Sound waves have many benefits for orthopedic pain

Americans love technology and will flock to try some new gadget or device. Oftentimes the hype is completely “over the top” and it turns out to be nothing more than a reconfiguring of an older technology. But new developments occur regularly, with new consumer electronics attracting much attention. Just look at the fanfare, as well as the crowds, involved in the latest phone release.

Research into new medical technologies is on-going. A significant new development has the potential to trigger the expenditure of millions. A breakthrough technology has the ability to radically change the treatment, and therefore the outcomes, of some common and debilitating conditions. Think about what a game-changer it was when pacemakers were first developed?

Many other examples can be found, some of which are common knowledge. The availability of magnetic resonance imaging, more commonly known as MRI, was a radical and startling new technology, allowing for the crystal clear imaging of bone and soft tissue. MRI has no complications and produces no radiation. Unfortunately, it continues to be quite pricey. Consequently, the insurance companies tend to be loath to approve them. (The hoops required to get an insurance rep to say “Yes” can be intimidating.)

A much more recent example of the excitement associated with new medical technology might be pain lasers. These have become almost commonplace in general medicine, from human to animal, physical medicine to wound care. And as a physician, I must admit, it is wonderful to have a beneficial therapy, without side effects or complications. The biochemistry of the effects of lasers is a complex subject. Suffice it to say that it makes the cells composing the tissues being treated healthier.

Another technological advancement less publicized is in the field of gait analysis. Not an oft-discussed topic, significant breakthroughs have been made of late, largely because of certain new technologies. For example, sensors placed inside a shoe and over specific body parts can transmit information to a specialized computer program, to learn about the critical act of ambulation. CT scanners, which stands for computed tomography, have been developed allowing real time imaging of the lower extremity. This means that the subject can, for example, wiggle their toes, and see it all on the screen, digitized and recorded, analyzed and dissected.

Generating great excitement in the world of musculoskeletal medicine recently is the development of shockwave therapy for many common conditions including heel pain, chronic tendonitis, and many others. Once again, an effective therapy, actually a VERY effective therapy, with no complications or side effects. This device is actually an extension of lithotripsy, whereby sound waves are used to break up kidney stones, a technique well established for decades.

Multiple studies, performed world-wide, have established the effectiveness of this modality, shockwave therapy (technically termed Extracorporeal Shock Wave Therapy but shortened to ESWT). Its effects are multiple and include such things as stimulating new blood vessel formation, reversing chronic inflammation, stimulating collagen production, and more. Depending on your knowledge of the human body, you may have just an inkling as to the benefits of ESWT although there are imitators and knock-offs). Treating an already diseased, damaged soft tissue structure, like a tendon or ligament, by administering a steroid is suppressing the natural healing process. Mind you, this is a structure already damaged, with likely degenerative changes secondary to poor blood flow.

A shockwave is an acoustic wave that carries high energy to a painful area and provokes the body’s healing and repair processes. This makes it an ideal modality for orthopedic medicine, rehabilitative medicine, sports med and others. Refinement of the mechanization has continued, with the latest iteration of shockwave performed comfortably without anesthesia.

An extremely recent development in acoustic medicine, we are now able to unblock calcified arteries with shockwave technology. The catheters inserted into the affected vessel have several small nodes at the end which produce the sound energy, breaking up the calcific deposits. This may be another “game-changer” but it’s too early to know. Suffice it to say, it is not yet approved in the U.S.

Because ESWT stimulates the initial phase of the tissue healing process, which is acute inflammation, the benefits are lasting. This is not a band-aid or a simple pain reliever. Shockwave therapy is classified as a form of regenerative medicine, and therefore of lasting benefit. Being both beneficial and safe makes it an effective, viable alternative to the risks and recovery time of surgery.

The most common cause of heel pain is plantar fasciitis, in which the arch ligament becomes inflamed where it attaches to the heel bone. Stretches, physical therapy, and some kind of supportive device placed in the shoe, provide sufficient relief most of the time. When they don’t, rather than being cut open, extracorporeal shockwave therapy is a great option, and has proven to be extremely effective in resolving the pain of plantar fasciitis, 80 to 90 percent, depending on the study.

Achilles tendonitis is an extremely stubborn, resistant condition, with many different but associated problems. All the conservative options to this point have been slow to provide relief with a low success rate. Here again, shockwave therapy has turned out to be consistently helpful in initiating the healing process within the tendon. Relief can be obtained, even when bone spurs are present inside the Achilles tendon. And Achilles surgery is fraught with slow healing and a high rate of complications.

When treating people who are active, or at least want to get active, it is gratifying to be able to get them moving, atraumatically yet quickly. It is easy to be able to recommend a technique with such a well-proven success rate, knowing it is improving their regenerative potential. With extracorporeal shockwave therapy, we are now able to treat the root of the individual’s pain, not just the symptoms, and thus, helping them get better, faster. And without downtime. Shockwave has been called “the next frontier” when it comes to non-invasive muscle and ligament repair. But it’s really just another example of the new frontier: regenerative medicine, in which the process of tissue repair is enhanced, quickened, strengthened. It will be exciting to see where this new road leads in the world of modern medicine.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.