The Truth About Shockwave Therapy: What Chiropractors Need to Know

If it's not significantly improving through shockwave within about three or four visits, we're likely missing something. So it's a very fast acting therapy. About 80% of the time, the patient will feel improvement the first visit.

Hey everybody. As promised, I am here with Dr. Dan from Shockwave Centers of America and I'm excited to talk all about Shockwave today. Dan, thanks for coming on and chatting.

Appreciate you. Absolutely.

Hey, my pleasure. So I think there's a lot of docs out there that have heard a lot about Shockwave over the last few years. But let's start with the basics. What is shockwave therapy and why, in your opinion, has it become so popular?

Sure, and I think that's a great place to start because shockwave has been almost misconstrued as far as, okay, this versus this machine versus that. Shockwave should be used as the terminology for the therapy. Right. So every device is a shockwave device, whether it's, you know, stem wave, softwave, all kinds of other different branding names out there. But think of it from the baseline. Shockwave is the therapy term. And we use that to help us describe what happens to the human body when we administer a shockwave. It almost looks like or feels like I'm turning this muscle tissue or this harder tissue into a little bit more fluid motion. And that's because of that shockwave activity that's happening. So it's very, very basic. We're using sound waves, not like ultrasound, but more slower, more robust sound waves to create a pressurized change at some level into the tissue. And that pressurized change is going to happen to the bone tissue, to the muscle tissue, to the ligaments, to the skin. And all of those different areas are going to have a different response to that sound wave. And unlike ultrasound, which we get compared to a lot because they're both in that category of sound wave, ultrasound is creating deep thermal therapy. So we get a lot of heat in into penetrating areas where we can't necessarily get from, like a heat pack. There is zero heat created by a shockwave at all. It is all that rapid, pressurized changes into different elements of the tissue. And we can do three things with shockwave. We can stimulate some healing. We'll talk in depth more about that. We can do some trigger point or some muscle relaxation therapy, and then we can do some deeper breaking down of bone spurs, calcium deposits, fibrous adhesions. And that'll all depend on the strength. And how deep is that sound wave penetrating into the human body?

Yeah, there's a lot to unpack there. And let's start with conditions. So you mentioned a few of the ways in which it works, which I think many people listening and watching are immediately gonna be thinking, okay, what are the patients here? Right. So in your experience, what are the kinds of conditions? I know the breadth and depth. It's wide and deep in terms of what shockwave can help with. But if you had to cherry pick some of those top conditions that respond best, asked to shockwave therapy, what are few you'd point out?

So I think you put it perfectly. There's so many different things we can do with shockwave, but there are some things that are very much shockwave, Specific things that we do best in the world of shockwave therapy. And I do, you'll hear me talk about a lot as shockwave, I think, is the most chiropractic therapy, because at its core, we're just stimulating the body to do what it's supposed to be doing and getting rid of things that are inhibiting it from doing so. Right. So things that are lower blood flow, that don't get as much natural oxygenation are great for shockwaves. So think about, you know, plantar fasciitis, frozen shoulder syndrome, carpal tunnel, thoracic outlet, anything that involves calcium depositing. So calcific tendinopathies, those are big things that are like, okay, very obvious shockwave therapy options. Some things that are off the beaten path that also are helped with shockwave that you'll see. Neuropathy is one of them, because that wave profile of the impulse that we create with the device is very similar to an action potential. And we can create action potential in nerve tissue through shockwave. And so it's there, it's a great option, but it's not like, okay, this is just a shockwave problem. Whereas the tennis elbow, frozen shoulder, plantar fasciitis, osteoarthritic knees, those are very common things that we're going to see in the world of shockwave.

That's great. So from a patient perspective, is this something where patients are expecting some relief immediately? Is this something that takes time? How's it play out from a patient perspective? And this kind of goes into mechanisms of action as well. But what's typically the expectation? There's some therapies out there where the patient doesn't feel a thing. And, you know, it's like. But it still might be doing something, I think of, you know, many times, laser or red light therapy. And there's other, you know, like a chiropractic adjustment, where it's very clear most of the time, especially if it's done by hand, that something happened. Right. So from, from a patient perspective, how does Shockwave play out?

Perfect. So most of the time, and my general rule based on the research that we have is that if it's not significantly improving through shockwave within about three or four visits, we're likely missing something. So it's a very fast acting therapy. About 80% of the time the patient will feel improvement the first visit, which is great. It's a good way to get people on board or to show them that hey, this is the right therapy at the right time. So again, within three or four visits we should see significant improvements in their condition. And that could be improvements in range of motion, their pain experience, their functionality able to get into a squat better where they were able to before. And so we're tracking all these things to make sure that there's a functional improvement for them as well as the subjective improvement. Um, but it's pretty common to see a rapid change of improvement in their symptoms that 20% that don't. It's kind of like same thing with this chiropractic conversation. Some people are more sore immediately after the therapy and then three, four, five days later they're like, okay, yeah, now I'm feeling the improvements there. And there's so many different factors in the human body, whether that's metabolic health or how chronic the issue is that could lead to a situation like that. But the beauty in Shockwave is if it's going to work, it's going to work pretty quickly. Um, and if it's not, then we have to go back and revisit whether it was the right therapy or if we're missing something that we should get imaging for.

Yeah, that totally makes sense. So you mentioned tissue regeneration. So let's dive into some of the mechanisms of action at a high level. I know this can get like super complex very quickly and a lot of, you know, but just at a high level. You mentioned tissue regeneration. I guess, you know, when I've thought of shockwave technology, you know, from a consumer language perspective, I'm always saying things like this helps. It does a really good job at reducing inflammation and helping you move better. Right. In consumer language. But I'll ask you to go one level deeper than that, having your knowledge base. You mentioned tissue regeneration. What do you mean by that? How does it work? What are some things that you think the docs listening would really perk up their ears in terms of, oh wow, that really is going to add something to my practice that's new and different and meaningful.

So this is really cool and is worth the conversation because a lot of the times, the. The verbiage that we use in the world of shockwave therapy can make things feel almost impossible. Like, there's no way that can do that. Right. You know, hey, this. The word stem cell gets thrown around about a lot. You know, the tissue regeneration capabilities and all that kind of fun stuff. A reminder for therapies like shockwave is that we're not introducing anything new to the human body. I'm not bringing exogenous stem cell production. I'm not bringing in new fibers that the body doesn't know how to handle. This is all stimulation of tissue that already exists. So what our capabilities are in that world will make sense in a second here. If I have zero cartilage whatsoever and I'm trying to stimulate cartilage growth into a tissue, there's nothing for me to feed off of. Right. I can't just grow cartilage with no stimulation whatsoever. Right. What I can do is I can stimulate the replication process of more. Same idea. If I have an avascular necrosis or I have a bone that has zero blood flow whatsoever, I can't bring in brand new blood flow. There's. I can stimulate the epithelial level, endothelial level of the blood vessel to stimulate more growth with that hormone of vegf, which is something that we absolutely do in the world of laser and in shockwave, but it has to have that base to build off of. Right? So those are the limitations. If there's nothing to work with, there's no tissue for me to stimulate more of, then it's not going to happen. But we do have this awesome opportunity to replicate tissue and stimulate more growth of what's already there. So again, Even if it's 99% gone, that 1% can help improve that cartilage growth. And the way that it works on the higher level is that we found through the research is that fibrinogen itself. That molecule is mechanoreceptive or mechanoduplicating, which means that I can actually stimulate that cell to then elongate the cell, replicate it faster through something like shockwave therapy. There are other therapies that can do that, but this is one of the easiest ones that we have. With it being so mechanoreceptive, the more can be better. But there's also kind of a dose response where sometimes a gentle shockwave gets better. Fibrinogen Release versus a stronger shockwave. And we're learning that especially in the upper extremity, less is more, a little bit lighter, a little bit more gentle, gets better fibrinogen release and better replication of that collagen production there too. So that's a little bit of the, the higher level. But we do have limitations. Not every candidate is going to do really well if they're bone on bone and there's nothing to feed off of. But we have a great opportunity to sit in between, you know, the chiropractic or PT world and then the stem cell injection world. We can be right here to keep people away from more aggressive therapies.

I love that. Do you find that many docs that bring shockwave into their practice are using it, as, I'm going to say, a new business line, or are they adding it in with their existing care plans or does. It depends upon the practice.

So it can certainly depend. What I've seen done very, very successfully is that for us this is new, right? For a clinician who's never used this in their practice, I don't recommend jumping right into new business because if you're not the expert yet, it's not a great idea. And you can certainly, you can hand off the responsibility of the actual therapy because it's relatively simple, it's gentle, you're not going to hurt somebody. But if you're not at a high level, at the machine yet yourself, then it's a great thing to start with your existing patient base and grow that into its own ent. Um, it's easy because you then, you know, infuse some table talk. You might put some posters and handouts out there. You can work this into your day one and your day two process if that's something that you stick with. But I do recommend all in house stuff. No great crazy marketing plans yet, because once you see where it sits and fits into your practice, then you can start building off of that because again, you don't want to treat everything. It's the same thing in chiropractic. Some people are family, some people are peds, some people are sports. And you're going to figure out where you sit in the shockwave world too. You might not want to treat feet and you want to just do upper extremity work. So once you know where your wheelhouse is and what your patients that are around you are looking for, then a great option to build this separate revenue stream within your practice that's very chiropractic friendly. A lot of the times I'm doing both in the same visit or a lot of my chiro patients would be great shockwave patients and vice versa.

That makes sense to me. So you have a unit to your left right now, and we're going to be doing in depth with some of your units coming here in Tampa in a few weeks time. But probably for the docs that have been looking at shockwave, maybe for a little while, they heard a friend bought a unit that maybe they see something at an event. There's a lot of different brands out, you know, out there. And making a good decision can sometimes be challenging. So when we look at shockwave centers of America, what are some of the unique aspects that you are able to bring to the table? Whether it's the hardware itself, whether it's support behind the scenes. What are some things that set you apart that everybody listening and watching should know about?

Sure. And we'll have a deeper conversation on the different branches in Shockwave as well. There is radial and there is focus shockwave and there's obviously a huge price difference, but there's a mechanism of action difference as well. The focus therapy works a little like a sniper rifle, where it gets stronger and more pinpoint the deeper it gets into tissue. And radial devices like ours, they start at a focal spot and they radiate outwards to create a little bit more spread, but it limits how deep they can penetrate into the tissue. So there's uses for both. Definitely for Most Cairos and PTs if they're just getting started in the world of shockwave, radial is going to cover more than enough for them. If they want to specify and get into deeper intensive therapies like hip labral tears and more orthopedic stuff, then maybe a focus unit could be on their radar too. No one device is perfect for every clinic. We just have to kind of figure out where they fit. Especially for me, who sees everything from the younger children to older ladies, the radial devices are very broad spectrum and very helpful for me. And so for us, early on early days, we started as a consulting company for all kinds of different machines and we wanted to figure out where the holes were in the market and how we could fill those holes with our own devices. After having conversations with manufacturers and like, we don't really want a white label to you, we don't know who you are. And we wanted to do their own protocols and I wanted to use our protocols to make this a little bit more robust or easier to implement into the chiropractic practice. So the one big thing that's different from ours is going to be the protocols themselves and that's the care planning. So how many visits for how long, the tempo and the power and how many shockwaves per session. So the volume. Those things are beautiful because we have 40 years of history of research to go off of and all of the pre programming in our machines goes straight back to those research articles. Because yes, you may change this based on the patient in front of you, but at least we have a parameter that's been proven to work. And so this is the one conversation that I have with the other guys is they've been doing the Same protocols for 40 years where the new research is actually showing us that difference. And so one of the beautiful things about our machines is that they're updatable and they're formable to new protocols that are coming out. There's a little slot for a USB device to go in the screen behind here. And so new protocols that come out or better research that comes out, we're able to actually update the device for the client at the same time. And we do of course have great backend help. I'm the one who does a lot of the training. I'm doing CE courses now for the last few weeks has been crazy in the world of chiropractic. I don't know why everybody has the same weekends for events, but I did like eight hours over two weeks of different CE credits, which was so fun for me in both the PT and the Cairo world. So support is there. We're based out of Atlanta, so all the machine maintenance, all the services done here in Atlanta as well. Our compressors are actually made in Texas, our electrical devices so that the components that support where things go at what time are built in Michigan. So as much as humanly possible, we infused American influences into the machine. The handles are still designed in Switzerland where everybody's handles are made, which is totally fine. We didn't want to reinvent the wheel, but we wanted to bring a device to market that made sense for the chiropractor. That's the biggest part of it.

I absolutely love it. So I'm going to encourage everybody listening and watching. Head over to shockwavecenters.com I will also drop a link down in the show notes or video notes. Connect with Dan and his team. If you are looking towards bringing in new technology that can help you help more people in a proven way that people are searching for, that really give you an opportunity to have an advantage in your community, I cannot recommend bringing shockwave in enough. Dan. Shockwave Centers of America, fantastic resource. And be on the lookout in a few weeks time where Dan and I are knee to knee and we're going to go deep into all of what his technology brings to the table. Dan, thank you so much for coming on and chatting today. Pleasure.

Thank you.

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