Focused Shockwave Therapy and Bone Healing: Mechanisms and Review References
Stemwave therapy, a form of focused shockwave therapy, is a vital component of our conservative joint care program at Levante Chiropractic.
Stemwave therapy for joint pain and muscle injury supports our structural balancing, spinal alignment and inflammation reduction protocols that can both help painful joints heal, as well as prevent problems in the future.
Some of the most exciting research on focused shockwave therapy is in bone repair, as it demonstrates the regenerative properties of the therapy for joint and muscle healing.
Shockwave stimulates the biology of bone repair through mechanotransduction: bone cells translate a mechanical pulse into biochemical signals that influence blood-vessel growth, cell activity, and new bone formation.
This process of mechanotransduction is also at work in the healing effects we see on ligaments, tendons and other structures surrounding the painful joint.
How Shockwave Therapy Supports Bone Healing
- Mechanical signals activate cellular responses
Shockwave activates signaling pathways that influence gene expression, cell proliferation, migration, and differentiation. These responses can help initiate and coordinate repair.
- Angiogenesis supports the vascular supply
Experimental studies describe increased vascular endothelial growth factor (VEGF) and endothelial nitric oxide signaling. These responses may support the blood-vessel development needed for bone repair.
- Osteogenesis supports new bone formation
Bone-forming signals, including bone morphogenetic proteins (BMPs), can promote osteoblast activity and the differentiation of precursor cells into bone-forming cells.
- Matrix formation and mineralization support developing bone
Experimental studies report changes in the extracellular matrix and mineral deposition that support new bone formation.
These Processes Interact
The strongest mechanistic interpretation is that focused shockwave such as Stemwave stimulates an endogenous repair response in bone, meaning it stimulates the body’s natural internal healing mechanisms.
Here are four useful references for your review:
- Mittermayr R, Haffner N, Feichtinger X, Schaden W. (2021).
The role of shockwaves in the enhancement of bone repair—from basic principles to clinical application.
Injury. 52(Suppl 2):S84–S90.
DOI: 10.1016/j.injury.2021.02.081
https://pubmed.ncbi.nlm.nih.gov/33714550/
This is a strong starting point for understanding the mechanism. It connects mechanotransduction with cell proliferation, migration, differentiation, and clinical fracture healing. It also references Donald Ingber’s work on mechanotransduction.
- Cheng JH, Wang CJ. (2015).
Biological mechanism of shockwave in bone.
International Journal of Surgery. 24:143–146.
DOI: 10.1016/j.ijsu.2015.06.059
https://pubmed.ncbi.nlm.nih.gov/26118613/
A concise, bone-specific mechanism review covering mechanotransduction, angiogenesis, bone remodeling, and preclinical and clinical applications of shockwave.
- Sansone V et al. (2022).
Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis.
Journal of Clinical Medicine. 11:1977.
DOI: 10.3390/jcm11071977
https://pmc.ncbi.nlm.nih.gov/articles/PMC8999664/
This review focuses on clinical bone-union outcomes.
Across 23 studies, 876 of 1,200 nonunions healed—approximately 73%. Outcomes varied with nonunion type and treatment protocol. This pooled percentage is not a treatment-versus-control effect.
Some included studies documented additional healing beyond six months after treatment, supporting the possibility that repair continues after the treatment sessions have ended.
- Zhang Q et al. (2017).
Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences.
Medicine. 96:e5897.
DOI: 10.1097/MD.0000000000005897
https://pubmed.ncbi.nlm.nih.gov/28121934/
This review is reports promising findings for pain, function, and bone-marrow edema, especially in earlier disease. It did not establish reversal of necrotic bone.