One of the therapies I find useful for DDD is shock wave therapy. PiezoWave Pulse Therapy and EnPuls are two of the top brand names in this type of non-invasive treatment. Shock wave therapy changes the degenerative disease environment of the inner spine to a healing environment.
Shock wave therapy stimulates stem cells. When stem cells are stimulated towards the spine or a targeted joint they initially start a line of new communication with the immune system and begin exchanging messages. The stem cells tell the immune cells to call healing factors to the site of damage and to meet them at the points where repair is needed. This is when healing begins.
Using the current research to explain how this change of environment works: When introduced into a diseased joint or spine, stem cells display plasticity and multipotency. This is the ability to change/morph into other cell types and multiply. One of the specific cell types is called Mesenchymal stem cell (MSCs) or connective tissue stem cells. These suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The shockwave treatment actually stimulates a ‘controlled irritation’ or ‘controlled injury’ that leads to the beginning of the bodies dampening effect on the chronic inflammation.1
Shockwave therapy also signals the native stem cells and other growth factors to regroup and begin repairing damaged joints.
Stem cells and the herniated disc
A bulging disc bulges because the soft jelly like nucleus (inner colloid substance of the disc) are able to push through the weakened, damaged outer wall of the disc.
New research suggests that stem cells, without direct injection to the site of disc lesions in the spine, can repair disc lesions by changing the healing environment of the spine.
1 Davatchi F, et al. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016 Mar;19(3):219-25
Research suggests the White Zone can heal
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! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.
- 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.
- 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.
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.
Dupuytren’s contracture is an abnormal thickening and tightening of the normally elastic tissue beneath the skin of the palm and fingers. In Dupuytren’s contracture, the cords tighten, or contract, causing the fingers to curl forward. In severe cases, it can lead to crippling hand deformities. The nodules can occur in the palm of the hand or the foot.
These contractures can affect the old and the young alike. Dr. Tucker consults people with Dupuytren’s and looks for food sensitivities and allergies, sleep disturbances, blood sugar issues, and nutritional deficiencies as a potential cause or contributing factor to Dupuytren’s Contractures. Tucker says “I have seen cases improve with diet, fascial stretching and lifestyle changes. Other recommendations are to stop smoking, lose fat, and decrease alcohol intake.” For some individuals, Dr. Tucker recommends his specialty creams, a fat loss diet, fascial stretches, and even surgery. However, Tucker is in search of identifying the underlying cause instead of just sending patients off to surgery.
Fascial inflammation is an under-looked at diagnosis in the medical profession and needs to be evaluated in these types of chronic conditions. Dr. Jeffrey Tucker works with other practitioners to rule out the potential causes of Dupuytren’s contractures.
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.
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.
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!
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.
You say you want to be like an athlete? Ok, then let me check the range of motion in your breathing patterns, neck, thoracic region, lumbopelvic region, hips, shoulders and feet. I don’t mind if you are slow when you run or workout. I do mind if you are stiff, because that can put you at risk for injury.
Then let me check some ‘isometric hold’ positions of your back side, abdominal side and lateral side muscles. I am more interested in you owning your own body weight then I am interested in how much you can squat, or how much you can deadlift, or bench press. I want to watch you perform body weight squats, deadlifts and perform a push up because I am interested in your movement patterns. These tests are part of a good functional assessment.
If you can demonstrate that you own your body weight in isometric holds and squats, I want you to start thinking about more STRENGTH in everything else. For my CROSSFIT patients this means using barbells, dumbbells, kettlebells, TRX, sleds, and sandbags, etc. I need you to demonstrate strength and power in every plane of movement both bilaterally and unilaterally.
I work with the general population and crossfit athletes, and give them cutting edge treatments like laser, shockwave, pneumatic cupping, and vibration therapy. I use training tips and methods from how athletes train.
Dr. Jeffrey Tucker is a Diplomate in Chiropractic Rehabilitation and a Sports Practitioner, Certified Chiropractic Soft Tissue Practitioner, PES/CES – NASM, FMS Level 1 & 2 Certified & SMFA Certified, Instrument Assisted Tools Certified and a Performance Health Lead Instructor.
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
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We are the only office in West Los Angeles with two types of laser and two types of shock wave devices