Storz Medical ESWT – Focused Shock Wave (DE/EN)

What is ESWT? / What is ESWT?

ESWT (Extracorporeal Shock Wave Therapy) uses short, high-energy pressure waves that are generated outside the body and precisely focused into the target tissue. This creates mechanical stimulation that can trigger biological healing processes. The treatment is carried out on an outpatient basis, without anesthesia, and is carried out in series.

Focused shockwave therapy delivers controlled acoustic pulses to a defined tissue depth. The intent is to modulate pain, improve local blood flow, and stimulate tissue regeneration. It is considered when structured conservative care has not achieved sufficient improvement.

• Non-invasive, outpatient, short sessions
• Focusable depth and dose (energy flux density)
• Supplement to physiotherapy, activity adjustment and, if necessary, infiltrations – no isolated “miracle therapy”

Focused vs. radial – what’s the difference?

With the focused shock wave (fESWT), the impulses are bundled into a focal point at a defined depth. Radial shock wave (rESWT) distributes the energy more superficially and diffusely (pressure wave shock, no focused focal point). Both processes have areas of application; The selection depends on structure, depth and objectives.

• Focused (fESWT): precise depth, suitable for deeper tendon attachments, calcium deposits, certain bony indications
• Radial (rESWT): more superficial, often for myofascial trigger points and muscular tension conditions
• The evidence varies depending on the indication; The decision is made individually based on examination and imaging

Storz Medical – precisely focused shock waves (neutrally classified)

Storz Medical is an established manufacturer of shock wave systems. Focused systems allow the adjustment of energy, depth and number of pulses to specifically address different tissue layers. What is particularly relevant for patients is that parameters can be set and documented reproducibly.

• Variable energy flux density (e.g. low to higher ranges depending on indication and tolerability)
• Adjusted frequency and number of pulses per session
• Focused application for deeper structures; Radial handpieces may also be available for superficial areas

Important: Which parameters are used depends on the diagnosis, tissue depth, pain location, previous illnesses and treatment goals. There is no “one-size-fits-all” attitude.

Indications with good to moderate evidence

ESWT is considered if guideline-based, conservative measures (load adjustment, physiotherapy, exercise programs, possibly anti-inflammatory measures) do not have sufficient effect after an appropriate period of time. There is a comparatively good to moderate study situation for the following diagnoses:

• Plantar fasciitis (chronic heel pain): good evidence, in Germany partly covered by health insurance under certain conditions
• Calcific shoulder (tendinosis calcarea of ​​the rotator cuff): good evidence for pain reduction and calcium resorption
• Tennis elbow/lateral epicondylitis: moderate evidence, can be considered individually
• Patellar tendinopathy (Jumper’s knee): moderate evidence
• Achilles tendinopathy (midportion): mixed evidence; careful indication is required

Special case of bones: In cases of delayed bone healing/pseudarthrosis, ESWT is used in specialized centers. This requires individual case assessment and radiological support.

Possible further areas of application (limited evidence, case-by-case decision):

• Trochanteric pain syndrome (lateral hip pain)
• Medial tibial edge syndromes/shin splints
• Myofascial pain syndromes (more radial)
• Chronic tendon insertion pain in other locations

How does ESWT work? – Mechanisms of action

The biological effects are based on mechanotransductive stimuli. Repetitive pressure wave pulses lead to microreactions in the tissue, which can trigger repair and remodeling processes. An immediate reduction in pain can occur through neuromodulatory effects; Structural adjustments take time.

• Improvement of local blood circulation and neovascularization
• Modulation of nociceptive mediators (e.g. substance P)
• Stimulation of cellular regeneration processes (tenocyte activity, matrix remodeling)
• Fragmentation/promotion of resorption of calcium deposits in the shoulder
• Possible reduction of pathological neoinnervation in degeneratively modified tendons

Note: Individual effects vary. ESWT is not a replacement for load management, targeted exercises and root cause work (e.g. axle and gait optimization).

Process of the treatment in Hamburg / Procedure

1. Diagnostics: Anamnesis, clinical examination, if necessary ultrasound/imaging to determine target structure and depth.
2. Clarification: indication, benefit-risk assessment, alternatives, parameter planning (energy, depth, impulses).
3. Test and target marking: localize pain zone, sonography for focusing.
4. Treatment session: 1500-4000 pulses depending on region; 5-15 minutes. Local sensitivity is possible; Pain is closely coordinated.
5. Series: usually 3-5 sessions spaced 1-2 weeks apart; sometimes more in the case of lime deposits.
6. Aftercare: relative rest for 24–48 hours, continuation of specific exercises; Re-evaluation after the series.
7. Follow-up: Decision about continuation, adjustment of the program or alternative options.

Pain during treatment is typically tolerable and adjustable by modifying energy and frequency. We aim for the lowest effective dose.

Focused means dosable – parameters and dose

The dose is defined by energy flux density (mJ/mm²), number of pulses, frequency and focus position. Lower energies are suitable for sensitive areas and initial sessions; Higher energies can be considered for more robust structures and calcium deposits - always depending on the indication, tissue tolerance and pain feedback.

• Typical pulse numbers: 1500-4000 per session
• Frequency: approx. 2-8 Hz depending on the target region and tolerance
• Session interval: usually 7-14 days
• Total time until effects: often 4-12 weeks, longer in chronic cases

Safety, side effects and contraindications

ESWT is considered safe when indexed and performed correctly. However, side effects are possible. We clarify carefully in advance.

• Common: temporary increased pain, tenderness, redness, swelling, small hematomas
• Rare: irritation of nerves or tendons; With previously damaged tendons, ruptures are very rare – risk assessment necessary
• Follow-up treatment: short-term reduction in activity, cooling if necessary, no high-intensity exercise immediately afterwards

Contraindications (selection):

• pregnancy
• Local infections, open wounds, tumors in the treatment area
• Severe coagulation disorders; Be careful with anticoagulation
• Acute inflammation or fresh tears in the target tissue
• Treatment of the lungs, head/brain, large vessels or nerve trunks, growth plates in children
• Immediately after cortisone injection in the same area (note individual distances)

ESWT as a component of conservative orthopedics

Shockwave does not replace basic therapy. Our basic principle is “conservative first”: ESWT has the best effect when it is embedded in a structured program.

• Load control and progressive exercise programs (e.g. eccentric tendon training)
• Physiotherapy and education
• Analysis of axis, gait and posture (e.g. 4D/gait analysis)
• Optional additions depending on the findings: manual medicine, acupuncture, neuromodulatory procedures
• Only if there is no response: discussion of more invasive options

Useful combinations (individual selection)

Depending on the findings, additional procedures may be considered. These do not replace the treatment of the underlying disease, but complement it - evidence-conscious and with transparent information.

• Physiotherapy and home exercises as a compulsory component
• Axis & gear analysis for load optimization – see Diers 4D/Gang (DE/EN)
• Neuromodulation for pain syndromes – see Axomera (DE/EN)
• TCM acupuncture for pain modulation – see TCM (DE/EN)
• Regeneration support and metabolism: individual, e.g. B. IHHT (DE/EN) in appropriate cases

Costs and reimbursement in Germany

Billing depends on the indication and insurance status. For those with statutory health insurance: ESWT can be reimbursed for chronic plantar fasciitis under certain conditions. Other indications are often considered self-pay services (IGeL). Private health insurance companies reimburse depending on the tariff situation; a cost estimate is possible.

• Transparent information before the start: expected number of sessions and costs
• Individual consultation with your cash register is recommended
• No promises of success; the decision is made based on medical indication

Media reports and study situation – classify them seriously

There are media reports circulating about the shock wave - from limescale dissolution to cognitive effects. Classification is important: not every heading corresponds to the reality of care. Parameters, protocols and target tissues differ significantly.

• Orthopedic ESWT: Pain and functional improvement in selected tendon and calcification problems
• Neuro/experimental applications: belong in research or specialized settings and cannot be transferred to routine use
• We are guided by guidelines, meta-analyses and individual findings

What you can realistically expect

Many patients report gradual improvement within weeks, sometimes sooner, sometimes later. A complete response is not guaranteed. The decisive factors for sustainable success are diagnostic reliability, correct indication, appropriate dose and the consistent implementation of exercise and stress programs.

• First effects: often after 2-4 weeks
• Maximum effects: often 6-12 weeks after the series
• In the case of calcium deposits: gradual absorption possible over months
• If there is no response: repeat diagnostics and discuss alternatives

English summary – Focused shockwave with Storz Medical

Focused ESWT is a non-invasive option for chronic tendinopathy and calcific shoulder disease when structured conservative care has not sufficiently helped. We individualize indication and dosing, integrate ESWT into a broader rehab plan, and discuss benefits, risks and alternatives without promises of cure.

• Typical indications: plantar fasciitis, calcific rotator cuff tendinopathy, lateral epicondylitis, patellar tendinopathy, midportion Achilles tendinopathy
• Course: 3–5 sessions, 1–2 weeks apart; Effects often build over 4–12 weeks
• Safety: usually well tolerated; transient soreness or bruising possible; clear contraindications apply
• Costs: coverage varies by insurance and indication in Germany

The 5 tips at a glance

1. Non-invasive, outpatient, short sessions
2. Focusable depth and dose (energy flux density)
3. Supplement to physiotherapy, activity adjustment and, if necessary, infiltrations – no isolated “miracle therapy”
4. Focused (fESWT): precise depth, suitable for deeper tendon attachments, calcium deposits, certain bony indications
5. Radial (rESWT): more superficial, often for myofascial trigger points and muscular tension conditions

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