A Review on the Effects of Extracorporeal Shockwave Therapy on Bone Metabolism Markers in Various Musculoskeletal Conditions

Abstract

Several researches have demonstrated the effectiveness of extracorporeal shockwave therapy (ESWT) without surgery to treat various chronic musculoskeletal pathologies. From the current literature, extracorporeal shockwave therapy is one of the rehabilitation modalities that has a potential to be applied on bone to accelerate the healing process. The mechanical stimuli produced by the shockwaves are able to induce physiological responses at the cellular level. Therefore, detecting early changes to the bone may be crucial for certain cases, especially in the pathological conditions. Plain radiography approach requires a long follow-up time to observe the outcomes of the healing process, and biochemical bone markers provide information regarding the effects of treatment earlier than radiography. Several previous studies have reported the effectiveness of extracorporeal shockwave therapy on the mechanical structures of bones. However, evidences regarding the exact dosage of application and effectiveness of extracorporeal shockwave therapy on bone metabolism markers are still lacking. In previous research, diverse methods such as different number of treatment sessions, dosage of shockwave, time of treatment given, sites treated and time to follow-up were employed, and varied outcomes were observed.  This review paper will discuss on the overview of bone metabolism markers, the effects of extracorporeal shockwave therapy on bone metabolism markers in musculoskeletal conditions, and the potential mechanism of action of shockwave on bone biochemical markers. The exact mechanisms of shockwave act on bone biochemical markers are still debatable.