RTL report: Shock wave & memory – classification (DE/EN)

What was the RTL article about – and why this classification?

TV formats like to focus on medical topics. The article in question gave the impression that shock wave pulses could have positive effects on memory. That sounds exciting - but requires a clear separation between proven clinical evidence and early hypotheses.

As an orthopedic specialist practice, we have been using shock waves for years for muscles, tendons and bone attachment problems. There are currently no reliable human studies available for cognitive effects in the sense of improving memory. That's why a sober classification is important.

• Separate terms clearly: ESWT (shock wave) is not the same as ultrasonic neuromodulation.
• Pay attention to the evidence: Orthopedic indications have been comparatively well researched; cognitive effects do not.
• Reputable medicine means: realistic goals, transparent information, no promises of salvation.

What is Shock Wave Therapy (ESWT)?

ESWT stands for Extracorporeal Shock Wave Therapy. It uses short, high-energy pressure waves that are directed into tissue from the outside. There are two main forms: focused shock wave (precise concentration of energy at depth) and radial shock wave (pressure waves with a more extensive distribution).

In orthopedics, ESWT is used, among other things, to stimulate healing processes at overloaded tendon attachments, stimulate blood circulation and support pain modulation. The mechanism is described as mechanotransduction: cells react to mechanical stimuli, which can activate regeneration processes - within the scope of individual biological possibilities.

• Typical areas of application: Plantar fasciitis/heel pain, calcified shoulder, tennis elbow, Achilles tendon problems, runner's knee/patellar tendinopathy, trochanteric tendinopathy.
• Therapy is i. d. R. short outpatient, without anesthesia, several sessions at intervals of 1-2 weeks.
• Important: ESWT complements active measures (constructive/eccentric training, load management) – it does not replace them.

Evidence in orthopedics: What is certain?

For some musculoskeletal indications, the study situation for ESWT is solid to moderate. Randomized studies and reviews show clinically relevant effects, particularly in plantar fasciitis, calcific tendinitis of the shoulder or lateral epicondylitis - always with the caveat that results vary from person to person.

• Better evidence: plantar fasciitis, calcific shoulder, tennis elbow.
• Possible benefit depending on findings: Achilles tendon, trochanter pain, patellar tendon.
• No guaranteed success: Effect depends on diagnosis, duration of symptoms, tissue status, training program and accompanying factors.

The number of sessions is often 3-6 appointments. We attach great importance to embedding ESWT in a holistic concept: information, exercise plan, if necessary adjustment of load patterns and footwear as well as accompanying physiotherapy.

Memory & Brain: What does research say about ESWT?

There are currently no robust human clinical studies showing that extracorporeal shock waves improve memory. Part of the media confusion arises because different forms of energy are mixed: low-frequency diagnostic/therapeutic ultrasound, focused ultrasound neuromodulation and ESWT are not identical technically and in their tissue effects.

From an orthopedic perspective, ESWT is a peripheral tissue therapy. There is a lack of standardized protocols, safety evidence and clinical effectiveness data for head applications to influence cognitive functions. The statement is therefore serious: ESWT is currently not a recognized procedure for improving memory.

• What we know: ESWT can modulate healing processes at tendon/bone attachments.
• What we don't know: Whether ESWT improves cognitive function in humans.
• Important: Do not confuse ESWT with neuromodulatory ultrasound procedures or other brain stimulation methods (e.g. TMS).

Safety, side effects and limitations

ESWT is considered a safe procedure when indicated correctly and used professionally. Temporary discomfort at the treatment site is common. Contraindications must be carefully considered to minimize risks.

• Common, mostly mild side effects: pressure pain, redness, small hematomas, temporary increase in irritation.
• Possible contraindications: acute infection/inflammation in the treatment area, tumors in the target area, blood clotting disorders/anticoagulation, pregnancy in the treatment area, growth plates that are not closed, air tissue in the radiation path (e.g. lungs).
• Limitations: ESWT does not replace diagnostics, does not eliminate structurally advanced damage and is not a universal solution for “unspecific” complaints.

This is how we approach things in Hamburg

In our practice at Dorotheenstrasse 48, 22301 Hamburg, conservative orthopedics comes first. Before each ESWT, we check the medical history, clinical findings and – if appropriate – imaging. Only when the diagnosis and target structure are clear do we discuss the role of the shock wave in the overall concept.

We work with modern, focused systems and combine the treatment with an individualized activity program. Realistic expectation: The goal is a gradual, measurable improvement in function – not an “immediate cure”. If there is no benefit, we adapt the strategy or choose alternatives.

• Typical process: information → target structure check → ESWT session (approx. 10-20 minutes) → exercise recommendations → progress monitoring.
• Number of sessions: often 3–6, at 1–2 week intervals.
• Integration: load management, technology/ergonomics adjustment, if necessary physiotherapy.

For whom can ESWT be useful – and for whom not?

ESWT is particularly suitable for clearly assignable, overload-related tendon attachment problems, especially when conservative basic measures have been exhausted. It is not suitable for non-specific whole-body pain, unexplained acute conditions or as a replacement for training and stress control.

• More suitable: plantar fasciitis, calcific shoulder, tennis elbow, achillodynia, patellar tendinopathy, trochanteric tendinopathy.
• Rather unsuitable: diffuse pain without a clear structural diagnosis, acute tears, pronounced joint inflammation, neurological warning signs (e.g. paralysis).
• Warning signs (“Red Flags”): sudden severe pain after trauma, fever, significant swelling/redness, loss of sensation or strength – please seek medical advice immediately.

Good questions for your educational interview

• Which specific structure is treated with ESWT and why?
• Which alternatives (training, physiotherapy, injections) are realistic for my case?
• Which success criteria and which period of time are plausible?
• How many meetings are planned and how is the progress documented?
• Are there reasons why I should forego ESWT?
• How do I combine ESWT with exercises in everyday life/sports?

English summary: Shockwave & memory – our stance

Media coverage suggested that extracorporeal shockwave therapy (ESWT) might improve memory. From an orthopedic, evidence-based perspective, there is currently no robust human evidence supporting cognitive enhancement by ESWT. Please do not confuse ESWT with ultrasound neuromodulation or other brain stimulation techniques.

• ESWT has established use for tendinopathies and calcific shoulder pain.
• Cognitive effects are unproven and not a current indication for ESWT.
• Therapy goals should be realistic and embedded in active rehabilitation.

Further information & videos

Would you like to go deeper? In our accompanying articles you will find background information on focused shock waves, neuromodulatory procedures and modern diagnostics. In addition, Prof. Citak explains orthopedic topics in short videos that are easy to understand. See linked pages below.

The 5 tips at a glance

1. Separate terms clearly: ESWT (shock wave) is not the same as ultrasonic neuromodulation.
2. Pay attention to the evidence: Orthopedic indications have been comparatively well researched; cognitive effects do not.
3. Reputable medicine means: realistic goals, transparent information, no promises of salvation.
4. Typical areas of application: Plantar fasciitis/heel pain, calcified shoulder, tennis elbow, Achilles tendon problems, runner's knee/patellar tendinopathy, trochanteric tendinopathy.
5. Therapy is i. d. R. short outpatient, without anesthesia, several sessions at intervals of 1-2 weeks.

Information does not replace an individual examination. If there are any warning signs, please seek medical advice.