Extracorporeal shockwave therapy, safety and contraindications (narrative review)

Review of extracorporeal shockwave therapy covering its mechanisms and safety. The proposed mechanisms are mechanotransduction (mechanical pulses provoking a cellular healing and remodelling response), local neovascularisation, and an analgesic effect on sensory nerve endings; the exact pathway is not settled. ESWT is generally safe, with side effects largely limited to pain during treatment and minor bruising, and no severe complications expected when performed as recommended. Contraindications include high-energy treatment over a coagulopathy or in patients on anticoagulants, application over a pregnant uterus, over an active infection or tumour, near electronic implants such as pacemakers, and over a complete tendon rupture.