Acoustic Pulse Wave Therapy
INNOVATION
Christian Reichardt
Acoustic Pulse Wave Therapy — Bridging the gap between conservative care and surgery in the chiropractic office!
Sometimes a new modality arrives in the conservative treatment world that can actually alter the way we perceive what we can accomplish in the clinic setting.
Acoustic pulse wave therapy (APWT) is such a modality! Sometimes also called acoustic shock wave therapy (ASWT), it is still a relatively novel therapy here in the US. It has been used very successfully on thousands of patients primarily in Europe and Canada for the past 25 years.
A worldwide organization of acoustic pulse wave manufacturers, researchers, and practitioners sponsors more research and sets up recommended treatment protocols. The technology has also had a huge impact in the veterinarian application, particularly in the area of horse racing, an industry notoriously plagued by injuries to the ligamentous structures of lower extremities.
The clinical advantages of this treatment modality aie tremendous. It is noninvasive, time efficient, phenomenally effective, and has no side effects. The technology is designed to expedite recovery from most damaged tissue injuries without surgery and without the use of anesthesia or prescription drags.
In fact, it is so effective that all of my patients who were scheduled for surgeries for plantar fasciitis have opted for a short series of APTW treatments instead, and with phenomenal results. The most common reasons why the patients opt for a series of treatments are less downtime, less pain, and less cost.
Here is how I explain the technology to my patients who want to know what the therapy is and how it works:
Shock waves or sound waves accompany our daily life
without being noticed very much. The basic concept of AS WT is that sound wave energy can be broadcast over long distances if unobstructed. The best way to think about it is to consider how sound travels through any space. As long as it is unobstructed, it keeps traveling. Once the sound wave hits a solid object, it bounces off, like sonar pings in submarines.
When an airplane breaks the sound barrier, it generates a very loud bang that can lead to the jingle of glasses in a cupboard several hundred miles away. The shock or sound wave has transmitted the energy from the airplane to the glasses. Acoustic pulse waves act very similarly. The sound waves generated by the treatment head travel fieely and unobstructed through supple and healthy tissues. When the sound wave hits different tissue densities in the body (e.g., hardened, sclerotic, and rigid tissues of old injuries), these tissues become an obstruction and the sound wave will bounce off of it. This process actually creates a local microtrauma, literally breaking down the sclerotic layers. So acoustic pulse wave therapy is really a noninvasive treatment solution that uses high-intensity sound waves (or acoustic pulses) that interact with local tissues.
The treatments actually help stimulate the body’s natural, self-healing process by temporarily increasing local blood circulation, relieving minor muscle aches and pains via endorphin release, and by raising the body’s pain threshold.
Research has shown that some of the benefits and effects of technology are relaxation of muscle and connective tissue; improved microcirculation; acceleration of metabolic activity and therefore accelerated repair of chronically painful tissues; heightened local neurovascular performance; and increased serotonin hormone release. The more long-term results are significant stress reduction because of lowered cortisol levels and overall revitalization due to a return to better function-
ality, following a patient’s completed course of treatment.
When looking at the previously mentioned results, it is clear how well this therapy can integrate into the chiropractic office, particularly in the arena of chronic pain and reduced functionality. Many of our chiropractic patients with chronic pain issues suffer from hardened, sclerotic tissues, and this is where this therapy works best.
In my office, we have had incredible results on people with frozen shoulder syndrome, chronic Achilles tendinitis, planter fasciitis, long-term meniscus problems, carpal tunnel syndrome, and myofascial trigger points.
I think you get the picture—the type of conditions that often respond well to conservative care but aie challenging. It often takes a tremendous amount of care, treatment time, and effort because of the amount of hardening of tissues. However, these conditions are the perfect scenario for when to apply this technology.
To give you another example, a rattlesnake bit one of the associate doctors in my clinic on his right index finger about 25 years ago. He more recently presented with severely restricted range of motion in that finger. Within two treatments, we virtu-
The sound waves generated by the treatment head travel freely and unobstructed through supple and healthy tissues.
ally normalized the range of motion in his finger. Needless to say, he now uses the technology on a lot of patients!
A number of doctors in the past have asked me what they can expect when treating patients with acoustic pulse wave therapy. Most of the patients we have treated with the technology have had a significant improvement in range of motion, a reduction of pain, and a return to better functionality in five to seven treatments.
Next, practitioners often ask how APWT differs from ultrasound therapy. Well, ultrasound therapy is comprised of one continuous wave with a frequency range of 0.75 to 3 MHz, which is used to promote deep healing within the damaged soft tissues of the body. However, acoustic pulse wave therapy consists of several sound waves (or acoustic pulses) that have high amplitude, aie very short in length, and ultimately place negative tension on the body’s tissues, also called cavitation. This is where the actual therapeutic results originate.
How does it differ from laser treatment? Laser therapy is a type of treatment that uses focused and very narrowly collimated beams of light, which extends their effect on the mitochondria in each cell these beams strike, causing enhanced
cellular activity. The APWT uses sound waves (or acoustic pulses) instead, which aie pressure waves similar in nature to thunder and lightning or an airplane breaking the sound barrier, causing microdeformation of local tissues, which then causes enhanced connective tissue repair.
As such, the technology can aid in the treatment of chronic or painful soft tissue lesions of the musculoskeletal system, including trigger points in muscles, shoulders, elbows, and knees, as well as ankle pain, backaches, and neck pain. We even use the units in our office for acute exacerbations of chronic injuries with great results!
Contraindications for the use of APWT are coagulation disorders (hemophilia); patients on anticoagulants (especially Marcumar); thrombosis; right over a tumor or carcinoma; children with growth plate disorders (such Osgood-Schlatter disease); and patients who have had cortisone therapy.
The beautiful thing is that patients who have recently undergone treatment with this modality have reported no major side effects. Occasionally some swelling, reddening, hematomas, petechiae, localized increased pain, or skin have been documented in the literature. While such reported side effects generally diminish within two to five days, healthcare providers ai e encouraged to ensure that adverse reactions of any sort have dissolved before resuming each patient’s next round of therapy. None of these side effects has occurred after use of the units in
my offices.
The beautiful thing is that many patients notice improvements almost immediately upon receiving treatment, including reduction in pain and increased mobility. These results generally last for five to eight days, but some slight discomfort could, in some cases, return prior to a patient’s next scheduled treatment. Most patients, however, could become free of discomfort over the following three to five sessions in a three to four week timeframe, when the body’s natural healing process begins to take place. I have found that it is best to schedule the treat-
ments five to seven days apart for the best results.
While treatment times may vary from patient to patient based on his or her condition(s), typically 1,500 to 3,000 impulses are administered per session, which takes approximately five to eight minutes. Treatment protocols clearly depend on each patient’s diagnosis and/or severity of reported pain. This means treatments can vary in the number of impulses administered per session as well as the intensity of those impulses.
For certain cases involving more severe injuries, additional treatments may be required. Since treatments are quickly and easily performed on an outpatient basis and without sedation, this type of scheduling typically does not pose any hindrance on a patient’s régulai' routine, and it can be easily inserted into a patient’s chiropractic schedule. Most of the APWT units on the market do come with a variety of transmitter tips. Some are commonly used fortendons, ligaments, bone, joints, extremely painful areas, and tense or defined injuries located close to the bone. Other tips are used for trigger point therapy on large muscles and connective tissue areas.
As far as overall effectiveness goes, the literature describes a 75% rate of complete recovery among patients. However, I have to say that virtually every patient that we have used this technology on has experienced complete recovery or at least significant improvement of his or her symptomatic state. It may serve to notice here that many chiropractic physicians specialize in the conservative care of musculoskeletal disorders and thus ai e superbly adept at treating chronic injured and compromised tissues, so they may be particularly innovative with implementing this technology in their offices.
It has made a huge impact on the treatment plans implemented in our offices, and our patients aie showing their gratitude by sending their friends and family to see us!
References:
1. J Orthop Traumatol. 2008 Dec; 9(4): 179-185. Published online 2008 Aug 8. doi: 10.1007/sl0195-008-0024-4 PMCID: PMC2657331. Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. Enrico Rebuzzi,corresponding authorl,2 Nicolo Coletti,l Stefano SchiavettiJ and Fernando Giustol
2. Clin Orthop Relat Res. 2001 Jun;(387):47-59. Shock wave therapy for chronic proximal plantar fasciitis. Ogden JAI, Alvarez R, Levitt R, Cross GL, Marlow M.
3. Clin Podiatr Med Surg. 2003 Apr;20(2):323-34. Extracorporeal shock wave therapy for plantar fasciitis. Perez Ml, Weiner R, Gilley JC.
4. Am J Sports Med. 2008 No v ; 3 6 ( 1 1 ) : 2 1 0 0 - 9 . doi: 10.1177/0363546508324176. Epub 2008 Oct 1. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebocontrolled multicenter study. Gerdesmeyer LÍ, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H.
Dr. Reichardt, DC, has been in practice in Southern California since 1984. He currently owns two clinics that specialize in Rehabilitation and Functional Medicine. He can be reached at 310.829.0453
