If you or some one you know suffers from osteoarthritis than please consider sound wave (shock wave) therapy.

The four stages of osteoarthritis are:

• Stage 1 – Minor. Minor wear-and-tear in the joints. Little to no pain in the affected area.
• Stage 2 – Mild. More noticeable bone spurs. ...
• Stage 3 – Moderate. Cartilage in the affected area begins to erode. ...
• Stage 4 – Severe. The patient is in a lot of pain.

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Introduction

Osteoarthritis (OA), which is often described as a degenerative joint disease, is the most common form of arthritis, followed by rheumatoid arthritis (RA), gout and lupus [1]. The cardinal symptoms of OA include pain, transient morning stiffness, a grating sensation in the joint and a loss of function that may ultimately lead to instability and physical disability and an impaired quality of life, which places heavy burdens on the affected individuals and their communities [2,3].

The treatment of OA remains challenging, and the exact definition, risk factors and pathophysiology of the disease remain incompletely elucidated [4,5]. OA pain is the primary complaint expressed by patients who seek clinical intervention. Multiple therapies, including pharmacological and non-pharmacological interventions, have been applied to patients with OA [6]. However, none of these treatments can completely eliminate OA pain.

In the past 15 years, extracorporeal shockwave therapy (ESWT) has emerged as a leading option for the efficient treatment of musculoskeletal disorders such as tendinopathy, lateral epicondylitis, calcific tendinitis and non-union of long bone fracture, as well as avascular necrosis of the femoral head [7–10]. In the United States, the Food and Drug Administration (FDA) has approved several specific shockwave devices for the treatment of proximal plantar fasciitis and lateral epicondylitis of the elbow [11,12]. In recent years, ESWT has been considered and introduced in the treatment of OA and investigations have demonstrated that ESWT can ameliorate the pathologic changes of OA, including cartilage and subchondral bone changes [13].

Recent studies have shown that ESWT can accelerate the healing of meniscal degeneration and plays a chondroprotective role in OA [14–16]. ESWT treatment can increase the activity of chondrocytes and decrease cartilage fissuring, as well as chondrocyte apoptosis [17], and it also has been proved that the chondroprotective effect is consistent and beneficial both in early or later stage of OA [18,19]. Furthermore, ESWT treatment can alleviate OA pain and improve motor function both in animal models and clinical trials [7,20,21]. These reports indicate the potential clinical application of ESWT as a novel treatment for OA.

At present, evidence show that definite effectiveness of ESWT in OA remains insufficient. Encouraged by the benefit of ESWT treating other musculoskeletal diseases, the purpose of the present study is to provide a positive overview in ESWT treating OA. We collected evidence from clinical trials and animal model studies to explore the function and possible mechanism of ESWT as a potential treatment for OA.

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Extracorporeal shockwave

Extracorporeal shockwave can be generated using an electrohydraulic, electromagnetic or piezoelectric source, and each source possesses features that can address specific diseases [22]. The first-generation shockwave machine used for musculoskeletal disease therapy was based on an electrohydraulic source that generated high-energy acoustic waves through an underwater explosion with a high-voltage electrode spark discharge. The shockwave energy output was transmitted through an elliptical reflector with a large-axial-diameter focal volume, and targeted at the diseased area of the body [23].

An electromagnetic source can generate a shockwave by passing an electric current through a coil to produce a magnetic field, which results in a sudden deflection of the membrane and generation of pressure waves in a fluid. Subsequently, a lens is applied to focus these waves onto the diseased area of the body, and the length of the lens can be used to determine the therapeutic point [24]. Piezoelectric sources can produce shockwaves via a high-voltage discharge across piezoelectric elements (i.e., a large number (>1000) of piezo crystals) mounted in a sphere, which induces a pressure pulse in the surrounding water that increases to a shockwave. The expansion of each element generates a pressure pulse that can enable the self-focusing of waves toward the target, leading to an extremely precise focus and high level of energy within a focal volume. The different features of these shockwave devices, including pressure distribution, energy density and total energy at the second focal point, can be used to treat varied diseases such as urolithiasis and musculoskeletal disorders.

In contrast with an ultrasound wave, a shockwave is uniphasic, with a peak pressure as high as 500 bars (∼1000 times the pressure of an ultrasound wave) [23]. Despite its successful clinical application, the mechanism of ESWT remains unclear. Possible physical, physicochemical, chemical and biological mechanisms underlying the effects of ESWT on tissues have been identified [25]. In the physical phase, a shockwave induces a positive pressure and thus the absorption, reflection, refraction and transmission of energy to tissues [23]. In the physicochemical phase, ESWT stimulates cells to release biomolecules such as adenosine triphosphate (ATP) and thus activate signaling pathways such as the extracellular signal-regulated kinase (ERK), focal adhesion kinase (FAK) and Toll-like receptor 3 (TLR3) pathways [25–27]. In the chemical phase, shockwaves can mediate transmembrane cellular ion channels and intracellular calcium flux [28]. Finally, previous studies have demonstrated several biological effects of ESWT, including improved angiogenesis, wound healing and bone non-union healing; modulation of tissue and nerve regeneration and inhibition of inflammatory activities [29–32].

Studies have proved ESWT can treat bone- and muscle-related diseases. Most clinical studies that have investigated the efficacy of ESWT for the treatment of proximal plantar fasciitis [33–36] and lateral epicondylitis of the elbow [37–39] have reported promising results and negligible complications. Many studies of ESWT for the treatment of patellar tendinopathy and Achilles tendinopathy have also yielded favorable results [40,41]. Reports of ESWT for the non-union and delayed union of long bone fracture have demonstrated the successful achievement of bone unions [42,43]. ESWT was also recently applied to the treatment of avascular necrosis of the femoral head [44]. Other reports described the positive effects of ESWT on knee OA [18], spinal fusion [45] and chronic diabetic foot ulcers [46]. However, the exact mechanism by which shockwave therapy mediates these effects remains unclear. We here showed a diagram of ESWT generated by radial pressure wave source and the characteristic of the wave source (Figure 1) referring to a study by Moya et al [47].

Figure 1

Illustrations of ESWT generated by radial pressure wave source (A) and its characteristics (B)

Air is draw in and compressed in the tube, which could cause a sudden rise of positive pressure towards the projectile, forming a radial wave toward the target through the applicator. ESWT can be applied to treat several musculoskeletal disorders. After the peak positive pressure, a negative pressure is formed and forced the projectile back, being ready for the next wave cycle.

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Extracorporeal shockwave treatment for osteoarthritis

Phil Gainan D.C.

Dr. Phil uses shock wave therapy for osteoarthritis in his Boardman, Ohio office.

6960 Market St.

Boardman,Ohio 

(330) 629-9476