Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary microruptures in tendon and bone. Due to microruptures the expression of growth factors such as eNOS, VEGF, PCNS and BMP is significantly increased.

As a result of these processes arterioles are remodeled, stimulated to grow and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone.

Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.

Mast cell activation is followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step help restore normal healing and regenerative processes.

The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.

Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The granular particles of calcium are then removed by the lymphatic system.

Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines and other nociceptive metabolites also helps inhibit development of inflammatory oedema. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief.

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis”. The assumed mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable. Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons. A rotator cuff tear occurs when one of the tendons is torn from the bone from overuse or injury.

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse. There are many treatment options for tennis elbow. In most cases, treatment involves a team approach.

Medial epicondylitis (golfer's elbow) is a type of tendinitis that affects the inside of the elbow. It develops where tendons in the forearm muscle connect to the bony part on the inside of the elbow. Tendons attach muscles to bones. Due to injury or irritation, they can become swollen and painful.

Greater trochanteric pain syndrome (GTPS), also known as Greater Trochanteric Bursitis or Gluteal Tendinopathy, is a syndrome defined by tenderness to palpation over the greater trochanter with the patient in the side-lying position.

proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting.

The rectus femoris is the large quadriceps muscle running down the middle of the front of the thigh. Its function is to lift up the knee and straighten the leg. ... There is unlikely to be a sudden sharp incident of pain although chronic tendonitis can develop following a rupture.

It is often found co-existing with patellar tendinosis, which most commonly involves the tendon distally, but also the quadriceps muscle proximally. Quadriceps tendinopathy is a clinical diagnosis characterized by activity-related anterior knee pain with localized tenderness at the superior border of the patella.

Patellar tendinopathy (or as it is commonly known patellar tendonitis or tendinitis) is an overuse injury affecting your knee. It is the result of your patella tendon being overstressed. A common name for it is Jumper's Knee.

The posterior tibial muscle and tendon help stabilize the ankle. They are responsible for pointing the foot in and down. Posterior tibial tendinopathy includes both “tendonitis” (a condition involving inflammation of the tendon) and “tendinosis” (a condition involving degeneration of the tendon over time).

Peroneal tendonitis is the common term for a peroneal tendinopathy. Peroneal tendinopathy is a condition which is characterized by structural changes of the peroneal tendon in response to load. Peroneal tendon injuries are usually due to increased loads and overuse of the peroneal muscles.

Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon that joins your heel bone to your calf muscles. It is thought to be caused by repeated tiny injuries to the Achilles tendon.

Pain on the bottom of the foot may be caused by plantar fasciitis – a result of inflammation in the fascia, a connective tissue, which in this case stretches between your heal and toes.