Ep. 10: Shockwave Therapy

Hey everyone, welcome back to the NJRI channel. It’s Dr. Jay Bowen here!

Dr. Jay Bowen, DO big across screen then go to bottom left corner for the remainder of the blue text. NJRI logo bottom right for the whole video.

I’m an Osteopath or DO and a Board Certified Physiatrist, and today, I’m going to be talking about Shockwave treatment! This is the fourth video in our series, “The Good, The Bad, and The TRUTH About Regenerative Medicine.

Last week, I discussed BMAC, and before that I discussed PRP and MFAT. You can click right here to watch those videos. Today, the focus is all about Shockwave therapy. If you’re enjoying this series, please support us by hitting that LIKE button and subscribing so you won’t miss any of our upcoming videos!

So, what exactly is Shockwave therapy? First off, it’s not electrocution (kind of chuckle with this) I get that question sometimes! [or not and people just want to leave – haha]. Shockwave therapy in the United States actually has its roots in the early 80s, where it was first used in a completely different field—urology! Back then, the technology was adopted to perform lithotripsy, a non-invasive method of breaking down kidney stones using focused shockwave or acsoutic energy. This was a revolutionary approach, as it replaced the need for invasive surgery and allowed doctors to target the stones directly without damaging surrounding tissues. As research progressed, medical experts began to realize that these focused shockwaves could do more than just break apart kidney stones. They saw that the shockwaves were also having beneficial effects on nearby tissues, promoting healing and regeneration at a cellular level. This sparked the idea that shockwave therapy could be applied to musculoskeletal issues, and by the late 1990s and early 2000s, it began to be tested for treating orthopedic conditions like tendinosis, plantar fasciitis, and even delayed bone healing. As with all our treatments, we use DataBiologics to monitor patient outcomes and improve our understanding for what Shockwave is best used for and understand realistic outcomes to inform our patients.

The science behind shockwave therapy is fascinating. Essentially, the high-energy pulses create microtrauma, or controlled damage, to the tissues.  This sounds bad, but when you exercise you are actually causing muscle damage and then your body will repair it better and stronger.  With shockwave, the sound stimulates the body’s natural healing process, increases blood flow, and releases growth factors. Over time, the approach evolved, and more refined devices were developed to precisely deliver these energy pulses to areas that need regeneration.

Now, fast-forward to the present day, and shockwave therapy is becoming a popular tool in regenerative medicine. However, it’s important to note that it’s not always done the right way. Some providers may use low-quality devices or improper techniques, which can limit the effectiveness of the treatment. That’s why it’s crucial to distinguish between the different types of shockwave therapies available.

There  are two main types of shockwave therapy, and this is really important to differentiate: radial pulse wave and true focused shockwave.

Radial pulse wave isn’t technically a shockwave. It uses a sinusoidal wave and, while it can still give some good clinical outcomes, it’s not the same. Think of it as more superficial, like what we use for soft tissue or muscle pain. This is commonly used in athletic training rooms for quick recovery or muscle knots. This type of wave is best for myofascial injuries.

For example, if a patient has tennis elbow, we might start with radial shockwave therapy to address the muscle tension in the forearm, and then follow up with PRP at the tendon insertion to maximize recovery. After that, we might add a couple more shockwave sessions to promote healing by addressing the surrounding tissues.

The other kind of shockwave is true focused acoustic or sound energy. This is best for more serious bone injuries. True focused shockwave therapy delivers a high-energy pulse over a short duration, with a key characteristic called “negative deflection”. This essentially means the wave not only pushes energy into the tissue but also creates a suction effect, stimulating cellular repair and regeneration deep within tissues. Because of its power and precision, it’s especially effective for addressing deeper issues like bone injuries, fractures, or delayed healing. However, it is also beneficial for tendons and bone breakdown under damaged cartilage. 

In other countries, particularly in Europe, there’s greater availability of devices that can deliver true focused shockwaves at the necessary energy levels. These machines are typically more advanced and have been used for decades in regenerative medicine, especially for musculoskeletal conditions. However, in the U.S., the availability of these advanced devices is limited due to several factors, including FDA regulations with approval process for new medical technologies, but mainly the cost of the machine and that most insurance companies do not cover the treatments. This is some of the “bad” of shockwave in the US.  However, there has been some recent traction and we are seeing more clinics obtain the devices, which is super exciting!

To deliver focused shockwave there are 3 technologies: electrohydraulic, electromagnetic , and piezoelectric.

The electrohydraulic devices generally deliver a higher energy that translates into a painful treatment that is often performed under anesthesia and the machine and supply cost it higher despite only needing one treatment.  Electromechanical devices potentially offer the same benefit with less pain, no need for anesthesia, and can be performed in the office, but this will require a series of treatments.  This is usually delivered weekly for 3-4 sessions.

Depending on the problem, true shockwave may be performed in isolation, with radial pulse wave or EPAT as some reference it, or complement a cellular regenerative treatment such as PRP, MFAT, or BMAC.  That’s why it’s important to understand the difference when choosing a provider, as some clinics might offer ‘shockwave therapy’ but are actually using devices more suited for superficial treatments like radial pulse wave.

At NJRI we have radial pulsewave or EPAT as well as true focused shockwave devices to use to best address one’s issues or a combination of the modalities.

Now, the cool thing about this treatment is that no anesthesia is required. It’s all about patient comfort. Pain can be rated from 0-10 with zero being no pain and 10 the worst imaginable.  We typically keep the intensity between a 3 and a 5 on a discomfort scale, making it tolerable for patients. We do this once a week for four weeks, and patients usually start feeling better around week 3. If you don’t like needles and you have the time to do 4 in-person visits this is a GREAT treatment option for you.

What I love about shockwave therapy is that it works by stimulating the body to heal itself. Even though most people don’t think of it as a regenerative treatment, it actually is! Plus, no needles involved – a big win for many people.

Now, for the good, the bad, and the truth about Shockwave therapy! 

Let’s start with the good!

Like I mentioned earlier, shockwave therapy stimulates your body’s own healing processes. It’s non-invasive, and there are no needles, which makes it appealing to a lot of people and no pain after the session. The downside is that it can be time-intensive and there is some discomfort during the treatment . You’ll need to commit to four weeks of treatment, one session a week. So, when planning for this treatment you need to prioritize consistency of treatment to see the best results. If you choose to pursue shockwave treatment at NJRI, the good news is that we are a small practice and have the flexibility to accommodate your schedule.

Now, finally, the “TRUTH” is that shockwave therapy might not be widely seen as regenerative, but when done right, it’s a powerful tool for healing. I believe that shockwave unleashes your intrinsic ability to heal, which is why I offer it. Whether it’s bone or soft tissue, this treatment can make a real difference for patients when used properly!

So, that’s a wrap on shockwave therapy! If you’re interested in learning more about regenerative treatments, don’t forget to check out the other videos in this series.

You can also give my office a call to schedule a consultation and find out if shockwave therapy is right for you! I’d love to meet you and talk about how we can help you unleash your intrinsic ability to heal. As always, thanks for watching.

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We have some fun reels and shorts we’ll be rolling out over the next few weeks. Thanks for tuning in, see you next week when I’ll be discussing the controversial topic of stem cells!