“Any sufficiently advanced technology is equivalent to magic.” – Arthur C. Clarke
“…emerging research via prospective placebo-controlled, double-blind studies shows that ESWT
is effective and should be considered a proven technology.” – Lowell Scott Weil, Jr., DPM, MBA
In all situations, the PiezoWave2 is considered the non-invasive alternative to surgery. Shockwave treatments have been employed for several different musculoskeletal conditions including but not limited to:
Shoulder Impingement Syndrome – Peri-articular shoulder calcification
Medial (Golfer’s) and Lateral (Tennis) Epicondylitis
Tendonitis / Calcifying Tendonitis / Tendinopathy
Plantar Fasciitis and Heel Spurs
Non-unions and Avascular Necrosis
Repetitive stress injuries
Soft Tissue Strains
Neck, Hip and Back Pain
Michael Young is excited to be one of the first and few clinicians
in all of Boulder County that has the PiezoWave2 technology!
Make an appointment today.
What is Piezowave/Shockwave Therapy?
PIEZOWAVE, also known as Extracorporeal Shock Wave Therapy (ESWT), is also called MyACT or myofascial acoustic compression technique. While ESWT is used much more in the literature, the use of the term MyACT or myofascial acoustic compression technique is a more accurate description as this technology generates focused shock waves (sound) and allows the practitioner to direct them into the patient’s tissues at varying depths. Hereafter, I will use the term “MyAct.”
With MyAct, no electrical signals are transmitted, instead, precisely targeted sound waves stimulate the musculoskeletal system underneath your skin which results in the therapeutic stimulation that provides pain relief and leads to improved circulation in the targeted area triggering your body’s own natural healing processes.
MyAct is a treatment method that eliminates pain and improves mobility. These acoustic waves travel to inflamed areas prone to chronic damage and intense pain. These shock waves manipulate the targeted tissues by accelerating cell growth and repair. In doing so, the treatment can have several effects, including:
New Blood Vessel Formation
Release of Pain and Trigger Points
Reversal of Chronic Inflammation
Restorative Collagen Production
Stimulate Local Stem Cell Production
These effects work together to quickly repair tendons, bones, and soft tissues that are subject to chronic pain without the need for painkillers, injections, or surgery.
Myofascial Acoustic Compression Therapy (MyAct) is a relatively new technology in the United States but has been used in Europe for many years. Shockwave Therapy is an effective treatment focused on targeting the soft tissues affected by acute or chronic pain using acoustic waves. Utilizing acoustic pressure, it manipulates the targeted soft tissues in a precise spot giving a deep tissue procedure that directly targets at greater depths, without injuring the skin or superficial structures. Myofascial Acoustic Compression Therapy can lead to improved circulation, pain reduction, and healthy tissue remodeling in bone, tendon, and ligaments. MyAct is for those who are dealing with Myofascial (AKA musculoskeletal) pain syndrome. Disorders in the presence of myofascial trigger points that form abnormal tissue underneath the skin cause an increase in tension, lack of flexibility, and increased pain. MyAct helps to precisely identify these types of fibrotic changes and can help rehabilitate the muscle back to its original healthy state and restore motion by effectively targeting and treating them.
History of Shockwave Therapy (ESWT) and
Myofascial Acoustic Compression Therapy (MyACT)
cientists began exploring the potential use of ESWT on human tissue in the ‘60s and ’70s, and by the mid-1980s, ESWT began to be used as a lithotripsy treatment to break up kidney stones and gallstones.
Approaching ESWT from a “first do no harm” perspective, scientists wanted to know if ESWT on lower ureteral stones would adversely impact local bones. The result of these experiments was the discovery that ESWT has osteogenetic potential and stimulates fracture healing. Histological investigations confirmed the influence of ESWT on the activation of osteoblasts. It was later discovered that ESWT helped the vast majority of non-union fractures and also can speed up the healing of all fractures. This discovery led to the development of using ESWT on conditions other than stones. The technology for breaking apart stones was modified to make it safe and effective for myofascial complaints.
At the beginning of the 1990s, the first reports about shock wave therapy on various tendonitis were published. Further investigations led to the successful treatment of soft tissue diseases as well as orthopedic diseases such as heel spurs. The scientific evaluation of the ESWT aka Myofascial Acoustic Compression Therapy (MyACT) clinical studies and publications agree that this intervention shows high efficiency but very low complications and side effects (The FDA has classified the Piezowave as a Class 1 Device - this classification refers to medical devices with low to moderate risk that requires general controls.).
In the same way that added benefits of this technology have been discovered for orthopedic complaints, there are several other areas/types of health problems, for which the use of this technology is still relatively in its early stage which includes Erectile Dysfunction, Peyronie’s Disease, Dementia, Needle-less injections, Oncology, Cell Transfection, Bactericidal, and Fungicidal Applications, as well as its use in Dentistry. It should be noted that the use of this technology for medical applications is relatively in its infancy (less than 100 years old) and, like many medical discoveries, was serendipitous. So, obviously, this list is likely to expand.
Piezowave therapy is a non-invasive process with no side effects and many patients have found it to be an effective alternative to surgery. One additional advantage of MyAct is that these sound waves can be directed to help heal tissues that lie too deep for conventional physical manipulation. This type of challenge has always created limitations with cutaneous therapies such as acupuncture, cupping, bodywork, etc. While a practitioner can create change in most deeper tissue areas with techniques such as acupuncture and/or injection therapy using longer needles when there is something like an inflamed area that is not only on a deeper tissue/structure but also impacting a fairly large area and/or with larger patients influencing this region presents challenges. One of the promotional quotes from Piezowave, for example, states that ‘We go where your hands can’t.”
How It Works
The PiezoWave2 delivers mechanical energy in the form of sound waves to target tissue, including tenocytes in tendons, fibroblasts in ligaments and skin, osteocytes in bone, chondrocytes in articular cartilage, and endothelial cells in blood vessels, which are all highly responsive to mechanical energy. The PiezoWave2 then localizes trigger points and other pathologies, delivering highly focused acoustic pulses that penetrate precisely to the desired depth. This facilitates cellular repair by increasing blood flow and reducing pain.
This technology has been used successfully in the treatment of chronic pain since the early 1990s in Europe. While this technology is still relatively new to the United States (it was introduced only 4 years ago) it has become extremely popular in both the athletic community who usually want as much improvement in as short a time possible in order to return to a competitive level. It is also popular in those with more sedentary lifestyles as they become aware of how chronic pain syndromes can not only deprive them of fully participating in their day-to-day activities but also create a significant drain on their energy levels and quality of life.
Can Myofascial Acoustic Compression Technique Help You?
Like every therapeutic modality, some patients respond much better than others (not everything works equally for everyone). I have had patients report that this is the first modality where they experienced lasting improvement and I have had patients report that “they did not think that the machine did much.” Whether this has do to with the part of the body being treated, the individual patient, and/or other factors I have no idea currently regarding this. Perhaps if the patients with a lack of response pursued a series of treatments they would have experienced better results.
The musculoskeletal system is extremely complicated. In terms of myofascial pain what has been studied the most has been the “trigger points” that are found in skeletal muscles. Janet Travell, MD (perhaps most famous for treating JFK which resulted in her becoming the first female White House physician). Some other factors are relevant when trying to understand the complexity of myofascial pain. One of these is that Travell and others have noted that all body parts can develop “trigger points,” not just skeletal muscles. Skeletal muscles simply happen to be the easiest to study – usually, they can be “activated” by injecting them with hypertonic saline, which, while it is temporarily irritating, this irritation/activation of trigger points is short-lived. While other structures, such as bones, can also manifest trigger points, a researcher would find it difficult to find study participants to voluntarily have their bones injected not to mention potential safety and ethical violations. Another complicating factor is that muscles frequently develop adhesions and become “interdigitated” to each other and when you add in the formation of scar tissue, calcifications, and fascial connections you often get a gelatinous cluster and the exact percentage of any particular tissue pathology becomes an academic exercise. Perhaps the Chinese medical concept of “Blood Stagnation” better describes this pathology short of exploratory surgery to determine exactly what is occurring. Regardless of the specific mechanisms involved, the Piezowave machine can assist dramatically in reducing inflammation/improving circulation and as a result, not only improving symptoms but addressing the underlying pathology.
If you are suffering from conditions such as hip/leg pain, repetitive motion injuries, knee pain, MCL injury, back/neck pain, Achilles tendonitis, muscular strain, muscular adhesions, tennis/golfer’s elbow, frozen shoulder, shoulder impingements, etc. then MyAct therapy may provide lasting relief.
MyACT is Diagnostic as well as Therapeutic (and Patient Experience)
The diagnostic ability of the machine can be explained with details of the patient's experience:
When the machine is used on healthy tissue (no trigger points, inflammations, adhesions, etc.) the patient usually feels nothing (there are some “energetically sensitive” individuals who often feel everything, these include highly sensitive persons, synesthetes, etc.)
When the machine is used on pathological tissue (whether this is a result of trigger points, adhesions, inflammations, etc.) the patient will feel something. This is most commonly experienced as a “toothache in the tissue.” While this is not what one would describe as “comfortable” it is perceived as “therapeutic, similar to what a patient will experience when an acupuncture needle is placed in an “active” or “important” spot.” As with other modalities, the goal is to have the patient feel the intervention but not for it to become excessive or too uncomfortable. The intensity meter on the machine can adjust the output from an extremely low level (as is commonly best for sensitive inflammatory processes like Plantar Fasciitis) to a higher output. There are several variables at play here; the overall sensitivity (or lack of) of any individual patient as well as the degree of inflammation, etc. in the tissue itself. Usually, patients find a “therapeutic dosage” of stimulation where it is perceptible but not excessively uncomfortable.” Usually when the precise area related to a patient’s pain pattern is found they will confirm it, reporting that “that is my pain pattern” or something similar. This exact location(s) and tolerable intensity level are found in cooperation with the patient. Usually, very small movements of the interface and/or slight changes in angle will make a significant difference in finding the exact therapeutic location. As one would guess, accurate feedback is essential to obtaining maximum results.
So, in summary, the machine is “diagnostic” in the sense that when the interface is placed on the exact spot(s) the patient will recognize it as “their pain pattern.” There is no output or confirmation that is on the unit’s display that will inform the practitioner, so again excellent communication between patients and practitioners is a pre-requisite.
How Long Is an Individual Treatment and How Many Treatments Does It Take?
Most treatment protocols use 3 to 4,000 pulses and take approximately 20 minutes to complete. The initial treatment takes more time to properly review the patient’s situation and determine at what depth the likely pathology exists (there are two basic attachments, each with varying associated depths) . Of course, the specific number of pulses and time needed varies depending on the complexity and size of the pain area.
Commonly 3 to 6 sessions are administered for maximum benefit and these are usually separated by at least 3 days. While dramatic results are not uncommon, the Piezowave is not a panacea, it needs to be integrated with other therapies and lifestyle modifications, exercises, etc. For example, if a patient’s posture is perpetuating a chronic pain problem, while this tool may play a big role in a patient’s recovery, it will not serve as a substitute for correct posture, etc.
What Are The Side Effects Of MyACT?
There are many interventions that while temporarily can be experienced by the patient as “uncomfortable” (such as the use of intra-oral body work on several of the masticatory muscles) during the procedure however the long-lasting benefit is deemed “worth it” by patients. While the level of “uncomfortable-ness” of the use of MyACT is nowhere near as intense as receiving intra-oral work the comparison is relevant. Usually, patients report a mixture of “it hurts but feels good” (no safeword is needed). So most don’t consider this temporary mild discomfort to be a “Side Effect.”
In terms of actual side effects, the most prevalent one that has been reported is mild discomfort that could last for several hours after your initial session. Slight bruising, swelling, or numbness has also been reported, although have not had any patients report these. What I have been told is that these are extremely rare. Most patients suffer no side effects at all. (Again, the scientific evaluation of the ESWT aka Myofascial Acoustic Compression Therapy (MyACT) clinical studies and publications agree that this intervention shows high efficiency but very low complications and side effects, resulting in the FDA classifying the Piezowave as a Class 1 Device.
To learn if you’re an ideal candidate for Piezowave or shockwave therapy feel free to contact me and/or schedule a consultation! While the machine can treat myofascial trigger points, these on their own are not that challenging to create lasting change in (assuming that they are diagnosed and treated correctly). However, conditions that in my experience can be very challenging to create lasting change with include nerve-related conditions such as nerve injuries and neuropathy, and certain chronic inflammations, such as Plantar Fasciitis and De Quervain’s Tenosynovitis. At the time of this writing, I am 60 years old; I was not planning on purchasing another expensive medical device at this point in my career, however, after borrowing a unit for a month and seeing people respond to conditions that had largely eluded me for decades, especially nerve-related problems. was a game-changer for me and my patients.
Is Treatment with the Piezowave Affordable?
In my opinion, yes. I offer the first session (roughly 4,000 pulses) with my regular cost for initial visits. If someone wants to do a series of sessions I offer them as add-ons to my regular follow-up treatments which is currently $50 per treatment or 3 - 4,000 pulses, which is at the extreme low end of the national average. Packages are available, however, I recommend that you try a session first so you know if it is a good match for you.
As far as the cost per session, it should be remembered that purchasing the machine and its attachments is comparable with the average cost of purchasing a new car. Unlike a car, however, there are two attachments that are warrantied for a year and will eventually have to be replaced depending on usage. The other important factor that relates to the cost is that this is a relatively new technology. As some may remember, percussive gun “massagers,” were available 30 or more years ago, they simply cost 3 - 500 US dollars. Now that they are popular on a “Walmart” level you can find them at a fraction of that cost. Similar phenomena has happened with flat-screen TVs. So, while it is possible that 30 or more years from now similar things/price reductions may happen with this technology, currently it only serves a niche market of open-minded practitioners and educated, motivated patients.
The First and Only in Boulder County
Michael Young, L.Ac. is one of the FIRST and ONLY clinicians in all of Boulder County that has the PiezoWave2 technology and is now offering treatments in his office. If you are dealing with an acute or chronic injury or are looking for a new treatment approach, you have found the right spot.
Make an appointment today to experience it for yourself.
Extracorporeal Shock Wave Therapy (ESWT), or myofascial acoustic compression technique (MyACT) produces results that are backed by science. This is not just a fad treatment that fails to provide concrete results. Study after study has confirmed the method’s effectiveness in eliminating chronic pain and increasing mobility. By opting for this therapy you are getting a well-established therapy at a reasonable cost.
You can google this yourself but “ESWT or MyACT” is a proven effective treatment supported by medical literature.” The Success rate depends on the conditions treated. Statistics show over 90 percent of patients experience a reduction in their pain. In patients who suffer from plantar fasciitis and heel pain-related problems, pain reduction is remarkable. 39 studies showed a success rate of 94% in Plantar Fasciitis.
Research and Resources:
(Note - this is from Dr. Boaz Ritblatt, he is is a Doctor of Physical Therapy — http://aspirehw.com)
• Another good source — https://www.bodyprochiro.com/services/piezowaveshockwave-therapy
• For an example study — https://pubmed.ncbi.nlm.nih.gov/31221949
• All the above are from — https://boulderbackpainclinic.com/shockwave-therapy
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