Acoustic sound wave treatment (also known as Low Impact Extracorporeal Shock Wave Therapy) has been used for the past 30 years. High impact extracorporeal shock waves have been used to break up kidney stones (called lithotripsy). In the context of calcifications in the kidneys, the mechanism of action is purely biomechanical: sound waves smash renal calculi into tiny fragments. These fragments are detoxified from the body through the urinary tract.
At ChillRx we use lower impact radial acoustic shock waves to heal soft tissue injury and to generate new tissue, muscle, nerves, bone and blood vessels. Radial shock waves penetrate the skin in a more diffuse way than focused shock waves; radial shock waves “radiate”, creating a broader treatment area. The depth of penetration is more shallow and diffuse. Radial shock wave therapy has many benefits including patient comfort and lower risk for tissue destruction.
ChillRx sound wave therapy works in two distinct ways: biomechanically & biochemically.
Biomechanically: radial shock waves encounter calcifications in tendons and ligaments and breaks them apart. This mechanism of action is similar to lithotripsy—but the depth of penetration and the amount of energy applied is much lower. This mechanism of action is also effective for alleviating ganglion cysts, neuromas, scar tissue etc. Radial shock waves break apart thickened or otherwise dysfunctional tissue.
Biochemically: LI-ESWT has been shown to have significant biochemical effects. There are several mechanisms of actions at work here.
- Cavitation: acoustic sound waves are unique. When applied they create a positive and negative force on cells (called shear force). This force causes millions of microscopic bubbles to form in the area; these bubbles rupture, creating microtrauma to the local region. This microtrauma stimulates a cascade of biological effects which includes immune system activation leading to new tissue generation.
- Cell permeability: Shearing forces increase the permeability of cell membranes (this is in contrast to the cell destruction that can occur from injury). This increased permeability allows for the migration of cell contents like RNA. Neighboring cells perceive the presence of RNA via cellular receptors called Toll-like receptor cells 3 TLRC 3. The body is fooled into thinking that there has been injury (there hasn’t—just increased cell permeability). The natural biologic repair system is activated. TLR3 is known to control both the immune and inflammatory response of the cells as well as to initiate the biologic cascade associated with tissue regeneration or repair. Soon after the TLR3 receptors are activated, stem cell attractants are produced. Within hours, stem cells begin arriving from neighboring tissue, including from bone marrow where many stem cells reside. These stem cells produce original tissue, not scar tissue, and can even remodel existing scar tissue. This stem cell activation has profound capacity to regenerate tissue, bone, muscle and nerves.
This schematic illustrates the biological cascade that is triggered by acoustic sound waves.
As you can see from the graphic, there are various growth factors and stem cells that are triggered by LI-ESWT. These include:
- VEGF: Vascular endothelial growth factor. This stem cell is angiogenic—differentiates into new blood vessels.
- eNOS: Endothelial Nitric Oxide Synthase which has numerous effects on endothelial cells: enhancement of proliferation and migration, inhibition of apoptosis and further vascular endothelial growth factor and fibroblast growth factor (FGF) release.
- PCNA: Proliferating Cell Nuclear Antigen: essential for cell replication
- 4Growth Factors: IGF-1, IL-6, TGF-B (important for collagen expression), transforming growth factor B-1.
- Fibroblasts and Fibroblast growth factor-2 FGF-2, TGF-B1 (necessary for collagen regrowth) and PGDF (platelet derived growth).
- BDNF: Brain derived neurotrophic factor—a protein produced inside nerve cellsthat builds and maintains the brain circuits which allow the nerve signals to travel.
- Mesenchymal stem cells
The mechanism of action is the triggering of these stem cells which then induces the neovascularization that improves blood supply and increases cell proliferation and eventual tissue regeneration.
Timing is everything! The rise of angiogenic markers occurred around one week and lasted for approximately 8 weeks after treatment. Data suggests that 4 to 8 weeks following shock wave treatment, there can be a 400% increase in blood vessels of all sizes. Neovascularization was first noted at 4 weeks and persisted for more than 12 weeks, along with cell proliferation. The effects of shock wave therapy are dose-dependent and symptoms will improve over time (12 weeks or more after treatment).
Permanent blood supply has been shown to increase following shock wave treatment and this helps in the fight against infections. Bacteria levels drop dramatically and the biofilms that protect the bacteria are also destroyed. Shock wave treatment also decreases pain, swelling and inflammation.
Acoustic sound waves modulate inflammation to optimize the healing process.. Acoustic sound waves modulate the inflammatory response in human endothelial cells via the stimulation of Toll-like receptor 3 (which is part of the innate immune system). Acoustic sound waves initially stimulate TLR 3 which is pro-inflammatory; a middle and late phase of inflammation suppression follows. Healing is optimized through this delicate balance of acute inflammation followed by inflammation suppression. This modulation of inflammation is a pre-requisite for angiogenesis and repair of injured tissue.
ChillRx is dedicated to the non-invasive, pain-free application of acoustic sound waves to repair and regenerate tissue of all kinds. We successfully treat all kinds of soft tissue injury ranging from plantar fasciitis, achilles tendonitis, bursitis, tennis and golf elbow, lower back pain and many more. We also successfully treat erectile dysfunction with acoustic sound waves by stimulating improved blood flow and activating tissue and nerve regeneration through endogenous stem cells.
ChillRx is committed to treating injuries and disease processes with non-invasive, drug and pain-free treatments. Both cryotherapy and acoustic sound wave therapy stimulate the body’s own endogenous healing processes—not relying on exogenous resources such as drugs or surgical interventions.
Please contact us for more information on how acoustic sound waves can help you!!