A 78 year-old female came in 2 weeks ago with a long history of a neuroma on the 4th MTP (metatarsal phalangeal) joint of her foot (ball of the foot) noting pain walking on the carpet or floor bare foot and shooting pains in that 4th toe and the top of her foot. There was some discussion of a possible surgical solution. She had also in the past taped her 3rd & 4th toes together. A type of toe guard was also tried.
Normally I do shockwave and/or EMTT treatments on a weekly basis for 6-8 treatments for a variety of conditions but in this case we decided to go twice weekly because she was leaving for Hawaii in 2 1/2 weeks, so we did twice a week treatments and got in five complete treatments before she left for vacation.
Shockwave therapy (pulsed sound waves) can be uncomfortable but should not "hurt" enough that you can’t tolerate a treatment. You try and keep the discomfort under a 6 or 7 on a pain score. But everyone is different. This particular patient had very "sensitive" feet. During the first two treatments of focused and radial shockwave (15-20 minutes) followed by EMTT (pulsed electromagnetic fields; 10 minutes) she was so "jumpy" I thought we would never get a solid treatment session in. I was thinking it might take me a month to get to a full "strength" session completed. With the EMTT treatments patients usually do not feel anything, in fact many patients fall asleep. The EMTT treatments can take 10-20 minutes. She was given five thousand pulses of EMTT treatment directly after the shockwave treatments which was very well tolerated (remember the term “shockwave” does not mean electric shocks!).
The first two complete treatments of all three modalities over the first week did not result in any positive changes in her pain or painful tingling sensation in that left foot. She also did not calm down much with both applications so it was hard to feel like you were getting a complete treatment in. By the third treatment on week two she could tolerate the treatments a little better, but she was still very "squirmy" and there was not much pain reduction in the ball of her left foot. But I had told her at the beginning these treatments were best done on a weekly basis over 6-8 weeks. When she came in for the 4th treatment she very clearly said (after 3 full treatments) that she could walk barefoot and she had no pain in the ball of her left foot and the tingly pain on the top of her foot was significantly reduced. During that fourth treatment she was still very sensitive and fidgety when both the radial and focused shockwave treatments were applied. Usually, as one's symptoms improve you can increase the power of the treatment energy into the affected area. At her last treatment (5th) before leaving on her Hawaii vacation that weekend she noted she could walk barefoot on the floor or carpet pain-free and almost all the painful tingling sensations on the top of her foot was gone and that 4th toe was less tender and had more flexibility. Also! Finally! I could apply a little more power and lower the frequency of the treatment settings and she did not flinch hardly at all. In fact, we had a lively conversation while I was applying these treatments to her foot. So, you could tell she was definitely improving... and just in time for she and her husband's annual Hawaii vacation starting that weekend.
At the end of each treatment shockwave treatment, time permitting, I usually massage the treated area with a prescribed combination CBD cream (EB-C4; THC-Free Cannabidiol 3%; Myrcene 3%, Beta Caryophyllene 3%, Arnica 2%, MSM 2% in HRT Heavy Transdermal Cream - by prescription from EBM Medical, Chesterfield, MO). I was a massage therapist 30 years ago so there’s usually a couple of minute massage of the treated body part at the end of the shockwave treatment after applying this cream.
Again, shockwave therapy is not "electric shocks" being administered. These are pulsed sound waves delivered in a radial or focused fashion (two devices) and then in another room pulsed electromagnetic fields (EMTT) are applied to the area, in this case the feet.
Shockwave therapy stimulates a "healing response" to the "injured" or "damaged" tissues and improves growth factors and substances that build new blood vessels. If you improve blood flow (circulation) to an injured area healing will follow. Technically both types of shockwave therapies have been shown to stimulate:
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
The EMTT (electromagnetic transduction therapy) I usually do after the two above treatments (or it can be done as a standalone treatment) in another room for 5-15 minutes.
This technology is an "upgrade" on PEMF (Pulsed Electromagnetic Fields) which are selected low-frequency electromagnetic fields without an ionizing or thermal effect. PEMF is effective and safe for the treatment of bone fractures and nonunions. EMTT has higher oscillations which allows it to go deeper and provides more magnetic field strength. Some of the physiologic effects of PEMP and EMTT are:
1) Up-regulating anti-inflammatory adenosine receptor A2A and A3.
2) Reducing PGE2 and pro-inflammatory cytokine IL-6 and IL-8 and inhibiting factor NF-kB
transcription in human chondrocytes and osteoblasts.
3) Increased proliferation and enhanced osteogenic differentiation of mesenchymal stem cells
(MSCs) isolated from human bone in several in vitro studies.
4) Stimulate activity and differentiation of specific cell cultures of the musculoskeletal system.
5) PEMF devices are approved by the FDA to fuse broken bones, reduce tissue and joint pain
and support muscle function.
6) PEMP doesn’t have inadequate electromagnetic field power and is missing dynamic oscillations.
7) Electromagnetic transduction therapy (EMTT) is a promising new technology of a treatment
based on PEMF with magnetic field strength between 80 a nd 150 mT and oscillating frequencies
of 120 Hz of each impulse. EMTT acts via electromagnetic transduction. Impulses are emitted by
a high-speed generator to build up a voltage up to 30 kV which is released in nanoseconds and an
impulse release frequency of 3 Hz. The very short duration of each impulse ensures full
electrophysical reaction without any temperature increase in the tissue.
8) Electromagnetic impulses can stimulate osteoblast growth activity; neovasculogenesis; growth
factor release; improve blood supply to the treated area.
9) Studies have shown benefit of EMTT for low back pain, rotator cuff tendinopathy, osteitis pubis
(groin pain), bone stimulation therapy for scaphoid nonunions and Achilles tendinopathies.
In general there are very few tendon, ligament, muscle or joint problems where these technologies cannot be applied. While people can feel better immediately the full treatment is usually done over 6-8 weeks. Also, the healing response and release of these healing factors can continue for months. I remember at one conference listening to some very successful podiatrists that use these devices. They might do initial treatments of 4-8 weeks then tell the patient to go out and contact them 10 weeks later and the pain is gone. Sometimes the patient doesn’t even realize that all of a sudden there is no more pain. So patience is necessary for these therapies in the long-term. Usually there is enough pain relief or improved function in those first 4 to 8 weeks to get the person functional and get them through the whole treatment program. Point being the healing process that is started during the treatment phase continues for 2-3 months after the treatments end.
I initially see patients for an hour to go over their medical history and do an examination to plan
their treatment. The treatment sessions are usually a half hour and cost ($175-200). If there is more than one area then there will be appropriate charges for the 45 or 60 minutes visits.
If you want to call the office and make a 15 minute FREE phone appointment with me we can discuss if you are a good candidate for these therapies to address your pain problem or personal situation. I am happy to do that. I want your treatment to be as successful as you do. Call 916-489-4400 and make an appointment to see me (1 hour) or for the 15 minute free phone consult.
Lastly, I always talk about diet with pain patients. Diet can lead directly to pain and inflammation. Being overweight not only puts added stress on your joints, tendons and muscles but fat tissue is releasing inflammatory compounds that are aggravating your pain. You can start very simply by eliminating all dairy products, wheat products and eggs for at least two weeks and also eliminate all processed foods. It would not be a bad idea to be off alcohol during the treatment period as well or the time you are trying to heal. You want to know if and how much diet effects your pain. It sometimes can be dramatic like 80-90% of the patient’s pain disappears with diet change.
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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