title: Repetitive shock wave therapy improves muscular microcirculation.
abstract: BACKGROUND
  Extracorporeal shock wave therapy (ESWT) is mainly applied in tendon as well as bone problems based on stem-cell activation and healing acceleration. The effect of ESWT on muscle tissue is much less understood to date. However, from a clinical perspective, muscle injuries are of distinct interest especially in elite athletes such as soccer players.
  
  
  METHODS
  A total of 26 rats were randomized into two groups. Group A received a single application of high-energetic focused ESWT (0.3 mJ/mm(2), 4 Hz, 1000 impulses, 10 J), whereas group B underwent the same procedure every 10 min for three sessions (3 × 0.3 mJ/mm(2), 4 Hz, 3 × 1000 impulses, totaling 30 J). Blood flow at a depth of 8 mm was measured continuously and noninvasively by a combined Laser-Doppler-Imaging and photospectrometric technique (Oxygen-to-see, O2C, LEA Medizintechnik, Germany).
  
  
  RESULTS
  One minute after the application of high-energy ESWT blood flow in group A increased by 16.5% (P = 0.007). Thereafter, it decreased from minute 2 after application and remained significantly unchanged to baseline value until the end of the measuring period at 50 min (P = 0.550). Group B showed a similar significant increase in blood flow of 16.4% (P = 0.049) and a decrease afterward, too. After the second focused ESWT blood flow was boosted to 26.6% (P = 0.004), remaining significantly elevated until the third application was initiated. Muscular blood flow was increased to 29.8% after the third focused ESWT (P < 0.001), remaining significantly increased for another 10 min.
  
  
  CONCLUSIONS
  Focused ESWT enhances blood flow in the muscle of rats. Moreover, repetitive ESWT extended this beneficial effect.
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany. Electronic address: tobias.kisch@gmx.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kisch
authors.affiliation: Department of Otolaryngology, Hannover Medical School, Hannover, Germany.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Wuerfel
authors.affiliation: Department of Visceral and Thoracic Surgery, German Armed Forces Hospital Ulm, Ulm, Germany.
authors.forename: Vinzent
authors.initials: V
authors.lastname: Forstmeier
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Eirini
authors.initials: E
authors.lastname: Liodaki
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Felix H
authors.initials: FH
authors.lastname: Stang
authors.affiliation: SportPraxis Prof. Dr. Karsten Knobloch, Hannover, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mailaender
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraemer
mesh_terms: D000818:Animals; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D008833:Microcirculation; D009132:Muscles / Q000098:blood supply*; D011897:Random Allocation; D017207:Rats, Sprague-Dawley
keywords: ESWT; Muscular microcirculation; Repetitive shockwave therapy