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We can usually tell the future by examining the past; over the past 3 decades, the history of medical SWT has revealed that its safety and efficacy in each area of its utility has encouraged further research for its expansion, while remaining intransigent to becoming demoded. There is growing evidence that SWT is influencing the activation and differentiation of endogenous stem cells, and is stimulating more research in this area. Among such investigations are: the utility of the evolution FlashWaveTM technology for musculogenesis via endogenous skeletal muscle stem cell activation and differentiation, presently being investigated by Vincent et al. [71, 72] to determine the efficacy for skeletal muscle regeneration in the aging population (sarcopenia/dynapenia), and to improved skeletal muscle resilience in the athletic population. Holfeld et al. [65] are presently investigating intracorporeal SWT on the heart (Fig. 7a, b) ushering in an interesting era in SW medicine.

In urology where SW were first utilized (ESWL) as a destructive force, SWT is now utilized as a regenerative and restorative modality redefining andrology, addressing the issue of erectile dysfunction and is showing very promising results [53–59]. Other investigations include the utility of SWT in dystonia and spasticity [135–140], diabetic neuropathy [141, 142], knee osteoarthritis [143–145], low back pain syndromes [146], uterine fibroids [147], and possible intervention in Langerhans islet beta-cell regeneration in type-1 diabetes mellitus [148], among other emerging indications. The potential clinical utility of SWT is vast and more vigorous research, clinical exploration and collaboration is required to provide firm support for its use and to receive the recognition and funding from both the public and private healthcare sectors.

Fig. 7. a Intracorporeal shockwave (SW) treatment of the heart: Holfeld et al. [64], Dept. of Cardiac Surgery, Innsbruck Medical University, Austria. b Specialised intracorporeal SW (electrohydraulic) applicator designed for open heart interventions.