It can be contemplated that due to the execution of ESWT, reduction in the level of muscular tension and improvement of localized ischemia in the areas of abnormal shortening of the muscles can be achieved, which will in turn inhibit increase in metabolism and occurrence of energy crisis, reduce secretion of various pain inducing substances, and inhibit the induction of pain due to excessive stimulation of nociceptors of muscles and selective destruction of nonmyelinated fibers. Moreover, referred pain that occurs in myofascial pain syndrome is due to easy induction of central sensitization due to lowering of the activation threshold of nociceptors of peripheral muscles (Central hyperexcitability theory).22 Therefore, it can be thought that execution of ESWT could inhibit occurrence of referred pain by inhibiting excessive excitement of nerve cells due to reduction in the synthesis of substance P at the dorsal root ganglia while at the same time preventing central sensitization by inhibiting nociceptors of peripheral muscles.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503942/

pqq as a growth factor

http://www.ncbi.nlm.nih.gov/pubmed/16042869