Extracorporeal shockwave therapy in tissue repair and regeneration

In this article, we aim to provide a comprehensive overview of the development of shockwave therapy in medicine, from the first scientific description, through reports of soldiers injured by shockwaves during World War I and World War II, to the first clinical application for kidney stone fragmentation on February 7, 1980. Initially, attention focused on the destructive mechanical effects of extracorporeal shockwave therapy (ESWT) until it was recognized-often serendipitously-that shockwaves possess enormous regenerative potential. Through close collaboration between clinical practice and basic research, it has become possible to understand how the compressive, tensile, and shear forces generated by shockwaves affect tissue. Thus, over the past 30 years, more than 100 new indications for shockwaves have been developed from the four originally known. The realization that shockwaves not only improve blood flow by stimulating angiogenesis and vasculogenesis but also mobilize the body's own stem cells to enable local regeneration renders them of increasingly great interest to nearly all medical disciplines.