Thork


Thork Shock Wave Equipamento de Ondas de Choque Extracorpórea
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The equipment

Thork Shock Wave is a piece of equipment microcontrolled by extracorporeal shock wave therapy (ESWTExtracorporeal Shock Wave Therapy). The mechanical cavitational and thermal energy produced by Thork Shock Wave is transferred to the patient through a radial shockwave applicator.

It presents maximum energy of 200mJ, and the Shockwave emission mode can be single or sequential, with adjustment of frequency of up to 22Hz and the number of shots can be previously adjusted until 9999 or free mode (Free).

The equipment is accompanied by 3 projectiles, one in the applicator and 2 spare ones. Each projectile presents a durability of 3 million shots. After 9 million, that is, after the use of the 3 projectiles, it is necessary to send the applicator for overhaul and maintenance.

Thork Shock Wave can be used with tips of different sizes and materials for several therapeutic applications. It presents an ergonomic applicator, exclusive design, touchscreen and an informative tutorial. It is efficient, safe, precise and easy-to-operate equipment.

The equipment must be used only under prescription and supervision of a licensed professional.

 

Thork Shock Wave Tips

Metallic Tips (stainless steel)  

  • 6mm metallic tip: used in treatments in the rehabilitation area which aim to reach deeper tissue and structures in localized and specific areas. It can be used in trigger-points, acupuncture and tendinopathies;
  • 15mm metallic tip: used in treatments in the areas of physical rehabilitation and esthetics, which aim to reach deeper tissues and structures. In rehabilitation, it can be used in the treatment of trigger points, tendinopathies, bursitis, articular lesions and myofascial therapies. And in esthetics, it is used in the treatment of esthetic disorders of the body, such as cellulite, localized fat and body modeling;
  • 25mm metallic tip: used in the treatment of physical rehabilitation and esthetics which aim to reach deeper tissue and structures. In rehabilitation, it can be used in myofascial therapies. And in esthetics, it is used in the treatment of esthetic disorders of the body, such as cellulite, localized fat and body modeling;
  • 34mm metallic tip: used in treatments in the esthetics area which aim to reach deeper tissues and structures. In esthetics, it is used in the treatment of esthetic disorders of the body in larger surfaces, such as cellulite, localized fat and body modeling.

 

 

 

Plastic tips (polyacetal)

  • 6mm plastic tip: used in treatments in the esthetics area which aim to reach more superficial tissues in more specific and localized regions. It can be used for the treatment of stretch marks and scars, as well as the use in acupuncture;
  • 15mm plastic tip: used in treatments in the esthetics area which aim to reach more superficial tissue. It can be used in the treatment of body skin flaccidity, as well as combined with the metallic tip for cellulite, localized fat and body modeling;
  • 25mm plastic tip: used in treatments in the esthetics area which aim to reach more superficial tissues. It can be used in the treatment of body skin flaccidity and facial rejuvenation, as well as the use in the combined protocol with the metallic tip for cellulite, localized fat and body modeling. In the case of facial treatments, the silicone protection for the tip must be used;
  • 34mm plastic tip: used in treatments in the esthetics area which aim to reach more superficial tissues. It can be used in the treatments of body esthetic disorders in large surfaces, such as flaccidity of body skin, as well as the use in the combined protocol with the tip for cellulite, localized fat and body modeling.

 

Technical characteristics

  • Power supply: 100/240V | 50/60Hz;
  • Energy: 60 to 200mJ;
  • Frequency: 1 to 22Hz;
  • Shots: free or from 1 to 9999;
  • Pulse mode: single or sequential;
  • Ramp mode: On and Off;
  • Private protocols: 1 to 20;
  • Pre-programmed protocols: esthetics (1 to 9) and physical rehabilitation (1 to 25);
  • Limits of energy by frequency:
  • From 60mJ to 90mJ: from 1 to 22Hz;
  • From 60mJ to 120mJ: from 1 to 19Hz;
  • From 60mJ to 180mJ: from 1 to 18Hz;
  • From 60mJ to 200mJ: from 1 to 16Hz.

 

Pre-programmed protocols

ESTHETICS:

  • Body contour remodeling;
  • Localized fat;
  • Cellulite degree 1;
  • Cellulite degree 2;
  • Cellulite degree 3;
  • Stretch marks and scars;
  • Skin flaccidity post-liposuction;
  • Body skin flaccidity;
  • Facial rejuvenation.


Differentials


History and concept

ESWT – Extracorporeal Shock Wave Therapy started to be used in the early 80s in Extracorporeal Lithotripsy, becoming a golden standard for the treatment of gallstone, renal calculi, ureteral calculi and vesical calculi. After some patients treated with ESWT presented increase in bone density in the pelvic region and studies demonstrated the efficiency of the therapy in osteogenesis and in the treatment of musculoskeletal diseases, ESWT began to be used in orthopaedics, with the first approval by the FDA (Food and Drug Administration) in 2000, for the treatment of chronic plantar fasciitis in the United States. Today, ESWT is consolidated in orthopaedics, with satisfactory results in different musculoskeletal pathologies, and is indicated as a safe therapy with short recovery time and minimal complications.

As it had happened in the case of orthopaedics, the Discovery of the effects of shockwaves in esthetics occurred coincidentally, when women suffering from muscular disorders, after receiving hip prosthesis, reported improvement in mobility and pain, in the aspect of the skin and an additional effect that the clothes they wore clothes were more comfortable and looser. This phenomenon suggested that there was a decrease in the circumference of the treated area.

In esthetics, the first studies appeared in 2005. Until the present moment, there are in the literature about eleven relevant articles, which demonstrate the efficiency of shockwaves in the appearance and aspect of the skin and in the decrease of the circumference of the treated area and decrease in the thickness of the fat layer when used in the treatment of gynoid lipodystrophy (cellulite).

In Brasil, there are several imported shockwave devices available for the professionals in the area; however, Thork Shock Wave is exclusively manufactured in Brazil, develop and manufactured by IBRAMED.

Unlike the shockwave devices in the international market, which are generally pneumatic and present different applicators, Thork Shock Wave presents an electromagnetic generator. That means that in the interior of the applicator, there are coils which, when excited by electric current, generate a magnetic field, which makes the projectile located inside the applicator move rapidly, generating impact on the tip and propagating mechanical energy in the treatment area.

This energy wave produces two effects: the first is the mechanic effect in the tissue and the second is the cavitation, which is the formation of gas microbubbles in the biological fluids. Thork Shock Wave present a radial applicator, which propagates the energy in a diffuse manner.

These energy waves are converted into shots and for each therapeutic objective there is a specific number of shot to be programmed in the equipment. In trauma orthopaedics, the number is pre-established to about 2 thousand shots, but in anesthetic alterations, there is not a specific number; most scientific articles mention from one thousand to five thousand shots depending on the treatment area with the applicator in slow movement.

 

Mechanisms of action and physiological effects

Shockwave therapy promotes the following physiological effects:

  • Mechanotransduction of signal: is the process by which the mechanoreceptor and parenchymal cells convert the mechanical stimuli (shockwaves) into a chemical response, activating the fibroblasts and increasing the density of the collagen and elastin fibers, due to the production of neocollagen and neoelastin;
  • Remodeling of the collagen: o the mechanical stress tractions the collagen fibers, stimulating the remodeling of collagen, stimulating remodeling of the collagen and elastin fibers and of the fibroblasts. The traction of the collagen fibers in the skin incites the rearrangement by the movement of the applicator, and improves the malleability of the collagen;
  • Microcirculation stimulation: the increase of circulation reduces the concentration of vasoneuroactive substances such as bradykinin, prostaglandins, serotonin and histamine, which also decreases the excitation of the nociceptors and of pain. It also increases the active transport of oxygen and nutrients to the tissue;
  • Release of nitric oxide: nitric oxide is an important vasodilator, formed in the neurons of the posterior spinal dorsal horn, which promotes an inhibitory effect in the afferent nerve pathways of pain, causing pain modulation and vasodilation for the increase of blood flow;
  • Elimination of toxins and increase of lymphatic flow: activation of the lymphatic system, which accelerates the transport of metabolites of the extracellular matrix and causes the lymphatic drainage to reduce the edema and promote the fast regeneration of the tissues;
  • Release of growth factors VEGF (Vascular Endothelial Growth Factor), eNOS (endothelial Nitric Oxide Synthesis) and of BMPs (bone morphogenetic proteins): these factors aid in the healing of tendinopathies in tendinous insertions and stimulate the release of angiogenic factors and in neovascularization, which improves local blood flow accelerating healing of tendon and bones;
  • Increase of permeability of the cellular membrane: this effect results from the cavitation phenomenon;
  • Reduction of adipose tissue: por by diagnostic ultrasound and clinically observed by standardized photographs, the thickness of the hypodermic layer is reduced by shockwaves.

Treatments


Application techniques

  • Examine the skin and clean the treatment area prior to the application, using alcoholic chlorhexidine at 0.5%.;
  • Apply Thork neutral lotion or neutral gel for the sliding of the tips;
  • Depending on the therapeutic objective, carry out a punctual static application or in slow movements with the applicator horizontally and vertically, scanning the treatment area;
  • After the procedure, it is common that the patient presents hyperemia and hypersensitivity;
  • Clean the tips and the applicator before and after each treatment session. The tips can be cleaned with water and sanitize with alcoholic chlorhexidine. For the 25mm and 34mm tips, if necessary, use a small brush to remove gel residues.

Indications


  • Cellulite;
  • Localized fat;
  • Non-invasive body modeling;
  • Skin flaccidity;
  • Stretch marks;
  • Facial rejuvenation;
  • Late liposuction post-operative.

Contraindications


  • Hemophilia or other hemorrhagic disorders;
  • Ingestion of anticoagulants;
  • Over tissues with acute undiagnosed inflammation;
  • Over cutaneous eruptions or other types of tissue lesion;
  • Over polyneuropathy areas in patients with Diabetes mellitus;
  • In patients subjected to cortisone therapy up to 6 months before the first session of extracorporeal shockwave therapy;
  • Over neoplastic areas;
  • Directly over metallic implants;
  • Over occlusive vascular diseases and circulatory deficiency, as in cases of deep venous thrombosis, phlebitis, varicose veins, obliterative arteriosclerosis and obliterative thromboangiitis;
  • Over reproductive organs;
  • In the presence of systemic inflammation (sepsis, tuberculosis) or if the temperature of the patient is high (fever);
  • Implanted electronic device (ex.: cardiac pacemaker, deep brain stimulation device etc.);
  • Over laminectomy or spina bifida;
  • Directly over the carotid sheath, stellate ganglion or vagus nerve located in the anterior triangle of the neck;
  • Over the area of the lungs, cardiac area, large nerves and vases, spine and head;
  • Over or next to bone growth centers, until the bone has completed its growth;
  • Areas with tendency of hemorrhages after acute trauma or fracture.

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