Shockwave therapy is a term give to pulsed sound waves administered to body tissues to promote a healing response that can be applied to wide variety of conditions to stimulate healing along with diet and lifestyle. Since I work in a general practice, I am able to apply shockwave therapy (acoustic wave, pressure wave, EPAT - extracorporeal activation technology) in a wide range of conditions unlike, let's say, a podiatrist who frequently use these devices to treat the feet, ankles, and lower extremities only. High frequency shockwaves have been shown to break-up kidney stones and other hard stones in the body for more than 30 years (i.e., lithotripsy). But low frequency shockwaves, (soundwaves, acoustic waves, or pressure waves) delivered by focused and radial devices have been used to treat all kinds of tendon and ligament problems, arthritidies, circulatory problems, wound healing and fractures, and even has improved muscle tone in areas like the bladder.
Focused and radial shockwaves promote:
1) Neovascularization – the building of new blood vessels
2) Release of growth factors such as eNOS (endothelial nitric oxide synthase)
3) VEGF (vascular endothelial growth factor)
4) PCNA (proliferating cell antinuclear antigen)
5) An anti-inflammatory effect
6) A breakdown of fibrous tissue
7) Stimulation of stem cells
Here are four recent cases of varying levels of benefit with combination shockwave therapy that may seem unrelated unless you accept the premise that by improving circulation, the breakdown of fibrous tissue, stimulation of new tissue growth (stem cells) and nerve regeneration one can help a variety of different conditions. Remember the body is always trying to heal itself if we give it the right nutrition, exercise, mindset, "clean" environment and therapies which support natural processes.
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Case 1 Bladder Control - Frequent Urination
An 86 now 87 year-old female came in for frequent urination, 20 or more times per day (another time she told me every 5 minutes) and her urologist wanted to put implant a wire device with a battery to provide "neuromodulation" of the area to help control the frequent urination. The patient was overweight and took two anti-hypertensive meds, thyroid, a rheumatology medication and the blood sugar lowering medication metformin.
She received focused shockwave therapy over three different areas of the bladder which takes
about 20 minutes followed by 10 minutes of pulsed electromagnetic field therapy EMTT (July 11, 18 July 25th). She was to come back for 2-3 more weekly treatments but then got sidetracked with another condition and was finally seen on October 31st. I asked her how her bladder symptoms were. She said her bladder was dramatically better, now in late October 2022, compared to when I had seen in her July 2022. See said she might urinate every two hours now instead of every 5 minutes. She also said she noticed improvement about a month or so ago so which would be 8-12 weeks after I finished a shortened treatment on her. Now was this improvement related to the shockwave therapy? I am not 100% sure but it fits the model of healing stimulated by the therapy which continues 10-12 weeks after the initial treatment session is completed. I have heard more than one podiatrist using shockwave tell me at a meeting they will treat a plantar fasciitis or Achilles tendonitis and it will improve during the initial treatments but not be gone in 4-6 weeks. Then they will tell the patient to let me know in 10 weeks how they are doing and then the pain will be gone... Point being with shockwave there can have an immediate effect like some pain reduction and improvement in function. But when you are trying to regenerate tissue through stimulation of stem cells and building new blood vessels this process can occur several months after the treatment. We'll see how long it lasts!
REFERENCES
Low Intensity Extracorporeal Shock Wave Therapy as a Potential Treatment for Overactive Bladder Syndrome.
Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study
Low Intensity Extracorporeal Shock Wave Therapy as a Novel Treatment for Stress Urinary Incontinence: A Randomized-Controlled Clinical Study
Case #2 - Right Hip Pain - Post Stroke - An 87 year old post-stroke patient with hypertension came into the exam room in a wheelchair complaining of right hip pain and that same leg "giving out" when he was standing. It is the same side effected by his previous stroke (right side). So, we wanted help with pain in the right glut and hip and improve his walking with a walker and help keep his right leg from giving out. The first five weekly EPAT treatments were with the focused and radial devices, along with pulsed electromagnetic fields (EMTT - extracorporeal magneto transduction therapy) went smoothly with mild improvement in pain and sturdiness of his right leg. It was a challenge to keep him in a position where I could get to his hip so we wheeled him up to the foot end of an exam table, helped him stand up and bent him over the end of the exam table with a pillow under his chest. I actually used both focused and radial shock wave devices (FSWT & RSWT), with a vibration treatment as well (V-Actor) and then massaged in a CBD cream we use (people can buy it - I have to fax in the prescription to EBM Medical). Then on several, but not all treatment sessions, he would get a 10-15 minute treatment with 5000 pulses of EMTT (extracorporeal magneto transduction therapy) on his right hip. Then last week several days after his 5th treatment he noticed a dramatic improvement in the pain being "gone" from his right hip. Also, he said his right leg was more stable when he was standing and wasn't "giving out" and he could walk more with his walker for longer periods of time to get exercise. The unique things about this case are there was mild to moderate improvement the first 4 weeks then there was a considerable "jump" in improvement. He will return after a possible medical procedure to get 2-3 more treatments in this series. This is an older individual (87) who has had a stroke and hypertension. I don't look for cures but improvement in function and reduction in pain to help people live their lives independently as possible. Again, I don't like relying just on one technology but use a variety of approaches to control pain and inflammation - an anti-inflammatory diet, certain nutraceuticals and persistent exercise (strength training, aerobics and flexibility) is critical to improving pain syndromes and function even with the best technology.
REFERENCES
Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial https://pubmed.ncbi.nlm.nih.gov/32769596/
Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/30585498/
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Case #3 - Bilateral Knee Pain in Avid Hiker - A Tune Up!
A 74 year old avid hiker who came in with pain in his knees especially when going downhill had an initial series of combined shockwave treatments on his knees on 3/17/21, 3/23/21, 3/30/21 and 4/6/21 without the EMTT device and had considerable improvement in his knee pain. He was also told to stay off dairy products (cheese especially) and refined carbohydrates. He had two treatments on his knees on 11/1/21 and 11/5/21 (8 months later) and felt definite pain relief. He returned for treatments on 1/14/22 and 1/21/22 (2 months later). He was continually active during this time with hiking. His knees had been good pain-wise since January 2022 (for 9-10 months) and then he came in for a "pre-hiking" treatment where he'll be gone for several weeks. He received shockwave therapy treatments on 10/31/22 and 11/3/22 and he was then off on his trip. On his very last treatment we also did a treatment on the back (posterior) portion of the right knee and on the back of the calf and thigh above the knee because he had pain in those areas. Maybe muscle strain or ligament tendinitis? In the past he has changed his diet getting off cheese consumption, not having eggs daily and eating processed foods.
Joint inflammation is something that can be chronic depending on how you live and what you eat and the nutrients you take. This individual had an aggressive supplement program. He has also been instructed to to quad and calf strengthening exercises like quad sets, calf raises and the "Wall Sit" (P.S. If you do the Wall Sit correctly and just stay at 90 degrees with your legs and then put your hands out like a "cross" pressed against the wall with the back of your head touching the wall for 30 seconds to several minutes this is a great low back exercise as well. So, you can help your quads and back at the same time! He had done well with regards to having reduced his knee pain from January 21, 2022, to October 31, 2022, without chronic medications or drugs using a "regenerative" therapy. Is shockwave a "cure" in this case? Probably not but the patient found it valuable enough to request further treatments on his own.
REFERENCES
Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism https://pubmed.ncbi.nlm.nih.gov/33074309/
Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/23953895/
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Case #4 - Shingles Down Right Leg - Helped with Pain Control?
Interestingly I just had a case of herpes zoster (shingles) arising from the L5-S1 nerve roots sending pain and a rash down the right glut, lateral thigh, back of the calf and then into the sole and top of the foot in which shockwave therapy was helpful in reducing the pain but it has not been curative. The patients always feel better after a treatment, they ask for it and her pain is slowly reducing over time so I continue with it weekly. There is some data which supports the use of shockwave for herpes zoster, (shingles) but it's not a solo "slam dunk" treatment therapy for shingles. This person also has been taking the anti-viral medication Valtrex, some temporary pain medication (now just a couple of times per week), vitamin C and D, lysine 3000-5000 mg, and stopped eating nuts rich in arginine (and chocolate! Tough for the patient!). This patient also had 4 treatments with IV vitamin C 5-25 grams with combined intramuscular injections B1,B12, folic acid, but she didn't get them for a month after the first three. She has a big aversion to getting something stuck in her arm which some people do. But it's part of early and aggressive treatment for shingles that I have used over the years with success. She also had some pain management treatments from her chiropractor.
The reason I shared this shingles case is not that the treatment approaches are a quick "cure" but while the patient has improved there is still lingering symptoms which need to be "stayed on top of." Treating people early and aggressively with shingles can prevent, slow or reduce the severity of post-herpetic neuralgia a long-term pain syndrome that is harder to treat and miserable. You want to treat it with the "kitchen sink" so-to-speak at the very beginning. With Covid and the vaccines some people have been observing more reactivation of viruses. This person didn't take the vaccines but had a severe case of Covid over a 2 month period (12/21 to 2/22). I am adding to this patient’s regimen some treatments I learned from another physician using vitamin C and D (already using) and very low dose Ivermectin and spironolactone (a potassium sparring diuretic). The patient has also been taking low dose naltrexone and restarting low dose IV vitamin C with B vitamins a couple of times per week. We will continue with weekly shockwave therapy and hopefully progress to a pain-free patient soon!
REFERENCES
Observational Study Efficacy of extracorporeal shockwave therapy in the treatment of postherpetic neuralgia A pilot study https://journals.lww.com/md-journal/fulltext/2020/03200/efficacy_of_extracorporeal_shockwave_therapy_in.31.aspx
Comment: Shockwave therapy is a tool that stimulates the healing process that your body is trying to do. It has an immediate effect within days to weeks, then it has a long-term health effect that can take several months. It is an excellent non-invasive tool along with diet, nutritional supplements, and exercise for different pain syndromes.
If shockwave (ESWT/RSWT) is something you know you would like to try, then just make a new patient appointment with me. The initial office visit is 60-75 minutes, and we can sometimes do a treatment at that first visit. Then visits are usually 30-45 minutes a session depending on the area (s) treated. Usually, the treatment length is 6-8 treatments (unless for erectile dysfunction then it is 10 treatments). If you would like to make a FREE 15 minute appointment by phone to discuss if shockwave therapy is right for you call 916-489-4400 and ask for that free 15 minute appointment.
People can sign up for my Health Letter Here.
If you are interested in shockwave (EPAT/ESWT pulsed sound waves) or EMTT (pulsed magnetic fields) for pain management, stimulating healing and/or for erectile dysfunctions make an appointment as well.
I still recommend variations of "Kirk's 21 Day Program" and different fasting regimens (Prolon and Inflamx) for reversal of heart disease, diabetes, memory loss, aging and overweight issues. If you have concerns about memory, CIRS (Chronic Inflammatory Response Syndrome), and/or mold illness those are also areas of significant interest and study for me.
Kirk Hamilton PA-C
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com