Deliver waves directly to the affected area of the body
Class IV laser has been my go-to therapy during my 42 years in practice. Throughout my career, I have continually looked for methods to improve patient outcomes, increase the clinic’s profitability and support my desire to help patients live up to a higher potential.
I treat some of the top musicians and bands in the world with my laser and feel this is still the greatest therapy for my patients. However, as mentioned, I want the best results for my patients, and I often use a combination of both Class IV laser and acoustic shockwave therapy side by side.
An acoustic wave or often-called shockwave is a noninvasive treatment that uses a generated acoustic wave to stimulate healing, promote tissue regeneration and relieve pain. Acoustic shockwave works by delivering waves to the affected area of the body. These waves generate mechanical pressure, which can stimulate the body’s natural healing processes, increase blood flow and break down scar tissue. acoustic shockwave therapy is commonly used to treat conditions like plantar fasciitis, tendinitis, calcific shoulder tendinopathy, low–back pain and other musculoskeletal conditions.
Acoustic shockwaves are generated in several different ways, and it is debatable if one method is more effective than another. These waves travel at extreme speed through tissue to the targeted area. When the acoustic shockwaves reach the targeted tissue, the waves create mechanical stress and microtrauma. These mechanical stimulations trigger several biological responses to the body, including:
Neurovascular: Acoustic shockwaves stimulate the formation of new blood vessels (angiogenesis). This improved blood flow helps with tissue repair and regeneration.
Cellular effects: Mechanical stress from the waves can activate certain cellular signaling pathways, leading to increased production of growth factors and cytokines as well as stem cell proliferation.
Pain reduction: Acoustic shockwave therapy can have an analgesic effect by inhibiting pain receptors and reducing inflammation.
Breakdown of calcification: In certain applications, such as when treating calcific shoulder tendinitis, acoustic shockwaves can break down calcified deposits, making them easier to eliminate or reabsorb by the body.
Acoustic shockwave therapy should never be confused with ultrasound therapy. Ultrasound produces inter–tissue heat by vibrational stimulation of the cells. As mentioned earlier, the mechanism of acoustic shockwave is by high–velocity sound. One can imagine how this works by throwing a rock into a pool of water and watching the corresponding waves produced.
There are many ways to produce an acoustic shockwave, and it has not been proven that one method is superior to the other.
The first method is electromechanical, where a “bullet” hits a striker plate which in turn produces the acoustic shockwave. The intensity of the wave can usually be increased with a simple adjustment on the base unit as can the impacts per second or Hz. Power is measured in m/J or milli joules. Certain patients can tolerate more intensity than others.
Some units use a piezoelectric method, meaning a small electrical discharge is produced in a medium in the head of the unit, which in turn produces the corresponding acoustic shockwave.
There are also two other methods, pneumatic, meaning air is used to produce the acoustic shockwave, and hydroelectric, when water pressure is used. As mentioned, it has not been proven one method is superior over the other in creating the acoustic shockwave.
It should be understood that notwithstanding the method of creation, an acoustic shockwave will be extremely similar no matter how it is produced. There is no such thing as an “exclusive type” of acoustic shockwave or one that is proprietary. An acoustic shockwave device must produce a high–velocity wave; it is just the method of obtaining it that varies from manufacturer to manufacturer. Certain machines do allow more flexibility when it comes to the number of impulses per second and m/J of energy delivered. The DC needs to find that special unit that satisfies the clinical needs and yet meets his or her ability to pay for the cost of that particular unit.
My clinic started using a combination of acoustic shockwave therapy and Class IV laser as a one-two punch. Initially, we started using acoustic shockwave for plantar fasciitis followed by Class IV laser. When we marketed this combo therapy, we had 44 new patients in one week; a couple even came from a podiatrist’s office. Compliance was fantastic and many stayed for treatments on other areas of concern they had. By the time I retired, we had transitioned into a 50% laser and acoustic shockwave clinic only.
One thing that makes acoustic shockwave therapy so useful is that unfocused acoustic shockwave therapy allows you to treat over a larger area, even more so than laser, and this is a great benefit when treating musculo-skeletal injuries.
A new piece of equipment should never be added unless two caveats are met: will it help my patients and can I make money using it? My clinic charged $40 for acoustic shockwave therapy or Class IV laser. If we did both therapies, the price was $60, and this was in a small Missouri farm town and this therapy was paid for at time of visit as these therapies for now are non-insurance reimbursable. Other locations can easily get $50 to $100 per session for one therapy alone. To say the least, return on investment can be very fast and profitable.
One exciting new piece of technology that has surfaced in a few of the acoustic shockwave therapy machines is those that focus on low–impact (m/Joules), low–impulse cycles (Hz) per second settings. These machines keep the science of acoustic shockwave therapy present but with different and less aggressive treatment protocols. One major difference between the new softer protocol machines and the more powerful units is the soft units do allow you to go over superficial bone and joints, where the stronger units can produce a bit too much power and be painful over bone due to vibration of the periosteum. This is a big advantage in some treatments. However, certain conditions of deep tissue or muscle origin may benefit more from a stronger treatment cycle. If you decide to purchase an acoustic shockwave machine, it would be beneficial to find one that does both soft and stronger protocols.
Final thoughts
Acoustic shockwave therapy is a fantastic treatment modality that is easy to use and can produce excellent clinical and financial rewards. It is always an attended therapy. Like any piece of equipment you may want to purchase, make sure that equipment will do what you want, fit it into your practice and start getting results. Also, make sure you can afford the investment. When you purchase the right acoustic shockwave device for your practice, you will experience greater healing results as well as greater financial benefits.
GARY HUDDLESTON, DC, is the founder of Medray Laser and Technology. Besides building the Medray Class IV laser, Huddleston just designed the Medray Softshock, an acoustic shockwave therapy device that combines both stronger and lighter treatment protocols. Huddleston works exclusively in the professional sports and music industry. He can be reached at 573-745-1086 or drg4000@att.net.
