The pursuit of speed, strength, and all things athletic places intense, repeated physical demands on the human body. With this highly intense demand being a prerequisite for peak athletic performance, athletes are all too familiar with incurring the various musculoskeletal injuries and disorders that can arise—the effective treatment and resolution of the underlying condition impeding performance is then of paramount importance for any serious athlete.
对速度、力量和所有运动事物的追求对人体提出了强烈、反复的体能要求。由于这种高度强烈的需求是达到最佳运动表现的先决条件，运动员们都非常熟悉可能出现的各种肌肉骨骼损伤和疾病——有效治疗和解决阻碍表现的潜在病症对于任何认真的运动员来说都是至关重要的。
With the world of rehabilitative technology evolving at an ever-quickening rate and athletes looking for the quickest path back to full health, one particular intervention—known as extracorporeal shockwave therapy (ESWT), or shockwave therapy—has created quite the buzz among athletes and practitioners alike.
随着康复技术世界的快速发展以及运动员寻求恢复完全健康的最快途径，一种特殊的干预措施——称为体外冲击波疗法 (ESWT) 或冲击波疗法——在运动员和运动员中引起了不小的轰动。练习者都一样。
While this therapeutic intervention has been gaining popularity in recent years, it’s imperative for coaches, athletes, and clinicians who are considering incorporating it into their rehabilitative endeavors to have a rudimentary understanding of this modality. This includes its mechanism of action, the conditions it can treat, and, most importantly, the research behind ESWT’s ability to treat various disorders. This basic understanding is all in the name of ensuring optimal outcomes for those looking to make a full return to their athletic pursuits.
虽然这种治疗干预措施近年来越来越受欢迎，但对于考虑将其纳入康复工作的教练、运动员和临床医生来说，必须对这种方式有一个初步的了解。这包括其作用机制、可治疗的病症，以及最重要的 ESWT 治疗各种疾病能力背后的研究。这种基本的理解都是为了确保那些希望完全回归运动追求的人获得最佳结果。
This article will walk you through these various facets pertaining to shockwave therapy, hopefully allowing you to make more informed decisions when it comes to administering or receiving shockwave therapy for your or your athlete’s needs.
本文将引导您了解与冲击波疗法有关的各个方面，希望能让您在根据您或您的运动员的需求进行或接受冲击波疗法时做出更明智的决定。
How ESWT Works ESWT 的工作原理
While the in-depth mechanisms behind shockwave therapy are outside the scope of this article, a basic rundown is warranted for:
虽然冲击波疗法背后的深入机制超出了本文的范围，但有必要进行基本概述：
- How this therapy is administered.
如何进行这种疗法。 - What shockwaves are. 什么是冲击波。
- How shockwaves are believed to produce their desired effects on injured tissue.
人们相信冲击波如何对受伤组织产生预期的效果。
With that said, don’t get too hung up on the details; for the average reader, knowing the scientific consensus of shockwaves’ effects on human tissue is what truly matters here (and will be discussed after this section).
话虽如此，不要太在意细节；对于普通读者来说，了解冲击波对人体组织影响的科学共识才是真正重要的（将在本节后讨论）。
Shockwave therapy has been used for treating various bone and soft tissue disorders involving the musculoskeletal system for the past 20 years.1 The process involves a handheld applicator being applied directly onto the skin over the area being treated as a series of shockwaves are administered to elicit their therapeutic effects.
过去 20 年来，冲击波疗法一直用于治疗涉及肌肉骨骼系统的各种骨和软组织疾病。 1 该过程涉及将手持式涂抹器直接涂抹在治疗区域的皮肤上，同时施加一系列冲击波以产生治疗效果。
The term “shockwave” is a bit of a misnomer; no electrical activity or “shocking” is involved with this treatment. Shockwaves are acoustic energy waves (pressure waves) that consist of high peak-pressure amplitudes rising to their peak pressure within nanoseconds and dying out within microseconds (i.e., transient pressure oscillations).2 So, once the peak pressure of this sonic energy wave has been reached, its pressure drops to a negative value within microseconds.
“冲击波”这个词有点用词不当。这种治疗不涉及电活动或“电击”。冲击波是声能波（压力波），由高峰值压力振幅组成，在纳秒内升至峰值压力并在微秒内消失（即瞬态压力振荡）。 2 因此，一旦达到声波能量波的峰值压力，其压力就会在微秒内降至负值。
As a shockwave passes through tissues within the body, its high-pressure phase can be reflected (bounce off) or absorbed by the tissue(s). As the negative phase of the shockwave interacts with these tissues, air bubbles are created in a process known as cavitation. These microbubbles then implode, leading to direct and indirect effects within the tissue(s) being targeted.3
当冲击波穿过体内组织时，其高压相可以被组织反射（反弹）或吸收。当冲击波的负相位与这些组织相互作用时，在称为空化的过程中产生气泡。然后这些微泡会内爆，从而对目标组织产生直接和间接的影响。 3
If that sounds a bit confusing, don’t sweat it. Essentially, it’s a sonic pulse that works in the same way a fast-flying aircraft produces a sonic boom, and it leads to stimulation of human tissue at the cellular level.
如果这听起来有点令人困惑，请不要担心。从本质上讲，它是一种声波脉冲，其工作原理与快速飞行的飞机产生音爆的方式相同，并且会在细胞水平上刺激人体组织。
More specifically, these “sonic booms” that penetrate the tissue stimulate physiological cellular activity of the targeted tissue through a process known as mechanotransduction.4,5 This fancy-sounding word simply means that a physical impulse or mechanical force is being converted into cellular activity within the targeted tissue(s).
更具体地说，这些穿透组织的“音爆”通过称为机械转导的过程刺激目标组织的生理细胞活动。 4,5 这个听起来很奇特的词只是意味着物理冲动或机械力正在转化为目标组织内的细胞活动。
图 1. 冲击波波形显示正压和负压，正压峰值发生在纳秒内。图片改编自 Ogden 等人，2001 年。
While the specific biological changes that occur to tissue through ESWT are far outside the scope of this article, tissue regeneration through the delivery of shockwaves has been shown to occur by inducing:3,4,6,7
虽然通过 ESWT 使组织发生的具体生物学变化远远超出了本文的范围，但通过冲击波传递进行的组织再生已被证明是通过诱导以下因素而发生的： 3,4,6,7
- Blood vessel formation (known as neovascularization).
血管形成（称为新血管形成）。 - Growth factor release. 生长因子释放。
- Inhibition of inflammatory molecules.
抑制炎症分子。 - Increased tenocyte proliferation and collagen synthesis.
肌腱细胞增殖和胶原蛋白合成增加。
Additional effects have also been documented; however, the above effects are likely the primary mechanisms involved with optimizing cellular activity and health. Despite the scientific community’s general understanding of these biological changes occurring from ESWT, the exact mechanisms for how these biological and physiological responses occur are not fully understood.
还记录了其他影响；然而，上述效应可能是优化细胞活动和健康的主要机制。尽管科学界对 ESWT 发生的这些生物学变化有普遍的了解，但这些生物学和生理反应发生的确切机制尚不完全清楚。
Parameters of ESWT ESWT参数
As with any therapeutic intervention that can be implemented, shockwave therapy relies on a series of parameters that must occur to achieve the overall desired treatment effect. For the average reader, I would advise not to get hung up on these specifics; I have merely (and briefly) included them for clinicians and the curious of mind who like knowing the details of therapeutic interventions.
与任何可以实施的治疗干预一样，冲击波疗法依赖于一系列必须发生的参数才能实现总体所需的治疗效果。对于普通读者，我建议不要纠结于这些细节；我只是（简单地）为临床医生和那些喜欢了解治疗干预细节的好奇心人士提供了它们。
When treating various orthopedic disorders, shockwave parameters include:8
治疗各种骨科疾病时，冲击波参数包括： 8
- Pressure distribution. 压力分布。
- Energy flux density. 能量通量密度。
- Total acoustic energy. 总声能。
Pressure distribution refers to the area of tissue being stimulated from the shockwave being administered.
压力分布是指受到所施加的冲击波刺激的组织区域。
Energy flux density refers to the measure of the energy per square area that is being released by the sonic pulse at a specific point. Or, more simply put, it’s the intensity at the focal point of the shockwave. It is measured in joules of energy per area (mJ/mm2).
能量通量密度是指声脉冲在特定点释放的每平方面积的能量的度量。或者，更简单地说，是冲击波焦点处的强度。它以单位面积的焦耳能量 (mJ/mm 2 ) 为单位进行测量。
The extent of energy flux density can be classified as high or low; however, there is no scientific consensus on these particular definitions. It has been proposed as a guideline that low-energy ESWT involves a flux density below 0.12 mJ/mm2, while high-energy flux density is above 0.12 mJ/mm2.1
能流密度的大小可分为高能流密度和低能流密度；然而，对于这些特定的定义尚未达成科学共识。据建议，低能 ESWT 的通量密度低于 0.12 mJ/mm 2 ，而高能 ESWT 的通量密度高于 0.12 mJ/mm 2 。 1
Total acoustic energy refers to the energy flux density within a single shockwave pulse multiplied by the total number of pulses administered.
总声能是指单个冲击波脉冲内的能量通量密度乘以所施加的脉冲总数。
Focused vs. Radial ESWT
聚焦与径向 ESWT
It’s worth noting that when administering ESWT for musculoskeletal conditions, two primary types of shockwave therapy can be administered to injured tissue:
值得注意的是，在对肌肉骨骼疾病进行 ESWT 时，可以对受伤组织进行两种主要类型的冲击波疗法：
- Focused shockwave therapy.
集中冲击波疗法。 - Radial shockwave therapy.
放射状冲击波疗法。
Focused shockwave therapy is the more “pure” or established form of shockwave therapy within the medical world. Much of the research involves studying the effects of EWST using this form of treatment.1 It involves administering shockwaves to a much more focal region of tissue, typically 2–8 millimeters in diameter.
聚焦冲击波疗法是医学界更“纯粹”或更成熟的冲击波疗法形式。许多研究涉及研究使用这种治疗形式的 EWST 的效果。 1 它涉及将冲击波施加到更集中的组织区域，通常直径为 2-8 毫米。
Radial shockwaves are not concentrated directly over the targeted tissue in the same manner as focused shockwaves. Instead, the pressure waves disperse outward from the applicator tip of the device. The primary benefit is that this allows for the treatment of larger areas of tissue with less precision. However, these pressure waves do not penetrate as deep, and their characteristics are different enough that some authors contest they should not be considered true shockwaves.1,9
径向冲击波不像聚焦冲击波那样直接集中在目标组织上。相反，压力波从装置的涂抹器尖端向外扩散。主要好处是，这允许以较低的精度治疗更大面积的组织。然而，这些压力波的穿透深度并不深，而且它们的特性也截然不同，以至于一些作者认为它们不应该被视为真正的冲击波。 1,9
While both forms of shockwave therapy are employed in literature and clinical settings, the existence of two different forms of ESWT muddies the water when looking at the research (this will be discussed further in the article) and is a potential reason why results can vary differently across studies.
虽然这两种形式的冲击波疗法都在文献和临床环境中使用，但两种不同形式的 ESWT 的存在使研究变得混乱（这将在本文中进一步讨论），并且是结果可能有所不同的潜在原因跨研究。
Analyzing the Scientific Research
分析科学研究
Enough research on ESWT has been performed that meta-analyses and systematic reviews often exist for specific orthopedic conditions. Despite this, I certainly can’t cover the findings for every condition. Rather, my aim is to skim the surface for the overall scientific findings for conditions most likely to affect the SimpliFaster audience and point those interested in further details in the right direction. For those looking to dive into the specifics of ESWT for specific orthopedic conditions (issues affecting muscles, tendons, bones, and joints), the references listed at the end of this article will serve as a solid starting point.
对 ESWT 进行了足够的研究，通常针对特定的骨科疾病进行荟萃分析和系统评价。尽管如此，我当然无法涵盖每种情况的研究结果。相反，我的目的是粗略地了解最有可能影响 SimpliFaster 受众的总体科学发现，并为那些对更多细节感兴趣的人指出正确的方向。对于那些希望深入了解特定骨科疾病（影响肌肉、肌腱、骨骼和关节的问题）的 ESWT 细节的人，本文末尾列出的参考文献将作为一个坚实的起点。
When analyzing the research behind ESWT’s effectiveness on various orthopedic conditions, I have tried to include findings from results and discussions within meta-analyses and systematic reviews, which offer the highest level of evidence possible within research.
在分析 ESWT 对各种骨科疾病的有效性背后的研究时，我尝试将结果和讨论的发现纳入荟萃分析和系统评价中，以提供研究中可能的最高水平的证据。
Findings for Tendinopathies
肌腱病的发现
Tendinopathy is one of the most commonly diagnosed conditions within athletic populations, with reports of approximately 30% of all elite athlete injuries.10 As such, findings of ESWT’s effects on tendon health should be of paramount interest to coaches and clinicians alike who are involved with athletes.
肌腱病是运动员群体中最常见的诊断疾病之一，据报道，约 30% 的精英运动员受伤。 10 因此，ESWT 对肌腱健康影响的研究结果应该引起与运动员相关的教练和临床医生的极大兴趣。
In the lower extremity, the most commonly afflicted tendons are the Achilles tendon, the plantar fascia, gluteal tendons (notably the glute medius and minimus), the patellar tendon (knee tendon), and the tibialis posterior tendon (near the inside of the ankle).11 For athletes involved in running-based sports, tendinopathy in the knee, foot, and ankle appears to be the most common.12
在下肢，最常受影响的肌腱是跟腱、足底筋膜、臀肌肌腱（特别是臀中肌和臀小肌）、髌腱（膝肌腱）和胫骨后肌腱（靠近踝关节内侧） ）。 11 对于从事跑步运动的运动员来说，膝盖、脚和脚踝的肌腱病似乎是最常见的。 12
In the upper extremity, the rotator cuff and the flexor and extensor tendons of the elbow are most commonly affected, though I am not covering the upper extremities in this article.10
在上肢，肩袖以及肘部的屈肌腱和伸肌腱最常受到影响，尽管我在本文中不讨论上肢。 10
When looking at ESWT’s effects on tendinopathy, the quick takeaway is that shockwave therapy has been found to have a notable influence on reducing pain and producing health-promoting biological effects. Meta-analyses for the treatment of patellar tendinopathy, Achilles tendinopathy, and rotator cuff tendinopathy have shown statistically significant effects for various aspects of improving tendon health and function.
当研究 ESWT 对肌腱病的影响时，我们发现冲击波疗法对减轻疼痛和产生促进健康的生物效应具有显着影响。治疗髌腱病、跟腱病和肩袖肌腱病的荟萃分析显示，对于改善肌腱健康和功能的各个方面都有统计学上显着的效果。
Critical to this topic, however, is that multiple adjunctive treatments should still be considered and implemented (when appropriate) alongside ESWT to ensure optimal tendon stimulation and subsequent healing. Which specific combined interventions lead to superior outcomes is likely best left to the clinician. The research isn’t entirely clear as to which combined intervention(s), when stacked with ESWT, will offer the best results.4
Based on our understanding of the cellular processes that arise and occur with tendon stimulation, it seems that combining ESWT with optimal tendon loading parameters will yield the best possible outcomes, though again, this depends greatly on the athlete’s condition. I have written a detailed article on SimpliFaster for the latest findings for tendon loading when treating tendinopathy, which can help provide a foundation for this approach.
根据我们对肌腱刺激产生和发生的细胞过程的理解，将 ESWT 与最佳肌腱负荷参数相结合似乎会产生最佳的结果，但这在很大程度上取决于运动员的状况。我在 SimpliFaster 上写了一篇详细的文章，了解治疗肌腱病时肌腱负荷的最新发现，这可以帮助为这种方法提供基础。
Anecdotally, I will say that my patients experience far better outcomes when ESWT is paired with a loading program suitable for their needs, abilities, and overall condition. I often need to reduce training load, volume, and intensity to an appropriate level as well.
有趣的是，我想说，当 ESWT 与适合他们的需求、能力和整体状况的负荷计划相结合时，我的患者会获得更好的结果。我经常需要将训练负荷、训练量和强度减少到适当的水平。
For conciseness and to appeal to the general nature of running- and sprinting-based readers on this site, I’ll only cover lower-body tendinopathy and soft tissue findings here.
为了简洁起见并吸引本网站上跑步和短跑读者的一般性质，我在这里仅介绍下半身肌腱病和软组织的发现。
Knee Tendinopathies 膝关节肌腱病
Overall, the findings for ESWT to produce statistically significant and favorable changes for patellar tendinopathy seem quite promising. A meta-analysis by Mani-Babu et al. reviewed seven papers examining the efficacy of ESWT on characteristics of patellar tendinopathy and found six out of seven of those papers to report significant improvement in symptoms after treatment, concluding it to be a largely successful form of conservative treatment.13
总体而言，ESWT 对髌腱病产生统计学上显着且有利的变化的研究结果似乎很有希望。 Mani-Babu 等人的荟萃分析。回顾了七篇论文，研究了 ESWT 对髌腱病特征的疗效，发现其中七篇论文中的六篇报告治疗后症状显着改善，得出结论，它是一种基本上成功的保守治疗形式。 13
As with essentially all other systematic reviews that have analyzed the efficacy of ESWT, the review mentions that each paper utilized different shockwave parameters when providing treatment to the patellar tendon, making it difficult to determine optimal shockwave parameters when treating the condition. (This is a common theme within almost all ESWT meta-analyses dealing with soft-tissue pathologies.) The authors are quick to point out that more research is needed to determine optimal treatment parameters.
与分析 ESWT 疗效的所有其他系统评论一样，该评论提到，每篇论文在治疗髌腱时都使用了不同的冲击波参数，因此在治疗该病症时很难确定最佳的冲击波参数。 （这是几乎所有处理软组织病理的 ESWT 荟萃分析中的一个共同主题。）作者很快指出，需要更多的研究来确定最佳治疗参数。
A similar meta-analysis by Liao et al. examined the effects of ESWT to reduce pain and improve functional outcomes for individuals with various soft tissue disorders of the knee (such as pes anserine tendinopathy, IT band friction syndrome, and post-traumatic tendon/ligament stiffness, among others) in addition to patellar tendinopathy.5 The results of this meta-analysis determined that ESWT showed significant moderate evidence for safety and efficacy for improving overall treatment success, reducing pain, improving functional recovery, and performance-based outcomes.5
Liao 等人进行了类似的荟萃分析。研究了 ESWT 对患有各种膝关节软组织疾病（如鹅足肌腱病、髂胫束摩擦综合征和创伤后肌腱/韧带僵硬等）以及髌骨损伤的患者减轻疼痛和改善功能结果的效果肌腱病。 5 这项荟萃分析的结果确定，ESWT 在提高整体治疗成功率、减轻疼痛、改善功能恢复和基于表现的结果方面显示出显着的安全性和有效性证据。 5
Readers should note that in this meta-analysis, some studies utilized focused shockwave therapy while others utilized radial shockwave therapy. As such, the authors mention it is unclear whether therapeutic effects on these knee disorders differ from one shockwave form to another. (This is another common theme in many ESWT meta-analyses.)
读者应注意，在这项荟萃分析中，一些研究采用聚焦冲击波疗法，而另一些研究则采用径向冲击波疗法。因此，作者提到，目前尚不清楚一种冲击波形式与另一种冲击波形式对这些膝关节疾病的治疗效果是否不同。 （这是许多 ESWT 荟萃分析中的另一个常见主题。）
Achilles Tendinopathy 跟腱病
With the Achilles tendon being one of the most adversely affected tendons in the lower body and the cornerstone of any athletic activity involving jumping and running, the effects of ESWT on this region of the body have been well studied. On the whole, meta-analyses tend to go back and forth on the efficacy of ESWT on different portions of the Achilles tendon. It would seem that some of this is due to examining various studies that largely use different shockwave parameters within each respective study.
由于跟腱是下半身受影响最严重的肌腱之一，也是任何涉及跳跃和跑步的运动活动的基石，ESWT 对身体该区域的影响已得到充分研究。总体而言，荟萃分析倾向于反复讨论 ESWT 对跟腱不同部分的疗效。其中一些似乎是由于检查了各种研究，这些研究在每个各自的研究中很大程度上使用了不同的冲击波参数。
Mani-Babu et al. concluded in their analysis that ESWT has moderate evidence for being more effective than eccentric loading for insertional Achilles tendinopathy and equal to eccentric loading for mid-portion tendinopathy. They are quick to point out that combining EWST with eccentric loading may likely produce superior outcomes.13
马尼-巴布等人。他们在分析中得出结论，有适度的证据表明 ESWT 对于插入性跟腱病比偏心负荷更有效，并且与中部肌腱病的偏心负荷相同。他们很快指出，将 EWST 与偏心载荷相结合可能会产生更好的结果。 13
Similarly, a systematic review by Cathy Speed concluded that focused and radial shockwave therapy both have limited evidence to suggest they can be beneficial to insertional and mid-portion Achilles tendinopathy.1
同样，Cathy Speed 的一项系统综述得出结论，聚焦冲击波疗法和放射状冲击波疗法都没有足够的证据表明它们对插入和中部跟腱病有益。 1
To cloud the water even more, a meta-analysis by Fan et al. concluded through a subgroup analysis that low- and mid-energy level ESWT led to better functional outcomes and improved pain outcomes than patients who received other treatment interventions.14 They are quick to note within this paper that further investigation should take place to determine the optimal energy level of shockwave delivery.
Fan 等人的荟萃分析使水变得更加浑浊。通过亚组分析得出的结论是，与接受其他治疗干预的患者相比，低能量和中能量水平的 ESWT 可以带来更好的功能结果并改善疼痛结果。 14 他们在本文中很快指出，应该进行进一步的研究以确定冲击波传递的最佳能量水平。
This last point regarding the optimal energy level of shockwave therapy is critical to understand, as it likely largely influences efficacy and outcomes when treating Achilles tendinopathy (or other tendinopathies, for that matter). A brief discussion of optimal parameters is given later in this article.
关于冲击波疗法的最佳能量水平的最后一点对于理解至关重要，因为它可能在很大程度上影响治疗跟腱病（或其他肌腱病）时的疗效和结果。本文稍后将简要讨论最佳参数。
Findings for Plantar Fasciitis
足底筋膜炎的发现
An extensive volume of research on ESWT’s ability to treat plantar fasciitis has been undertaken over the past decade, with results generally finding favor in its ability to reduce pain and improve functional outcomes.
在过去的十年里，人们对 ESWT 治疗足底筋膜炎的能力进行了大量研究，结果普遍认可其减轻疼痛和改善功能结果的能力。
A meta-analysis by Sun et al. examining nine randomized controlled trials of ESWT on 935 patients with plantar fasciitis concluded that focused shockwave therapy could relieve pain in chronic plantar fasciitis but could not draw conclusions about radial shockwave therapy.15
Sun 等人的荟萃分析。对 935 名足底筋膜炎患者进行的 9 项 ESWT 随机对照试验得出结论，集中冲击波疗法可以缓解慢性足底筋膜炎的疼痛，但无法得出关于径向冲击波疗法的结论。 15
In a meta-analysis with the same title, Aqil et al. concluded that ESWT produced favorable results for reducing pain in patients with chronic plantar fasciitis and recommended its use for those failing to make improvements after three months of other conservative measures.16
在同名的荟萃分析中，Aqil 等人。得出的结论是，ESWT 对于减轻慢性足底筋膜炎患者的疼痛产生了良好的结果，并建议对那些经过三个月的其他保守措施仍无法改善的患者使用 ESWT。 16
When determining optimal parameters, a systematic review and network meta-analysis by Chang et al. concluded that optimal delivery parameters when treating plantar fasciitis with focused shockwave therapy should involve selecting the highest tolerable energy output within a medium intensity range.17 They also concluded that radial shockwave therapy could be an appropriate alternative due to its lower price point and therapeutic effectiveness.
在确定最佳参数时，Chang 等人进行了系统回顾和网络荟萃分析。结论是，用聚焦冲击波疗法治疗足底筋膜炎时的最佳传递参数应包括在中等强度范围内选择最高可耐受的能量输出。 17 他们还得出结论，径向冲击波疗法由于其较低的价格和治疗效果可能是一种合适的替代方案。
Other Lower Body Conditions
其他下半身状况
The research and subsequent effects of ESWT extend beyond soft tissue conditions. While not covered in this article, when pertaining to the lower body, favorable findings within meta-analyses have been found for knee osteoarthritis, acute and chronic soft tissue wounds, and medial tibial stress syndrome (shin splints), among others.18–20
ESWT 的研究和后续影响超出了软组织状况的范围。虽然本文未涵盖，但在涉及下半身时，荟萃分析中已发现膝骨关节炎、急性和慢性软组织伤口以及胫骨内侧应力综合征（胫骨夹板）等方面的有利结果。 18–20
Primary Advantages of ESWT
ESWT 的主要优点
When considering treatment interventions, coaches and clinicians alike should have a preliminary understanding of the inherent risks and advantages they feel may be warranted for their athlete.
在考虑治疗干预时，教练和临床医生都应该初步了解他们认为可能为运动员带来的固有风险和优势。
Regarding the use of ESWT for soft tissue disorders, this treatment is largely regarded as safe when used by trained professionals and can, therefore, be considered a first-line treatment option for soft tissue disorders that fail to resolve through traditional interventions. Its non-invasive nature can reduce risks that are inherent with injection-based therapies (such as infection) and surgeries.1,3,8,21
关于使用 ESWT 治疗软组织疾病，这种治疗方法在很大程度上被认为是由经过培训的专业人员使用时是安全的，因此可以被视为通过传统干预措施无法解决的软组织疾病的一线治疗选择。其非侵入性性质可以降低注射疗法（例如感染）和手术固有的风险。 1,3,8,21
Additionally, ESWT is becoming more commonplace within clinical practice, adding a convenience factor for those looking to receive this treatment. Radial shockwave is typically found in clinics more often than its focused counterpart due to its more economical price point. While it’s disputed whether they produce different outcomes, both are largely considered safe forms of shockwave delivery.
此外，ESWT 在临床实践中变得越来越普遍，为那些希望接受这种治疗的人增加了便利因素。由于其价格更经济，径向冲击波通常比聚焦冲击波更常见于诊所。虽然它们是否会产生不同的结果存在争议，但两者在很大程度上都被认为是冲击波传递的安全形式。
Shortcoming #1: Lack of Ideal Parameter Usage
缺点#1：缺乏理想的参数使用
For all that we know about the effectiveness of shockwave therapy on various tissues within the body, there is a bit of the Wild West when it comes to a scientific consensus as to the ideal combination of parameters to use.4
尽管我们了解冲击波疗法对体内各种组织的有效性，但在就理想的参数组合达成科学共识时，还存在一些狂野西部的情况。 4
ESWT treatment parameters often vary across studies, and there is often a surprising lack of recorded parameters (pressure distribution, energy flux density, and total acoustic energy) within studies, causing great frustration to researchers (and clinicians such as myself); a study that shows statistically significant effects on a specific condition without fully listing parameters that were selected is like providing a treasure map without a compass.
ESWT 治疗参数通常因研究而异，并且研究中常常令人惊讶地缺乏记录的参数（压力分布、能量通量密度和总声能），这给研究人员（以及像我这样的临床医生）带来了极大的挫败感；一项研究显示对特定条件有统计上的显着影响，但没有完全列出所选参数，就像提供没有指南针的藏宝图一样。
As such, it’s often up to clinicians to use anecdotal evidence to select the combination of parameters they believe to be best for the individual whom they’re treating, making for a notable shortcoming at this time when assessing the scientific strength of ESWT.
因此，临床医生通常需要使用轶事证据来选择他们认为最适合所治疗个体的参数组合，这在评估 ESWT 的科学实力时存在明显的缺陷。
Shortcoming #2: Focused vs. Radial ESWT
缺点#2：集中式 ESWT 与径向 ESWT
As alluded to earlier, the research regarding the superiority for different orthopedic conditions when comparing focused and radial shockwave therapy is quite unclear. To further complicate matters, it has been suggested that radial shockwave is an inaccurate term and that radial pulse therapy is more accurate for various reasons.1 It has been noted by the same author that some studies involving “low energy” shockwaves are, in fact, referring to radial pulse therapy.
正如前面提到的，在比较聚焦冲击波疗法和放射状冲击波疗法时，关于不同骨科疾病的优越性的研究尚不清楚。更复杂的是，有人认为径向冲击波是一个不准确的术语，而由于各种原因，径向脉冲疗法更为准确。 1 同一作者指出，一些涉及“低能量”冲击波的研究实际上是指径向脉冲疗法。
I make mention of this preceding paragraph to highlight a likely cause for discrepancies between randomized controlled trials examining the effectiveness of ESWT on a particular condition; not only are parameters often not reported, but the type of shockwave administered (i.e., focused versus radial) is not mentioned within certain studies.
我提到前一段是为了强调随机对照试验之间存在差异的可能原因，这些随机对照试验检查 ESWT 对特定病症的有效性；不仅参数经常没有被报告，而且某些研究中也没有提及所施加的冲击波的类型（即聚焦与径向）。
In knowing that respective shockwaves have different characteristics (and likely therapeutic effects), treating a particular condition with radial shockwaves might not elicit favorable results, while treating the same condition with focused shockwaves might (and vice versa). This has the potential to lead to conflicting findings within the literature (and likely does).
在知道各个冲击波具有不同的特性（以及可能的治疗效果）的情况下，用径向冲击波治疗特定病症可能不会产生有利的结果，而用聚焦冲击波治疗相同的病症可能会产生有利的结果（反之亦然）。这有可能导致文献中出现相互矛盾的发现（而且很可能确实如此）。
ESWT Can Be Beneficial
ESWT 可能有益
While the research leaves more to be desired as to the precise mechanisms of how shockwave therapy works, which type of shockwave is most effective for a respective condition, and which set of treatment parameters will likely yield the best outcomes possible, it’s nonetheless quite clear that ESWT can offer benefits regarding tissue healing, pain reduction, and functional improvement for various orthopedic conditions.
尽管该研究对于冲击波疗法的精确机制、哪种类型的冲击波对于各自的病症最有效以及哪组治疗参数可能会产生最好的结果还有很多疑问，但仍然很清楚的是ESWT 可以为各种骨科疾病带来组织愈合、减轻疼痛和功能改善等益处。
Athletes, coaches, and clinicians looking for safe, non-invasive treatment for tendinopathies and soft tissue disorders, and potentially for bone healing, will likely experience the best results for what ESWT can offer and should consider combining this treatment with additional intervention such as physical therapy to maximize therapeutic outcomes.
寻求安全、非侵入性治疗肌腱病和软组织疾病以及潜在的骨愈合治疗的运动员、教练和临床医生可能会体验到 ESWT 所能提供的最佳结果，并且应该考虑将这种治疗与其他干预措施（例如物理治疗）结合起来。治疗以最大限度地提高治疗效果。
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