Extracorporeal shockwave therapy in bone overuse syndromes

Extracorporeal shockwave therapy (ESWT) can accelerate healing, particularly but not only of bone. Acoustic waves are translated via mechanotransduction into a tissue response. In addition to activation of stem cells, effects of ESWT are related to exosome release, modulation of inflammation and growth factors, which explain the positive effects on bone healing in cases of delayed bone healing, such as pseudarthrosis, stress reactions and stress fractures. Combined treatment with oscillating magnetic fields (pulsed electromagnetic field therapy, PEMF and extracorporeal magnetic transduction therapy, EMTT) and orthobiological injections can possibly help to enhance the bone stimulating effect in the future.