S.W.A.G. - Shock wave acupuncture according to Dr. Germann -
a new type of acupuncture - first statistical results.
Dr. Michael Germann
Physician of General Medicine, Acupuncture
Vice President of WFAS (World Federation of Acupuncture Societies, Beijing)
Vice President of ATCAE – (Acupuncture and TCM-Society of German
physicians educated in China e.V.)
Taunusstrasse 2 - 65183 Wiesbaden - Germany
Email: docgermann@t-online.de - Internet: www.docgermann.de
Preface:
The new method "S.W.A.G. - shock wave acupuncture according to Dr.
Germann” can be presented for the first time. With it, a new form of pain
therapy is initiated, which leads to significant results in the treatment of pain in
the musculoskeletal system. The “S.W.A.G.” combines for the first time the
knowledge of Traditional Chinese Medicine (TCM) with modern shock-wave
therapy. The devices used are described in detail.
The statistics presented here are the first pilot statistics from the clinic of the
author covering 37, not previously selected ailments of the musculoskeletal
system. The results of these first pilot statistics are very encouraging.
“S.W.A.G.” was successful in about 80% in relieving the pain for the patients
who mostly had been pre-treated unsatisfactorily with other methods. Only in 6
ailments there was no improvement. Among them was one case - an
osteoarthritis of the hip - in which the treatment was discontinued due to
increasing of the pain.
To control the initial results of the pilot statistics, a multicentre observational
study is being carried out in 18 clinics from November 2010 to April 2011 and
the results of 5,000 individual treatments are expected.
Details of the method:
For many years, acupuncture - despite of its many other applications - has been
successfully used in the treatment of ailments of the musculoskeletal system. In
the past, the impressive effects of acupuncture are explained through the

principles of Traditional Chinese Medicine (TCM). In addition to this traditional
philosophic concept, the scientific and clinical research on acupuncture in
recent years unveiled many new findings. They did not always confirm the old
ideas. In fact, they questioned many of them and rejected some of them in part.
Some of the traditional views were even abolished or put on a completely new
basis.
Acupuncture is one of the main pillars of TCM – and the use of the traditional
acupuncture needles in the treatment of painful disorders of the musculo-skeletal
system, has been used over a very long period. Acupuncture uses either local
acupuncture points or distal influential acupuncture points for treatment. This
procedure is well known to all acupuncturists. The distal influential acupuncture
points do not only have a local effect at the spot where the needle is inserted, but
have in addition a considerable effect on the organism as a whole. In pain-
acupuncture, the use of peripheral distal acupuncture points and local points are
of equal importance.
Painful disorders of the musculoskeletal system - only these are included in
these statistics - are of course not solely treated by acupuncture, but also with a
variety of other treatments as well. These treatments are often very distinctive.
One of these methods is the shock wave therapy. In orthopaedics mere shock
waves have been used for many years in the treatment of painful disorders of
muscles, ligaments, tendons and joints, i.e. without combination with
acupuncture. When applied on the local points, shock waves have a direct effect
which is clinically proven.
The majority of painful local points in the musculoskeletal system have a dual
property: they are simultaneously acupuncture points and trigger points
(synonyms for trigger points: myogelosis, muscle tensions). This dual property
of the acupuncture points in the locomotor system is familiar to all
acupuncturists. The author calls these points "acupuncture /trigger points". The
relevant local acupuncture /trigger points are identified by palpation and
according to the rules of TCM, the distal influential points are selected
according to the TCM diagnosis only.
The new feature in "S.W.A.G. - Shock wave acupuncture according to Dr.
Germann" is the fixed, mandatory combination of traditional needle acupuncture
of influential distal acupuncture points, combined with a shock wave application

on local acupuncture /trigger points in the locomotor system.
The dual properties of the points allow the consideration, that the shock waves
have two different, but complementary effects at these points:
1. Shock waves have a direct ”trigger” effect on the muscle tension.
That means that they act directly on the muscles at the local points. The effect of
shock waves in this respect is scientifically and clinically well documented.
2. Shock waves stimulate the local acupuncture points.
The shock wave stimulus is perceived as a minimal pain, similar to the De-Qi
sensation of acupuncture. Neurophysiologically the De- Qi sensation is nothing
else but the triggering of action potentials in the excitable structures, which are
accumulated at the acupuncture points. The action potentials are forwarded by
the sensory nerves to different synapsis where they are switched over, then
forwarded to the brain, where they are received and processed. It does not matter
by which means the action potentials are triggered, because the result, the action
potential itself, always has the same tension, duration and form. The
acupuncture needle itself does nothing different: it stimulates the excitable
structures and those release action potentials, which are processed in the
described manner.
Important:
Under "S.W.A.G. - Shock wave acupuncture according to Dr. Germann "the
author only understands the described combined use of traditional acupuncture
needling of distal influential acupuncture points with parallel application of
shock waves on local acupuncture /trigger points.
Details about the shock waves:
Shock waves are very short, energetic sound pulses with a high repetition
frequency. Characteristic of these sound pulses is a short, steep increase in
pressure, which is followed by a longer phase of a decreasing pressure. The
medical application of shock waves began over 30 years ago as lithotripsy in

urology. In orthopaedics radial shock waves have been used successfully for
many years to treat painful trigger points (muscle tension, myogelosis), tendons,
ligaments and joints.
Even if the mechanism of the action of the shock waves in orthopaedic
application is still not completely understood, its clinical effectiveness, however,
is undisputed and is proven in a multitude of clinical works. Blood- flow
enhancing effects of shock waves and the stimulation of metabolism by shock
waves have been scientifically proven for tendon disorders. See also the book
”Enthesopathies" by Dr. Dreisilker. It is also assumed, that shock waves can
mechanically unloose adhesions in muscles and fascias.
The method and device:
Treatments according to the statistics, were carried out by a device whereby a
compressor provides air with the required pressure. The compressed air is let
into the hand grip through a pressure hose. There, the compressed air accelerates
a projectile to high speeds and makes it ricochet onto the applicator and there the
kinetic energy of the impact is converted into a radial shock wave. Pressure and
frequency of the compressor - and hence the shock waves - can be regulated
within a wide range. The system can be adjusted in this way to meet many
therapeutic requirements, and also different thresholds of tolerance of a wide
range of patients.
In the statistics an applicator with a tip diameter of 6mm was used. By means of
this applicator it was possible to bring the shock waves specifically and
accurately into the local acupuncture /trigger points. The question occurs
whether a larger applicator could be more advantageous. This important issue
will be examined in a later study.
The tip of the acupuncture needle has only a relatively small effective area. In
comparison to the needle, the effective area of the applicator is several decimal
points larger. The likelihood that the shock waves hit the points well - due to the
larger effective area of the applicator - is therefore significantly higher than by
the comparatively smaller effective area of the needle.
Not only hitting the point is of importance for the treatment, but also the
effective area of the applicator itself, and the number of stimulations of the

points. Both are greater in “S.W.A.G.” than in needle acupuncture. The high
accuracy of the shock wave application hereby results in an easier use which is a
special advantage of the method and is not to be underestimated. The method is
virtually free of side effects, when contraindications of acupuncture and shock
wave therapy are regarded.
This combination of acupuncture of the distal influential acupuncture points and
the application of shock waves on local acupuncture /trigger points, is in the
author's opinion the reason for the good therapeutic effect of the S.W.A.G.
The monitoring:
The statistic show the total effect of the “S.W.A.G.” without breaking it down to
single diagnosis. The number of observed cases (37) is relatively small due to
the fact, that the statistics include only cases from the author's clinic. Because of
the already insignificant total number of cases, the author did not form
individual diagnoses groups. The breakdown into diagnosis groups would result
in a too small number of cases per diagnosis, and a statistically sound statement
would thus not have been achieved. The patients are not randomized and there is
no control group or blinding.
For a safe statement with robust statistical results, a larger number of monitored
patients would be desirable. To achieve this greater number, a multi-centre
surveillance in the whole of Germany was initiated (see below).
In the period October 2009 to June 2010, 37 ailments were treated with the
"S.W.A.G. - shock wave acupuncture according to Dr. Germann ". The cases
were recruited from non-selected, current patients of the acupuncture clinic of
the author. Only regular patients who were treated with "S.W.A.G." were
included anonymously in these statistics. Every ailment was regarded as one
case in these statistics. The age of the patients was between 35-79 years and the
majority of these were female.
All patients had one or more of the disorders mentioned below. Many of them
had already been treated more or less successfully with different methods:
Drugs, physiotherapy and pure acupuncture. The conventional medical diagnosis
was based on a clinical examination and on existing laboratory tests, X-ray or
CT/MRT- images. Additional laboratory tests or imaging procedures were not

carried out. The TCM disturbance- patterns were determined by medical history,
pulse and tongue diagnosis.
The acupuncture and trigger points were palpated and marked. On any of the
local acupuncture /trigger points (myogelosis, muscle tension) 2 series of 20
shock waves were applied. The shock waves had a frequency of 5 Hz and a
compressor pressure between 1.5 and 2.5 Bar - depending on the tolerance
threshold of the patient. The working pressure of the compressor must not be
confused with the peak pressure of the shock wave, because this is much higher.
Distal influential acupuncture points, which were indicated according to the
TCM diagnosis, were traditionally acupunctured with the needle. In addition two
ear points were acupunctured.
The treatment was mostly carried out when the patient was prostrate. The
working pressure of the compressor, which determines the intensity of the shock
waves, was adjusted in accordance with the patient, so that the shock waves –
similar to the De-Qi feeling in acupuncture – was clearly felt, but was not
regarded as "painful". If pain was felt during the treatment, the pressure was
reduced until the shock waves could be tolerated. In general, there were two
treatments per week.
Treated Diseases:
Pain of the cervical, thoracic and lumbar spine, shoulder pain
Pain in the sacroiliac joints, tennis elbow, golfer's elbow
Hip and knee pain, ankle pain
After an initial series of 20 shock waves with a frequency of 5 Hz and a pressure
of 1.5 to 2.5 Bar, a second series of just the same type was applied on the same
points. Some patients reported, that they temporarily noticed a slight muscle-
soreness in the treated areas after the shock wave application.
The needles remained inserted for 20 min. Standard were two treatments per
week over a period of 4-5 weeks. Depending on the therapeutic success, the
period was often much shorter, seldom longer. Before each new session, the

patients were asked about their feelings and the local points where varied if
required. This was only seldom necessary. An improvement was often noticed
after 3-5 treatments already. The duration of the treatment was statistically not
recorded.
Results:
In 31 of 37 ailments, the patients reported subjectively, that the "S.W.A.G." had
helped them well, mostly very well. Only six ailments treated by “S.W.A.G.”
failed to improve. Among these was a case, a hip osteoarthritis, in which the
treatment was prematurely ended due to the lack of success and increasing pain
after four sessions.
With a treatment success of 80% in these first pilot statistics, the "S.W.A.G."
seems to be very effective. Unfortunately the patients represented a negative
selection. They all had been pre-treated by other methods such as medication,
physiotherapy or by pure acupuncture without the desired success. In this
regard, the rate of an improvement of 80% gains considerable importance. For
the patients it was very impressive, that the first improvement could be felt
within a short period of time. Two already scheduled operations - one
impingement of the shoulder and one osteoarthritis of the knee – could
fortunately be cancelled after a successful “S.W.A.G.” therapy.
To have results on a broader basis and thus provide more reliable statistics, a
large multi-centre, Germany-wide surveillance study was initiated in Wiesbaden
on the 18.11.2010. This surveillance will comprise of at least 5,000 individual
treatments with “S.W.A.G.”18 German expert acupuncture doctors, all members
of the ATCAE – (Acupuncture and TCM-Society of Physicians Educated in
China e.V.) who all received their acupuncture training in China, are
participating. The results will be available mid 2011.
Summary:
The therapeutic progress of “S.W.A.G.” according to the present state of
knowledge, seems to be due to the fact that “S.W.A.G.” combines two systems
which act differently:
The Chinese Acupuncture with the needle which has been proven for thousands
of years, and the modern shock wave therapy.

According to the recent preliminary results, this combination- therapy seems to
surpass the pure needle acupuncture as well as the pure shockwave therapy.
According to the author, the "S.W.A.G. shock wave acupuncture according to
Dr. Germann" is a very effective new method, particularly suitable for the
treatment of ailments of the musculoskeletal system.
Another advantage of “S.W.A.G.” for the patient, besides its good therapeutic
power, is the practical absence of side effects. The advantage for the physicians
is the easy and safe use of “S.W.A.G.”
PS: At the WFAS- World Congress of Acupuncture in San Francisco on the 6.-7.
November 2010, the method was first presented internationally by the author
and found a very positive acceptance.
Literature:
D. G. Simons, J. G. Travell, L. S. Simons: Handbuch der Muskel-
Triggerpunkte, Obere Extremität, Kopf und Rumpf. Urban & Fischer. ISBN 3-
437-41402-X
W. Bauermeister, Schmerzfrei durch Trigger-Osteopraktik, Südwest Verlag,
ISBN 3-517-06947-7
C. Davies, A. Davies, Arbeitsbuch Triggerpunkt-Therapie, Junfermannsche
Verlagsbuchhandlung, ISBN 3-873-87677-9
Everke H. Mitteilung aus der Praxis. Behandlung von Asthma mit Stoßwellen
Akupunktur - vier Fallberichte. Dt. Ztschr. f. Akup. 50, 1/2007, S. 19-22.
Everke H. Druckwellen-Akupunktur. Eine neue Methode - Teil 1.
medicalsports network
02/09, S. 56/57.
Everke H. Druckwellen-Akupunktur bei Atemwegserkrankungen - Eine neue
Behandlungsmethode. COMed 1/2009, S. 42-46.
G. Stux, N. Stiller, B. Berman, und B. Pomeranz - Akupunktur - Lehrbuch und Atlas
Springer Verlag, Berlin September 2007
U. Dreisilker – Enthesiopathien - Level 10 Verlag - 2010