I have been doing shockwave therapy since May of 2020 (EPAT) and have used pulsed electromagnetic field therapy (EMTT) since January of 2022. They go hand-in-hand to help your body heal itself. The former stimulates a healing response, reduces pain (substance P), enhances new blood vessel formation, breaks down fibrous tissue and stimulates stem cells. The latter opens up ion channels and "resets" the cell, like when you reboot a computer so it can optimally function. I and other regenerative practitioners use these modalities together. Some physicians also use biologics (prolotherapy, PRP, stem cell injections, etc.) with EMTT and EPAT.
Since I work in a general practice I use these technologies for just about anything and everything. Joint pain, tendinitis, ED, frequent urination, neuropathies, sprains and strains, etc.. Just Google "Pub Med shockwave and whatever problem“ you have and see what comes up in the National Library of Medicine. There is a lot. With that said shockwave therapy is a bit of an art form. Everyone does it a bit differently. There is not an absolute protocol for every condition. You learn by reading the science, watching and listening to others who have seen and done a lot, and then experiment on what works in your hands. The really good thing about shockwave therapy is that there are very few side effects.
Many times I will say shockwave or EPAT there is like a "tsunami." You have that initial burst of the energy wave like from an earthquake let's say and as the wave goes through the water, underneath the surface it is stirring up the sand and biological life to create new life. Shockwaves do that by stimulating your body's own healing mechanisms.
Can shockwave "cure" a problem? Yes and no. You can do it for plantar fasciitis let’s say. It feels 80% better by the end of 6-8 treatments. Then 2-3 months later it is gone. Then it comes back months or a year later. Was it cured? Yes, and no. As long as people keep living and getting older, the biology of aging which includes inflammation continues at varying rates depending on how you take care of yourself, eat, exercise, take supplements, etc... Ailments may return, maybe at a lesser intensity and shorter duration. Just think about it. Those of you 40 and above does your body heal as fast and completely as when you were 15-20? So that is why lifestyle is so important in any therapy, especially therapies that stimulate your own healing response.
Mechanisms of Shockwave Therapy and EMTT include:
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 two biggest things I have learned from doing shockwave and studying under others who have more experience is that 1) Less (treatment) is more and 2) your final healing result won't be at the end of your 4-8 weeks of treatment but 10-12 weeks after that. I keep getting individuals saying after 10-12 weeks the problem just disappeared. That still catches me off guard but now it is easier for me to believe... the healing response continues after the treatment is done!
Here are Some Quick Cases Showing How I Approach Different Conditions...
#1 Sudden Calf Strain in 72-Year-Old...
A 72-year-old male comes in with a black and blue (ecchymosis) calf limping. He was doing some stretches, calf raises and squats without straining, and his leg gave out and he had a sharp pain in the back of his calf...and it was all black and blue when he came in and he had limped considerably. Immediately after the first treatment (EPAT/EMTT) as he was waiting to pay the bill, he said his calf felt much better. He came in one week later and all the black and blue areas were gone, and he was walking with a minimal limp. He has had four sessions on his calf (45 minutes) and he feels almost normal with no visual signs of swelling or black and blueness on his lower leg.
Comment: This was a simple injury that would eventually heal anyway. Little doubt in my mind and most importantly the patient who is paying the bill that it happened quicker with the treatment, and he is glad he did it. This individual was a farmer. After the initial injury he fell several times in the field just walking on uneven ground because his leg "gave out." So, getting him back to normal quicker wasn't just for the pain but to improve function and protect him from falling.
#2 Preventive Treatment for Knee Arthritis for Hike in the Italian Alps...
A 74-year-old male avid hiker had an original series of EPAT/EMTT therapy over 2 years ago in March, 2021 for bilateral knee arthritis came in prior to going on an eight-day hike in the Italian Dolomites with his 37 year old daughter. After his original series he periodically comes back for 1-2 preventive treatments before long hikes of several weeks (i.e., Death Valley, Eastern Sierras, etc.). His knees have remained mostly pain free. Occasionally he will feel them when he is walking downhill. This time he came in for a 1 hour treatment of both knees using the focused and radial shockwave devices for 15 minutes on each knee and then 30 minutes on the high frequency pulsed electromagnetic fields (EMTT) 15 minutes on each knee. He wasn't in pain when he started but it is worth it to him to come in for preventive treatment for an hour ($300/hr, $250/45 min, $200/30 min) before his trip. It is nothing I "twisted his arm " in doing.
Comment: It makes sense for "specialty athletes" to do preventive type treatments. Especially when you are 74 years old and have had a condition under control. Yes, you could take ibuprofen or naproxen during his treks but if you use those medications chronically they can eventually wear the mucus lining off your gut and increase gut permeability increasing the likelihood of more inflammation. This patient knows the cost of the treatment but it is worth it to him to do this prior to doing his passion of hiking.
#3 He Forgot He Had Heel Pain
A 49-year-old crazily busy small business owner came in for a follow up on lifestyle issues who had originally 8 EPAT/EMTT treatments for heel pain and notice his pain was 95% better but hadn't been seen in 2 months. He wanted to get two more weekly treatments to try and get rid of the pain totally. Two months later he comes in and relates all his other physical woes (weight, hypertension, pre-diabetes) and stresses are still there but said he had completely forgotten about his heel because there was absolutely no pain. His blood pressure, weight and blood sugar are not getting better and I am getting after him for these issues.
Comment: This is a case where the problem disappears well after you stop the treatment. It is very common. I tell the patient that the healing process triggered by the EPAT/EMTT therapy continues 10-12 weeks after you stop the treatments. True biological healing takes time. We are speeding up the process with EPAT/EMTT therapy.
#4 "Buzzing" and Burning of the Shoulder, Head and Neck
A 74-year-old female comes in with her husband who is getting shockwave for knee and heel pain and says she has had this buzzing, burning nerve sensation from her shoulder blade up that side of her neck, face and around her left ear. She asked if shockwave would help. I said I'd try EMTT therapy first (pulsed electromagnetic fields). Couldn't hurt. It's a gentler, simpler and a less costly treatment than EPAT and sometimes can help a problem considerably all by itself. At the second treatment she noticed the intensity of this "weirdly" described sensation being definitely better. At her third visit of just EMTT (25 min of pulsed electromagnetic fields, $120) she noted it to be unquestionably less intense but still present.
Comment: We will continue for 6-8 treatments. I am not totally sure what we are treating. If it continues to improve, we'll keep treating. If it gets worse, then we'd do a furthe r workup. EMTT resets the cells ion channels enhancing cell membrane function. It can be used as a standalone. In this case it seemed to "calm or quiet" this "nerve" sensation.
#5 Right Knee Improving and Left Heel Pain/Bone Spur Not.....Yet...
A 74-year-old male with right knee and left heel pain returns after he had 6 weekly treatments on his right knee from 11/29/22-1/9/22 and felt a very positive improvement in pain and swelling reduction. He also took some nutrients for inflammation (Joint Formula, Thorne) and Freedom (blocks inflammation). He also had some serious gut issues which we worked on. Five months later he wanted to repeat some treatments on his knee. He had also seen a podiatrist who had given him orthotics for his left heel pain which was believed to be a bone spur. His right knee has improved over 3 treatments, but his heel spur pain is the same after 3 treatments.
Comment: There are a few issues with this patient this time around. 1) I don't think his diet is as good. I see some inflammatory skin changes that would indicate his gut may be off again which can increase joint pain. 2) Though he has had improvement in his knee I haven't evaluated it with any types of basics like an Xray and MRI which I think I will do to see what actually is happening inside the knee. Doing treatments at the same time is no problem. The supposed heel spur (pain) hasn't improved in 3 weekly treatments. I also am not sure he is taking the same anti-inflammatory supplements. I am not worried though. It has only been 3 treatments. A bone spur is not going to dissolve in 2-3 weeks. I believe that this will be a case that we'll do 6-8 treatments and lay off for a few months and see greater improvement at 10-12 weeks after we stop the treatments. This patient is also older so metabolic changes make take a bit more time.
#6 Left Heel Pain - Plantar Fasciitis - Resolves Quickly
A 31 year old very fit male who was originally seen on 3/27/23 for left medial heel pain diagnosed by a podiatrist with acute left plantar fasciitis 6-7 months ago came in. He was prescribed a walking boot which he used for 2 months a couple of hours per day. He wore a night brace which helped a little. He had a job where he walks extensively about 5-6 mile per day for almost the last year. He had tried acupuncture and Bowen therapy (12/22-2/23). The latter helped a lot. He has had two arthroscopic left knee surgeries. He had PRP on his knees 3-4 times with great results in the past. Since late 2021 he has training for special operations for the military but his knees had kept him out of the service. He has put on 20lbs of muscle in 2 months doing body building. Over the last 2-3 months he has had weekly EPAT/EMTT therapy on his left heel. Since it is a focal, simple area, the left heel, the total treatment session was a half hour each. 15 minutes of EPAT/shockwave therapy with the focused and radial devices and 15 minutes of EMTT where he just lays down and "chills". Many people take a snooze with EMTT. He had 6 weekly treatments over the last 2 months, and he has noticed a dramatic 90% improvement in his heel pain and function. I told him to take 3 weeks off and come back. He said he then said it is about 95% gone with a little heel pain after a long day at working walking. He is sprinting, pushing a weighted sled and is lifting heavy weights and walking 5-6 miles per day at his job. He is preparing to take his entry military performance tests next week of running, swimming, push-ups, pull-ups and sit-ups. We did another treatment today and will do one next week then lay off for month.
Comment: There is a lot of things in favor of this young man getting well fast. 1) He wants it. He wants very badly to get into the military and his heel/plantar fasciitis could get in the way. 2) He works out a lot. He has a body builder type body, and he does a lot of aerobics. 3) He has youth on his side. Young people heel faster and have less prior damage and physiology to overcome. I will see back again in 1 week and then send him out for month or two. There is a little bit of time urgency because of his great desire to get into the military soon to treat him as quickly and completely as possible.
#7 Low Back Pain from Car Accident Plus Caretaking and Grieving...
This is a 61-year-old female who rear-ended someone and there was no release of the airbag but there was no immediate back pain either. Then six weeks later she developed lower lumbar back pain. She was given an MRI by her HMO. Before the MRI was done, she was also put on oral prednisone. There was no benefit. Afterwards the MRI showed an extruded disc at L4-5 on the right side. She decided not to do a spinal injection and "toughed" it out. She was off work for six months. She couldn't sit for a year. Then several months ago she got up suddenly from laying on the floor and she had a flare-up on her right lower lumbar area. Egoscue exercises a half hour daily helped a lot. She's not doing many aerobics. She is a dancer and when she dances that helps her back tremendously (and her spirit). Initially six months ago she did a series of 6 EPAT and EMTT combined treatments then four EMTT only treatments. She was somewhat better after but not dramatically so. She decided to go back and do her back exercises, go dancing, increase her adrenal support and possibly take some low dose SAMe because she was taking care of her mother who had a terminal illness. Four months later she was seen after her mother had passed and she wanted to try another series of treatments and this time I was able to find a location to really focus the shockwave at her left lumbosacral area which for whatever reason I was not able to find in the previous treatment series. There was immediate relief after the first treatment. So, with this in mind I tried to focus on that area around the L4-L5-S1 area on the left side. We are on the third treatment in the second series and she distinctly notes some improvement and reduction in pain in the left lower lumbar area.
Commentary: While there is a distinct location that seems to have brought some immediate improvement in t hat left L4-L5-S1 area I also think that this person's pain is aggravated by going through a long-term caretaking experience with their mother who recently passed of cancer. This is a type of individual that needs adrenal support, energy support and good therapy. Also, I think it is critical for her to continue her dancing and get out there at least two, maybe three nights a week and dance along with some gentle yoga two times a week. I know this person who was a competitive dancer would feel much better in spirit and body if she went out and did one of life's passions more frequently. Backs "love" movement and when done in a kind of controlled dance setting it can very healing and health promoting. Now if she had said, "Every time I dance my back hurts" then I would tell her find some other way to move. But every time I ask her how she feels after dancing she says she feels great (in body and spirit). So that's this health prof essional's prescription for this person. Also, along with time, dancing will help this person’s spirit transition through her mother’s passing. Dance, Egoscue and yoga maybe in conjunction with these regenerative therapies (shockwave therapy and EMTT) along with some simple nutrients (especially adrenal support) and a good diet may go long way in helping this back pain situation resolve or become manageable.
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Be Well,
Kirk
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