Table 3.

Various potential molecular and cellular mechanisms of action of shock waves on skin/fat tissue that have been proposed in the literature

Proposed mechanisms	Reference
Stimulation of blood and lymph circulation	Braun et al18
Increased membrane permeability	Braun et al18
Stimulation of the exchange of blood lipids	Braun et al18
Stimulation of metabolism	Angehrn et al19
Reduced oxidative stress	Christ et al21
Increased antioxidants (including ascorbic acid)	Siems et al76
Induction of neocollagenogenesis and neoelastinogenesis	Kuhn et al23
Increased angiogenesis	Ferraro et al44
Expression of vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen	Angehrn et al19
Apoptosis of fat cells triggered by inflammation	Ferraro et al44
Activation of C nerve fibers in the skin and release of substance P	Present study