What is shockwave therapy?
OMNE Chiropractic has one of the ONLY focused shockwave therapy devices in Omaha, Nebraska. As someone who doesn’t normally fall in love with shiny pieces of technology, I believe in this technology so much that I took out a home equity loan on my house to buy it. Find out why through the story and the science around bringing shockwave therapy to OMNE Chiropractic.
The story of shockwave
It all started with my patient Mike (not his real name), a middle aged, active adult like many of the patients at OMNE Chiropractic. What made Mike different is that he had two previous spine surgeries prior to becoming a patient and while under my care he had to have a third emergency spine surgery. I still remember where I was standing when Mike called me and told me he was going to have to have another surgery.
Our chiropractic office was helping him recover from his third spine surgery with our traditional sports chiropractic approach. A combination of hands-on muscle work, dry needling, and adjustments were helpful but not great. About what you would expect from someone who just had their third spine surgery.
I remember Mike asking me if I had ever heard of shockwave therapy and if I thought it might help. At that time, I knew very little about shockwave and was initially hesitant because I felt like it was just another modality that overpromised and under-delivered. I viewed it as ultrasound 2.0.
He decided to give shockwave therapy a shot at a different office in town. Getting a front row seat to his transformation is nothing short of a miracle. He still has his challenging days, as one would expect for a three-time spine surgery champion, but he remains active and the pain and muscle spasms he was experiencing are far decreased.
Undercover Chiropractor
That’s when I knew I needed to learn more about shockwave therapy. I needed to experience shockwave therapy for myself.
One of the chronic sports injuries that has bothered me since my time as a college athlete is my left proximal hamstring. The pain was just below my sit bone on the left and like most chronic tendinopathies, it’s difficult to treat. Admittedly, I had done a poor job rehabbing it because it only bothered me with periods of prolonged sitting, men’s league soccer, and strict/heavy deadlift sets.
I thought about going undercover chiro at the other chiropractic office to get the full patient experience, but it felt dishonest, so I ultimately disclosed I was another provider. I received 3 shockwave treatments and felt a difference immediately. It is hard to describe what a shockwave session feels like. It’s like trying to describe getting a tattoo to someone who doesn’t have any.
More recently I had a patient described shockwave as a “mini-jackhammer”.
The best way to describe the sensation with shockwave is an intense “hurts so good” like feeling. This is part of the treatment, aiming to experience somewhere between a 4-5 on the pain scale while providing feedback to the treating clinician. With shockwave treatments, you can feel the sensation in areas that are not necessarily where the applicator head is being applied, evidence of the depth of penetration of shockwave into your tissues.
After my personal experience and the front row seat with shockwave therapy through Mike’s story, I started referring difficult and stubborn cases to the other chiropractic office. Not every referral was a home run but often, shockwave therapy had a dramatic impact on their condition. I was gaining experience on what conditions responded well to shockwave therapy in a try it before you buy it kind of way.
I purchased my shockwave therapy unit in September of 2024, two weeks after opening my new office location. I was a little strapped for cash with the build out so I tapped a home equity line of credit on my house to fund the purchase. OMNE Chiropractic patients have been experiencing the positive effects of shockwave therapy since then.
The science of shockwave
Shockwave therapy gained mainstream medical usage in the early 1980s. Not for musculoskeletal pain but to blast kidney stones in the procedure known as lithotripsy.
The first successful stone fragmentation in the human body was performed by Professor Christian Chaussy, M.D., in Munich in February 1980.
Given the ability to create a powerful outcome without damaging surrounding tissues, researchers and clinicians believed that shockwaves could be beneficial in treating musculoskeletal conditions.
What is a shockwave?
Shockwaves sure sound cool, but what are they?
Shockwaves are just sound waves. Their uniqueness lies in the amount of energy they carry. Shockwaves are acoustic pulses with high, positive pressure amplitudes and a steep pressure increase compared to the ambient pressure.
Shockwaves are created during explosions, and they can travel large distances causing window pains to break. It’s so cool to think we can create this type of sound wave and then use it within the body to create beneficial biochemical reactions for pain reduction and healing.
Types of Shockwave Therapy
There are two types of shockwave therapy: Focused Shockwaves and Radial Pressures Waves
Without getting into too many of the details, the Stemwave device at OMNE Chiropractic is a focused shockwave therapy device. This was a strategic decision as many of the devices in Omaha are radial pressure waves rather than true shockwave devices. Both types of devices are effective in treating of musculoskeletal disorders.
One of the main differences that I was interested in when selecting a focused shockwave therapy device is more depth of penetration and precision.
Physical Mechanism of Shockwave Therapy
The primary mechanism of action of shockwave therapy is through a process of mechanotransduction. A mechanical stimulus created by the device is delivered into the body’s tissue through the pulse wave. This mechanical input signals the cell, which starts a cascade of biochemical events for pain relief, decreased inflammation, and tissue regeneration.
This mechanical stimulation from the Stemwave device creates compression, deformation, and stretch of the cells without cell damage. It gives the body the illusion of damage that kickstarts the healing process without the nasty side effects.
Pain Relief
One of the mechanisms of pain relief is through mechanical hyperstimulation, triggering the release of endorphins and other pain-relieving molecules through the descending inhibitory system. The descending inhibitory system is the “brakes” on pain transmission to the brain. They work at the level of the spinal cord and can decrease the intensity of pain signals reaching the brain. Opiod medication and a TENS unit, or transcutaneous electrical nerve stimulation device help reduce pain through the descending inhibitory system.
With shockwave therapy we can deliver targeted waves to the source of pain and inflammation.
Biochemical Mechanism of Shockwave Therapy
When shockwaves are introduced into the body they initiate deep, cellular pathways that decrease inflammation, promote new blood vessel growth, decrease pain, and aid in tissue regeneration.
Decrease Inflammation
Inflammation is a normal body process and is important for tissue recovery and regeneration. Shockwave therapy signals to the body to increase the production of an important protein known as vascular endothelial growth favor (VEGF). This protein is responsible for forming new blood vessels. The improved blood flow allows for oxygen and nutrients to reach damaged tissues and helps remove waste products allowing for accelerated healing and reduced inflammatory markers. These processes help heal both acute and chronic injuries.
Shockwave also helps by down regulating pro-inflammatory cytokines and increasing anti-inflammatory proteins. It is best to think about inflammation using the Goldilocks principle. Too little inflammation and injuries have a hard time healing. Too much inflammation and pain is uncontrolled and injuries have a hard time healing. A balanced inflammatory environment is crucial for proper tissue healing.
Cellular Processes of Shockwave Therapy for Reducing Inflammation and Accelerating Healing
Cellular Process | Mechanism | Effect |
Enhanced Blood Flow & Angiogenesis | Stimulates VEGF to promote new blood vessel formation. | Increased oxygen and nutrient delivery; faster removal of waste products; accelerated healing. |
Reduction of Pro-Inflammatory Cytokines | Downregulates cytokines like TNF-α, IL-6, and IL-1β. | Decreased swelling, pain, and inflammation. |
Increased Anti-Inflammatory Mediators | Boosts production of IL-10 and other anti-inflammatory proteins. | Balanced inflammatory response, aiding tissue healing. |
Stimulation of Cellular Repair | Activates fibroblasts and macrophages via mechanotransduction. | Collagen production increases; macrophages shift to anti-inflammatory (M2) phenotype. |
Breakdown of Calcifications & Scar Tissue | Creates micro-cavitation bubbles and shear forces to break down deposits. | Reduces barriers to healing caused by calcifications and scar tissue. |
Activation of Nitric Oxide (NO) Pathways | Enhances NO production, reducing oxidative stress and improving vascular health. | Anti-inflammatory effects; improved tissue relaxation and healing. |
Stem Cell Activation | Recruits and activates mesenchymal stem cells (MSCs). | Growth factors released by MSCs accelerate regeneration and suppress prolonged inflammation. |
Modulation of Nerve Activity | Reduces nerve excitability and neuropeptides like substance P. | Decreases inflammation-related pain and nerve irritation. |
Tissue Regeneration
In addition to creating a more balanced inflammatory environment through enhanced blood flow, shockwave therapy has a powerful effect on Mesenchymal Stem Cells (MSCs)
Mesenchymal stem cells are versatile stem cells that can transform into other more specialized cell types such as bone, cartilage, and muscle. They live dormant inside our body and shockwave can trigger the activation of these important cells to aid in tissue regeneration.
Conditions Treated with Shockwave Therapy
I purchased my Stemwave shockwave therapy device, in the Fall of 2024. I had been referring patients to another office for six months and I was ready to purchase my own unit. I wanted to add shockwave therapy to assist in difficult acute cases and stubborn chronic injuries.
Achilles Tendinopathy
Plantar Fasciitis
Rotator cuff injuries
Frozen shoulder and calcific tendonitis
Knee meniscus injuries and osteoarthritis
Golfer’s and Tennis Elbow
Running injuries
Bursitis
Benefits of Shockwave Therapy
- Pain Relief
- Accelerated Healing
- Non-invasive and drug-free
- Avoid unnecessary surgeries
- Quick Sessions
- Decreased Inflammation
- Enhanced Blood Flow
How to get started with shockwave therapy at OMNE Chirorpractic?
1. Schedule a Stemwave Mapping Session
We want to make sure you are a good candidate for shockwave therapy before we discuss treatment plans. The first session involves a brief history of the injury performed by an actual clinician, rather than a tech. We then use the shockwave device as a diagnostic tool over the area(s) of pain. We are focusing the shockwaves over the most tender areas to get the positive biological effects. We are looking for improvements in pain and range of motion after just one session.
2. Follow up and Response to Treatment
Ideally, we can follow up in 1-2 days after the initial mapping sessions to monitor progress and consider additional treatment. This helps us determine if you are quality candidate for shockwave therapy and along with your history can help form a recommended care plan.
3. Plan of Care Recommendation
With the history, response to mapping session, and patient goals we are able to determine a plan of care that best suits their needs. Most patients experience significant relief in 3-4 sessions and plan of cares are generally between 8-16 sessions.
Sources:
Saggini R, Di Stefano A, Saggini A, Bellomo RG. CLINICAL APPLICATION OF SHOCK WAVE THERAPY IN MUSCULOSKELETAL DISORDERS: PART I. J Biol Regul Homeost Agents. 2015 Jul-Sep;29(3):533-45. PMID: 26403392.
Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma. 2020 May;11(Suppl 3):S309-S318. doi: 10.1016/j.jcot.2020.02.004. Epub 2020 Feb 12. PMID: 32523286; PMCID: PMC7275282.
Sukubo NG, Tibalt E, Respizzi S, Locati M, d’Agostino MC. Effect of shock waves on macrophages: A possible role in tissue regeneration and remodeling. Int J Surg. 2015 Dec;24(Pt B):124-30. doi: 10.1016/j.ijsu.2015.07.719. Epub 2015 Aug 18. PMID: 26291028.
