Jahr, PhD, J.C. van der Linden, PhD,
J.H. Waarsing, PhD, J.A.N. Verhaar, MD, PhD, M. de Jong, PhD, and H. Weinans, PhD
Investigation performed at the Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves affected new bone formation, bone microarchitecture, and the mechanical properties of bone in a healthy rat model, in order to evaluate whether extracorporeal shock wave therapy might be a potential treatment for osteoporosis.
Thirteen rats received 1000 electrohydraulically generated unfocused extracorporeal shock waves to the right tibia. The contralateral, left tibia was not treated and served as a control. At two, seven, twenty-one, and forty-nine days after administration of the shock waves, in vivo single-photon-emission computed tomography (SPECT) scanning was performed to measure new bone formation on the basis of uptake of technetium-labeled methylene diphosphonate (99m Tc-MDP) (n = 6). Prior to and forty-nine days after the extracorporeal shock wave therapy, micro-computed tomography (micro-CT) scans were made to examine the architectural bone changes. In addition, mechanical testing, microcrack, and histological analyses were performed.
Extracorporeal shock waves induced a strong increase in 99m Tc-MDP uptake in the treated tibia compared with the uptake in the untreated, control tibia. Micro-CT analysis showed that extracorporeal shock waves stimulated increases in both trabecular and cortical volume, which resulted in higher bone stiffness compared with that of the control tibiae. Histological analysis showed intramedullary soft-tissue damage and de novo bone with active osteoblasts and osteoid in the bone marrow of the legs treated with extracorporeal shock waves. Microcrack analysis showed no differences between the treated and control legs.
This study shows that a single treatment with extracorporeal shock waves induces anabolic effects in both cancellous and cortical bone, leading to improved biomechanical properties. Furthermore, treatment with extracorporeal shock waves results in transient damage to the bone marrow, which might be related to the anabolic effects. After further examination and optimization, unfocused extracorporeal shock waves might enable local treatment of skeletal sites susceptible to fracture.
Unfocused extracorporeal shock waves might in the future be used to increase bone mass and
subsequently reduce the fracture risk.
From study 2 link HERE…
The Use of Extracorporeal Shock Wave-Stimulated Periosteal Cells for Orthotopic Bone Generation
To cite this article:
Cathal J. Kearney, Huping P. Hsu, and Myron Spector. Tissue Engineering Part A. July 2012, 18(13-14): 1500-1508. doi:10.1089/ten.tea.2011.0573.
Published in Volume: 18 Issue 13-14: July 16, 2012
Online Ahead of Print: June 4, 2012
Online Ahead of Editing: April 20, 2012
- Full Text HTML, Full Text PDF (1,173.6 KB), Full Text PDF with Links (497.1 KB)
VA Boston Healthcare System
Accepted: March 14, 2012
The cambium cells of the periosteum, which are known osteoprogenitor cells, have limited suitability for clinical applications of tissue engineering in their native state due to their low cell number (2–5 cells thick). Extracorporeal shock waves (ESWs) have been shown to cause rapid periosteal cambium cell proliferation and subsequent periosteal osteogenesis. This work investigates a novel strategy for orthotopic bone generation: applying ESW therapy as a noninvasive, inexpensive, and rapid method for stimulating cambium cell proliferation, and combining these cells with a bioactive scaffold for bone growth. ESWs applied to the rabbit medial tibia resulted in a significant 2.7-fold increase in cambium cell number and a 4-fold increase in cambium cell thickness at 4 days post-ESW. ESW-stimulated, or nontreated control, periosteal cells were elevated in situ and overlaid on an anorganic bovine bone scaffold to interrogate their ability to form bone. At 2 weeks post-surgery, there was a significant increase in all key outcome variables for the ESW-stimulated group when compared with controls: a 4-fold increase in osseous tissue in the upper half of the scaffold underlying the periosteum; a 12-fold increase in osseous tissue overlying the scaffold; and a 2-fold increase in callus size. These results successfully demonstrated the efficacy of ESW-stimulated periosteum for orthotopic bone generation.
From PubMed study 3 link HERE…
Am J Sports Med. 2008 Feb;36(2):340-7. Epub 2007 Sep 20.
Extracorporeal shock wave therapy in treatment of delayed bone-tendon healing.
Musculoskeletal Research Laboratory, Department of Orthopaedics andTraumatology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
Extracorporeal shock wave therapy is indicated for treatment of chronic injuries of soft tissues and delayed fracture healing and nonunion. No investigation has been conducted to study the effect of shock wave on delayed healing at the bone-tendon junction.
Shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling of healing tissue in delayed healing of bone-tendon junction surgical repair.
Controlled laboratory study.
Twenty-eight mature rabbits were used for establishing a delayed healing model at the patella-patellar tendon complex after partial patellectomy and then divided into control and shock wave groups. In the shock wave group, a single shock wave treatment was given at week 6 postoperatively to the patella-patellar tendon healing complex. Seven samples were harvested at week 8 and 7 samples at week 12 for radiologic, densitometric, histologic, and mechanical evaluations.
Radiographic measurements showed 293.4% and 185.8% more new bone formation at the patella-patellar tendon healing junction in the shock wave group at weeks 8 and 12, respectively. Significantly better bone mineral status was found in the week 12 shock wave group. Histologically, the shock wave group showed more advanced remodeling in terms of better alignment of collagen fibers and thicker and more mature regenerated fibrocartilage zone at both weeks 8 and 12. Mechanical testing showed 167.7% and 145.1% higher tensile load and strength in the shock wave group at week 8 and week 12, respectively, compared with controls.
Extracorporeal shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling in the delayed bone-to-tendon healing junction in rabbits.
These results provide a foundation for future clinical studies toward establishment of clinical indication for treatment of delayed bone-to-tendon junction healing.
- PMID: 17885225 [PubMed – indexed for MEDLINE]