Extracorporeal shockwave therapy, safety and contraindications (narrative review)

Narrative review of extracorporeal shockwave therapy covering its proposed mechanisms and safety. The main proposed mechanism is mechanotransduction — mechanical pulses provoking a cellular healing and remodelling response — and 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. The review’s stated contraindications are high-energy treatment over a coagulopathy, application over a pregnant uterus, and treatment over a severe local infection. Moderate (narrative review).