This is a two part blog and in the first part, we’ll discuss how true shockwave therapy works.  The second blog will discuss what we use it for and why true shockwave therapy is known to recruit stem cells to facilitate healing.  The first blog will be more technical than the second.

Please note that you do NOT need to be a patient to benefit from the StemWave or SoftWave.  You can simply make an appointment for shockwave therapy.  This also applies to Hbot and NormaTec.

In our previous two blogs, we discussed how hyperbaric oxygen therapy (Hbot) and NormaTec help with recovery and healing.  The evidence that Hbot can elongate telomeres, leading to greater cell function and a true anti-aging effect, is nothing less than amazing.  These above two referenced interventions constitute the first two prongs regarding how we go about tissue regeneration.  Now it’s time to introduce the third prong of this approach.

Before we proceed, we don’t want to anyone to misunderstand.  Healing and recovery are a very important focus for us at Columbia Advanced Chiropractic, LLC.  Dr. Manison has spent over 2 decades learning and applying the best techniques in the field of manual medicine and rehabilitation.  He does so in order to best help his patients obtain the greatest likelihood of recovery from a plethora of neuromusculoskeletal conditions.  However, aiding with recovery and healing are different from actual tissue regeneration, and this is the future of medicine.

As one who likes to be cutting edge, Dr. Manison is interested in anything that aids tissue healing and regeneration.  Working to help a patient heal from the inside out is the main focus of chiropractic, and using modern technology to help the body truly heal from a stem cell level to deliver unmatched results is what

Dr. Manison is now able to do.  Dr. Manison was so intrigued by the research shockwave therapy (ESWT) that he wrote the letter to the State Board of Chiropractic Examiners of Maryland to get both StemWave and SoftWave approved under the chiropractic license.  He is very thankful that they did so.  Now, the ability to help patients in a way they could never be helped before is a reality.  This is very, very exciting!

We know the technology is not easy to understand, but we do want our patients (and potential patients) to have access to information that explains a good part of the science behind ESWT and how it is unique from other types of wave therapies.

How StemWave and SoftWave shockwaves are created

Electrohydraulic Shockwave Therapy delivers shockwaves through a high energy electrical discharge in water.  The voltage is discharged between the opposing tips (plus and minus pole) of an electrode.  The spark creates an equalization of voltage between the two tips of the electrode and then a plasma bubble is created.  This bubble implodes, then explodes, compressing the water around it, and generates a pressure of about 100 MPa within 5-10 nanoseconds.

This form of shockwave is electrohydraulic in nature (the other forms of shockwave production are electromagnetic and piezoelectric, but they are more-so focused pressure waves vs. true shockwaves). The low to mid-intensity energy is then delivered through an applicator head in the form of either focused (StemWave) or parallel/unfocused  (SoftWave).  This allows for energy distribution that is able to be used for superficial and deep penetration to aid in healing.  Despite the speed of the  shock wave, it does NOT create  any micro trauma. 

Ultrasound Waves

As a comparison to other forms of sound therapies, ultrasound (see right) does not create shock waves, but rather periodic oscillations with no peak pressure or fast rise/drop times.  Radial pressure waves have a low steeping effect and slow rise time.  They are not true shock waves. Even electromagnetic focused shock waves  have been shown to not meet the true definition of shock waves.  

A true waveform for an ESWT is pictured to the left.  True shockwaves are composed of 3 distinct phases:
1.  Acoustic pulses with high positive pressure (up to 100MPa)
2.  Fast and steep rise time
3.  Comparatively small negative pressure (tensile wave).

Radial pressure waves (pictured to the right) are acoustic pneumatic pulses with a low steeping effect, slow rise time with comparatively large negative pressure (tensile wave).  The waves are shallow and have the highest energy and pressure located directly at the applicator’s surface.

These types of waves are superficial, meaning, they only penetrate a centimeter or two below the surface of the skin.  Although research shows radial pressure waves are a good treatment approach for superficial applications, their  lack of penetration does not allow them to be useful for deeper conditions.  Whereas radial pressure waves penetrate a little over 2 centimeters, acoustic shockwaves can penetrate likely well beyond 9 centimeters.  In addition, radial pressure waves create microtrauma whereas true shockwaves do not.

Focused shockwaves allow for directed, deep penetration.

When we look at the deeper penetration ability through ESWT, there are two types for this application.  They are focused and unfocused shockwaves.  Following the plasma bubble creation that occurs with both, there is a generalized radial wave of energy (implosion) that is immediately followed by a shockwave (explosion).  This energy is then directed outward in either a straight or focused direction forward (applicator head shape dependent).  

Focused ESWT is the best way to achieve the deepest penetration and address the most particular needs.  It works through an  hourglass type configuration (see white pattern in diagram to the right and below).  It has a convergent beam that will concentrate several centimeters into the body, and then it diverges and continues to penetrate.  This demonstrates less impedance for the focused beam as it penetrates into the body. Focused ESWT is best when specific areas of tissue damage are identified through evaluation/imaging.  Being it allows for more specific treatment, the more accurate the diagnosis, the better the treatment.

Unfocused, on the other hand , uses a wide flashlight-like beam that is better suited for more superficial and less specific applications.  To penetrate deeper, it requires more energy as it needs to pass through more tissue impedance/resistance.  Recall that focused shockwave converges, thus cutting out a lot of the unnecessary peripheral areas.   

Regarding comfort, both StemWave focused ESWT and SoftWave unfocused ESWT are quite comfortable, unless too much energy/intensity is used.  Pain is not an indication of treatment success in any way.  As long as the shockwave energy is getting to the desired tissues, the therapy will work as intended.  StemWave focused shockwaves tend to be a little more comfortable vs. unfocused SoftWave as the shockwaves are going to a more specific, targeted point.  In essence, it takes less energy as the beam is more specific.  StemWave is considered to be Area Directed Therapy.  SoftWave is better for larger, more generalized regions.

What we can extrapolate from this information is that StemWave and SoftWave both offer true shockwaves that aid the body unlike anything else. They both allow for adequate penetration to target most any structures that need regeneration.  The effects not only aid in reduction of pain and inflammation, but also in activating mesenchymal stem cells to do what they do best….regenerate damaged cells.  This is how we help the body regenerate from the inside out!

Please look for the second part of this blog.  That blog will will cover the uses of StemWave and SoftWave…and more!

*Images in this blog are from the SoftWave website along with Shockwavetherapy.org.

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