A 75 year-old male mildly overweight with type 2 diabetes step out of bed on June 28, 2022
and felt a sharp pain on the inside of his left knee when his left foot turned inward. He came
to me 2 weeks later on July 14, 2022 limping into the office with a cane asking for help. I took
a history, examined him and said it could be a ligament strain or a torn cartilage or both because
of the pain on the inside (medial) aspect of the left knee. I told him whether this ends up with a
surgical solution or not it is important to be on an anti-inflammatory diet; strengthen his quads
and calves to stabilize the knee, improve his range of motion of the knee and enhance the natural
healing process with shock wave (radial and focused) and some EMTT therapy (electromagnetotransduction therapy). Shock waves are pulsed sound waves not electrical shocks, while EMTT is high oscillating pulsed electromagnetic fields. Both promote healing.
TREATMENT APPROACH
Exercise daily - just walking
Strengthen Quads, Hamstrings and Calves
(yellow highlights are what the patient did)
Wall Sit - 10 seconds to a minute 2-4 x day
Quad sets
Straight leg raise
Short Arc Quads
Bridges
Sidelying Hip Abduction
Knee to Chest Exercises
Calf Raises flexing quads (can hold on to something)
"Sink" Squats - hold onto the sink - go down to 90% if no pain then return - eventually if no pain can do full squat - again not if there is pain (or clicking or locking of the knee).
Xray and MRIs of the knee on 7/14 and 7/23/22 respectively showed left knee osteoarthritis,
chondrocalcinosis of the menisci and upon MRI he had complexed tears of the medial meniscus and horizontal tears of the lateral meniscus.
Shock Wave (radial and focused) and EMTT Treatments
After two combined treatments 1 week apart of 4000 (1.2-2.0 bar.15 Hz) radial pulses ("shocks") and 2000 (.03-.07 mJ/mm2) focused pulses and EMTT treatments 5000-6000 oscillations (8/8Hz) there was a mild-to-moderate improvement though he was still using his cane. I then saw the MRI and referred him to an orthopedist which was scheduled for September 6, 2022 over a month away. I wasn't sure about the focused and radial shock wave improving actual cartilage tears (there is some suggestion of a positive effect on cartilage; see references below) but I believed these therapies along with exercise would have him optimally prepared for a great surgical outcome if that is what was to happen. So to keep expenses down until he had his surgical evaluation we decided to just do the EMTT therapy (high oscillation pulsed electromagnetic fields) on the left knee that only takes 15-20 minutes weekly until his orthopedist appointment on September 6, then decide if he wanted more shock wave treatments. He continued to do the weekly leg strengthening exercises (below). EMTT only sessions were continued at 8000-9000 pulses (8/8Hz) for sessions 3, 4 and 5. Coming into the 4th session (8/2/22) before the treatment he said he hadn't had any pain in his left knee since July 26 even though recently he had walked up and down 12 flights of stairs. He was still doing his Quad exercises religiously (and staying off all dairy products and processed wheat products; and his HgA1C was creeping down from 6.9 to 6.6 showing his diet was improving slowly). When he came in for his #5 EMTT session he said his left knee pain was almost completely gone and he hadn't used his cane at all for the last week.
He will be traveling to visit a lifelong friend who is seriously ill for the next 2-3 weeks. So we will see how long his good progress lasts. I may be able to see him for an EMTT treatment or two before his September 6, orthopedist visit. I will be curious to see what happens.
Even though traveling and away from home he can still do his Quad/knee exercises daily and eat well. The unique thing about using shock wave therapy is that there is an immediate effect many times but then there is a physiological effect that continues releasing healing substances for 10-12 weeks after the last treatment.
There is no perfect protocol with shock wave therapy and EMTT. There are guidelines then there is individual experience and "feel" and getting feedback from the patient. I used to be a certified massage therapist many years ago and putting my hands on people in a healing fashion is a natural for me. Many times I feel like I am "feeling" through the shock wave hand pieces, like extensions of my hands. These technologies and tools are very powerful because they stimulate your body to heal itself with minimal, if any side effects. I also can't emphasize enough the importance of an anti-inflammatory diet, taking some nutrients, selective exercises and muscle strengthening playing a big role in healing a chronic problem and then staying well.
Call me between 8-9 a.m. at 916-489-4400 if you have questions. Right now you can schedule a FREE 15 minute phone appointment with me to see if you are a good candidate for shock wave and EMTT therapy. If you are ready to go make an initial 1 hour appointment for me to obtain a good history, do an exam and then have a treatment session please schedule a new patient appointment. Call the office for our initial office visit charges.
Shock wave treatment sessions are $175-200 for a half hour (1 body part); $250 for 45 min (2 parts) and $300 for 60 min (3-4 parts). EMTT alone is $80 per 15 minutes session. Treatments are paid for at the time of service.
I look forward to working with you and sharing more cases with you. Shock wave works not only for musculoskeletal problems but for erectile dysfunction as well. You can do a 15 minute free appointment to discuss ED if you are interested. Some groups also use shock wave treatments for aesthetic medicine related health issues.
REFERENCES
Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: A systematic review and meta-analysis of randomized clinical trials. Int J Surg. 2020 Oct;82:64-75.
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Be Well,
Kirk
Kirk Hamilton PA-C
Prescription 2000, Inc.
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