moderate quality Experimental Animal Study Comparison Study

Low-energy extracorporeal shockwave therapy improves locomotor functions, tissue regeneration, and modulating the inflammation induced FGF1 and FGF2 signaling to protect damaged tissue in spinal cord injury of rat model: an experimental animal study

Hsu CC, Wu KL, Peng JM et al. International Journal of Surgery (London, England) 2024

TL;DR

This animal study provides early evidence that low-energy shockwave therapy may offer a non-invasive treatment option for spinal cord injury. The research demonstrates that multiple treatment sessions are more effective than a single session, showing improvements in motor function, reduced inflammation, and better tissue repair. While these findings are promising for understanding how shockwave therapy might help with nerve injuries, the results are from a rat model and would need to be validated in human clinical trials before being applied to patient care.

Participants
32
Sessions
3
Duration
3 weeks

Key Numbers

Three ESWT sessions (ESWT3) showed superior outcomes compared to a single session in motor function recovery

ESWT3 significantly reduced inflammatory markers IL-1β, IL-6, and macrophage (CD68) levels (P<0.001)

ESWT3 improved run average speed and maximum variation significantly better than single treatment (P<0.01)

Multiple shockwave treatments restored mitochondrial function marker MFN2 levels (P<0.05)

Key Findings

1

Three ESWT sessions significantly improved motor function compared to single treatment

Rats that received three shockwave treatments showed much better walking ability than those with only one treatment or no treatment at all.

BBB score improved significantly in ESWT3 vs SCI at 5 and 7 weeks (P<0.05 and P<0.01); ESWT3 was better than single ESWT at 7 weeks (P<0.05)

2

ESWT reduced key inflammatory markers in injured spinal cord

Shockwave therapy helped reduce inflammation in the damaged spinal cord, which is important because excessive inflammation can cause additional damage after injury.

ESWT3 significantly reduced IL-1β (P<0.01), IL-6 (P<0.001), and macrophage CD68 levels (P<0.001) compared to untreated SCI group

3

Three ESWT sessions improved gait parameters

Rats treated with three shockwave sessions could walk faster and more consistently than those with fewer or no treatments.

Run average speed and maximum variation significantly improved in ESWT3 vs SCI (P<0.05 and P<0.001); ESWT3 was better than single ESWT in both measures (P<0.01)

4

ESWT enhanced neuronal health and mitochondrial function

Shockwave therapy helped protect nerve cells and improved the energy-producing parts of cells (mitochondria), which are essential for nerve survival and repair.

ESWT3 increased NeuN expression (P<0.05) and MFN2 levels (P<0.05) compared to SCI group

5

ESWT modulated inflammation-related growth factor signaling

Shockwave therapy helped regulate proteins involved in scarring and inflammation, potentially preventing excessive scar tissue formation that can block nerve regeneration.

ESWT3 reduced FGF1, FGF2, FGFR1, and pERK levels (all P<0.001 or P<0.01) compared to SCI group; ESWT3 was better than single ESWT at inhibiting pERK (P<0.05)

Our Take

This is an exciting preclinical study that adds to the growing body of evidence supporting shockwave therapy's regenerative potential beyond its traditional musculoskeletal applications. The key takeaway is that dosing matters - three weekly treatments outperformed a single session across virtually every measure, from walking ability to cellular-level markers of inflammation and nerve health. While this is an animal study and we cannot directly apply these findings to human patients, the mechanisms being studied (reducing inflammation, protecting nerve cells, preventing excessive scarring) are highly relevant to human spinal cord injury. The use of low-energy settings (0.13 mJ/mm²) is particularly noteworthy, as it suggests therapeutic benefits can be achieved without the risks associated with higher-energy protocols. For patients interested in shockwave therapy for other conditions, this research reinforces the broader principle that this technology may have wide-ranging regenerative applications that science is only beginning to understand.

Treatment Protocol

Device
DUOLITH SD1 (STORZ MEDICAL AG, Switzerland)
Frequency
1x/week

Study Limitations

  • Rat model may not fully replicate the complexity of human spinal cord injury
  • Optimal ESWT treatment regimen (frequency, intensity, duration) remains undetermined
  • 6-week observation period does not address long-term effects including potential chronic complications
  • Molecular mechanisms by which ESWT modulates FGF signaling require further investigation
  • Direct translational potential to humans is limited without clinical trials
spinal-cord-injury nerve-regeneration animal-study eswt low-energy-shockwave inflammation tissue-repair preclinical
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