All posts in Shockwave Therapy

Shockwave Therapy for Knee Pain

  • Arthroscopy Journal, doctors concluded that PRP injections are a viable treatment for knee osteoarthritis and should be considered in patients with knee osteoarthritis.6 Studies like these add to the accumulating evidence that PRP can halt and reverse meniscus degeneration.7,8
  • J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472 they confirm that stem cell therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth (with stem cells).9 This means we can use the PIEZOWAVE and EnPuls to stimulate regeneration even after surgery.
  • Doctors at the University of Iowa found that stem cells and cartilage cells could be influenced to migrate to the site of “white-zone” where the most difficult meniscus tears are. I use Laser and PiezoWave and EnPuls to do just that!
  • I do think stimulating the tissues with PiezoWave and EnPuls shockwave can promote regeneration and is a promising new strategy in meniscus repair.10
  • Stimulating stem cell based strategies for meniscus tissue is a fundamental role in meniscal regeneration. 11
  1. Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
  2. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
  3. van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
  4. Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
  5. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42.  PUBMED Meniscus Growth With Stem Cells
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Meniscus Tears – Research suggests the ‘White Zone’ can heal (Los Angeles Chiropractor)

 

  • FACT: Regeneration of meniscus and cartilage is difficult to heal especially in the ‘white zone’ where there is a lack of blood vessels and therefore deprives the meniscus of healing nutrients and oxygen.
  • FACT: Stem cell injections and PRP injection treatments are in the infancy stages of research. These treatment options are as controversial as surgery.
    • New York Times, Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Hamilton, Ontario states: Meniscus surgery is expensive and has potential complications (British Medical Journal even agrees with this).
    • FACT: I want patients to return to sport or leisure activity as fast as possible.
    • Researchers in Denmark have published: “patients undergoing arthroscopic meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure-time activities after meniscal surgery.”1
  • Can PIEZOWAVE Pulse Therapy and ENPULS Radial Shockwave Therapy regrow meniscus tissue? What about stem cell therapy and PRP? Is one more successful at treating meniscal damage? All of these treatments are very promising! I have not seen 80-100% predictable positive clinical outcomes yet with any of these! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.4
  • We need more University and Hospital based studies to confirm this trend.
  • Again, everyone agrees that Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone (the inner portion of the meniscus that lacks a blood supply).
  • I use the non-invasive and less expensive EnPuls and PiezoWave therapy instead of PRP to achieve pain relief and attempt to halt the progression of meniscal damage. More time and research is required to see if this is the way to regenerate tissue.5
  1. Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop. 2016 Sep 13:1-7.
  2. Brelin AM, Rue JP. Return to Play Following Meniscus Surgery. Clin Sports Med. 2016 Oct;35(4):669-78. doi: 10.1016/j.csm.2016.05.010. Epub 2016 Jul 9. Review.
  3. Noyes FR, Barber-Westin SD. Long-term Survivorship and Function of Meniscus Transplantation. Am J Sports Med. 2016 Sep;44(9):2330-8.
  4. Niu W, Guo W, Han S, Zhu Y, Liu S, Guo Q. Cell-Based Strategies for Meniscus Tissue Engineering. Stem Cells International. 2016;2016:4717184. doi:10.1155/2016/4717184.
  5. Blanke F, Vavken P, Haenle M, von Wehren L, Pagenstert G, Majewski M. Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions. Muscles Ligaments Tendons J. 2015 Oct 20;5(3):162-166.
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Non-Surgical Options for Meniscus Tears – Los Angeles

You probably have knee pain and then you got an MRI and the doctor said “You have a meniscus tear and you’ll need surgery”.  Do you have other options? YES!

First off, let me tell you that research suggests the meniscus is always trying to heal itself. The length of time it takes to heal can depend on the location of the tear. The “Red Zone” part of the meniscus which is the outer edges, contain areas that have a blood supply and can receive oxygen and nutrients that help heal. This ‘Red Zone’ has a better opportunity than the “White Zone” which is more in the center of the meniscus to heal. The ‘White Zone’ does not have a well-organized blood supply which is required to bring oxygen and nutrients into damaged areas. If you are one of those people with a meniscus tear and your pain and dysfunction is not that great, meaning you can do most of the stuff you want to do, and you can live with the pain, I would recommend a trail of PiezoWave, EnPuls and laser. The research studies comparing people who had surgery and those who did not have surgery show that the outcomes are about the same after two years in those who did not go through a costly and invasive surgery!  Acoustic Pulse Wave (PiezoWave) therapy and radial pulse therapy (EnPuls) is changing the healing pace – results of healing are quicker in the “White Zone” damaged tissue. I suspect it’s increasing the blood flow to these deeper tissues and improving the healing nutrient supply to the damaged ‘White Zone’ tissue and people feel better, faster.

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Degenerative Disc Disease – Shockwave Treatments

Shock wave or radial pulse therapy (PiezoWave, EnPuls) is effective in “kick-starting” the healing process to treat degenerative disc disease. Radial (EnPuls) and acoustic (PiezoWave) pulse waves have been used for Achilles tendinopathy, plantar fasciitis, calf strains, and even cellulite. Pulse wave therapy is non-invasive and stronger than percussion treatments such as the Deep Muscle Stimulator (DMS). By stimulating the skin and muscles adjacent to the spine with pulse wave therapy we are doing two things 1) breaking up tight spasm and hard fibrotic tissue, 2) releasing the spasm allows the paraspinal muscles to be less dampened and work more efficiently again. In this way regeneration begins because the discs are indirectly treated and the discs show an increase in disc height.

Exercise is used along with the PiezoWave or EnPuls impulse treatment to address the problems of spinal ligament instability. The sooner you catch the degeneration, the better the results with pulse wave treatment and exercise. Stability exercise training has a protective effect on damaged discs. In the acute phase we may start with the pulse therapy and or laser to decrease the pain and inflammation. Dr. Tucker uses various isometric exercises in his practice. Clinical outcomes and patient satisfaction with these types of treatments is very high. We can use this model of therapy in the early treatment phase and in late stages of the degenerative process. “Earlier intervention in the disease process is more beneficial than later treatment of an already severely degenerated discs”, says Tucker.

“I think most people understand the repair process that the body naturally goes through after an injury but they do not understand how the body can also regenerate a degenerated discs”.  These newer treatments (PiezoWave, EnPuls, and Lasers) are able to recover the mechanical properties of denatured discs, thereby providing a promising effective therapeutic modality.

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Disc Pain: Non-invasive therapy

Does shockwave therapy such as EnPuls and PiezoWave stimulate stem cells in inhibiting disc degeneration and disc herniation? The research and my clinical experience suggest the answer is ‘Yes’. Stem cells can be injected into the area of local damage but this is invasive and costly. We are using EnPuls and PiezoWave pulse therapy and laser (all non-invasive) to stimulate stem cells to interact with the local stem cells and immune system cells to achieve successful disc pain relief and tissue regeneration.

 

The current theory is that the combination of these non-invasive deep tissue treatments stimulates stem cells that are able to bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Also inflammation comes in many forms. To keep it simple one type is healing and another type is non-healing inflammation. Research supports stem cells are able to reduce or prevent herniation by suppressing the non-healing inflammation.

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Stem Cell Therapy Alternatives

Here’s what we think is happening when a shock wave and laser treatment is applied to a damaged joint causing you (in your joints):

  • Stem cell stimulation occurs which sends signals to the local stem cells and other growth factors to regroup and begin repairing damaged joints.
  • Mesenchymal stem cell (MSCs – connective tissue stem cells) suppress inflammatory T–cell proliferation and provide anti-inflammatory effects. Applying these (Piezo Wave, EnPuls, TheraLase, Light Force) treatment modalities inhibits damaging chronic inflammation.
  • Mesenchymal stem cells express various growth factors – these are active molecules that stimulate local tissue repair. These growth factors, and the direct cell to cell contact between MSCs and chondrocytes (the present remaining cartilage cells in the joint), have been observed to influence chondrogenic differentiation and cartilage matrix formation – in simple terms – stem cells regenerated cartilage.

Can shock wave repair disc lesions and other degenerated joints? We are seeing clinical outcomes that suggest it does. Do I think you should try this before more expensive and risky injections of stem cells? The answer is Yes!

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Plantar fasciitis treatment

If you have Achilles tendinopathy and/or plantar fasciitis, Theralase laser and PiezoWave acoustic therapy is an effective and safe alternative to injections and cortisone medications. These are cutting edge non-surgical treatments for tendinopathies that are safer and less costly than platelet-rich plasma (PRP) treatments.

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Cartilage Pain Treatment

Cartilage is the soft padding that keeps your bones from grinding against each other.

When you’re young, the cartilage between your bones is moist and thick…but as you get older, that soft padding can start to get dry, wear thin or tear. Knee cartilage is meant to be smooth so you can walk, run, and even jump. If you have muscle imbalances this can cause excessive and uneven wear and tear in the joint cartilage.

Over time, friction may develop in the joint and you feel inflammation, burning, discomfort, and pain.

Cartilage pain relief – Patients ask me “Can I regrow and rebuild my joints?” The answer is yes!

I see this happen in patients who get laser and shock wave or pulse wave therapy. You can also make your joints fluid and flexible by decreasing inflammation by losing extra fat if you are overweight. I also recommend water-based “lubrication” supplements that help keep your joints soft and moist. If you need certain exercises I will teach you those.

These new technologies (laser and shock wave) are non-invasive without the pain and risk of costly surgeries or addictive drugs.

Some patients start to feel relief within the first 12-24 hours.

I used this very same procedure of laser and shockwave to help rebuild my knee when I had a meniscus tear years ago. I remember when the radiologist said “You need to go see an orthopedic surgeon”. After seeing the ortho surgeon I decided to use my own machines and it helped me avoid surgery and years of endless pain… and I think it could help you, too.

Laser and Shockwave is the Missing Technology that
Lets Your Body Build MORE Cartilage and Repair Tendons

Call 410-444-9393 for an appointment

We are the only office in West Los Angeles with two types of laser and two types of shock wave devices

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Pain Relief in Brentwood

I use two different types of shock wave devices for pain relief in my practice. One is a radial pulse wave (EnPuls) and the other is an acoustic wave (PiezoWave). Both carry energy that can be targeted and focused noninvasively to affect a selected region like the shoulder, hip or foot. When these devices are applied to the soft tissues, the impulses or shock waves interact with the targeted tissues and induce a cascade of biological reactions. This results in the release of growth factors, which in turn triggers new blood vessel formation (neovascularization) of the tissue with subsequent improvement of the blood supply and oxygen to the tissues. This helps healing.
Another effect of shock wave therapy is related to the stimulation of cell proliferation, tissue regeneration, and a process through which new blood vessels form from pre-existing vessels called angiogenesis.

The therapeutic effects of shock wave therapy can be used on patients who need pain relief and reduction of inflammation even in cases with diabetes, nerve pain, soft tissue injury, arthritic joint irritation, and healing of bone (2013, Qiu et al; 2013 Liu; 2013 Siegfried).

My practice is located in Brentwood, CA. I can be reached at 310-444-9393.

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Plantar Fasciitis Chiropractor

The bottom of your foot hurts. Maybe one side, or worse both feet hurt! The cause of the pain is probably something related to a change in your walking or running habits. People say to me “I haven’t changed anything so how does it happen?” There has to be something that you are doing wrong that you don’t even know you are doing wrong. It’s often in your gait or posture causing an excessive strain that is creating repetitive irritation of the arch of the foot.

Plantar fasciitis starts with some inflammation of the fascia on the bottom of the foot and eventual thickening of the plantar fascia. I don’t have to tell you that it can be a severe irritation. In order for me to evaluate and correct plantar fasciitis I examine the whole Superficial Back Line of fascia, which starts at the bottom of the foot and goes all the way up to your head. We might find this fascial band tight anywhere along its entire length. Fascia is the primary force transmission system in your body. If it cannot transmit force efficiently, there is too much strain in certain places: the bottom of the foot is often one of the spots that takes the burden of the excess stress (resulting in too much strain).

The examination includes checking for tightness in the muscles around the calf, especially the soleus and toe flexors. I also check stability and force generation in your glutes, psoas, quads, and abdominals. If they are inhibited or weak the lower leg and foot have to do more work. More work leads to pain and discomfort. A common movement pattern dysfunction of plantar fasciitis is lack of strength and timing of the Gluteus Maximus. Weak glutes contribute to foot dysfunction.

Key non-invasive treatments: 

EnPuls (radial pulse therapy or shock wave therapy) and Piezowave Therapy (Acoustic pulse therapy)

These therapies significantly reduce pain and inflammation while stimulating the formation of new collagen matrix in damaged foot tissues. Properly applied shock wave therapy with optimal dosage is one of the best modalities available for effective treatment of Plantar Fasciitis. Often you will feel significant changes and improvements within several sessions.

 

Kinesiology Taping 

Taping is an effective tool for alleviating symptoms and helping to form new movement habits. Sensory input from the tape on skin ignites the brain maps in discovering new options for movement. Tape adds stability. More stability leads to increased movement variability. Being stability is a good thing.

 

I am the only Chiropractor in Los Angeles with these combinations of modalities to target treatment to the site of pain and I teach patients the use of corrective exercises. This approach leads to more positive outcomes. The body will tell you very quickly what it likes and what it doesn’t like. If you feel better and it lasts you are on the right track. If you don’t, that’s a sign you need to change approaches. I can combine radial pulse waves, acoustic pulse waves, laser therapy, taping, and strength work to help you heal better and faster.

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