According to the National Library on Medicine, the lithotrite device was invented by French Surgeon and urologist Jean Civiale in 1832. His invention allowed surgeons to gain access to kidney stones too large to pass. The procedure involved insertion of the device through the urethra to the lodged kidney stone(s) where it could then be utilized to bore holes into the stone(s). Once numerous holes in the stone(s) were made, the lithotrite was additionally used to crush the stone(s) into smaller fragments. Then if all went as expected, the fragments were then able to be passed in the urine. This procedure became known as lithotripsy.
In the 1980's, a new technology called Extracorporeal Shockwave Lithotripsy (ESWL) began to rapidly replace the more than 180 year old manual procedure. ESWL allowed for an externally applied device with focused electrically generated energy waves to have the ability to completely break up kidney stones internally without the need for incisions or instrumentation being guided throughout the body. It was a major advancement at the time and remains a powerful and less invasive treatment for kidney, pancreatic, and gall stones.
Due to the overwhelmingly successful use of shockwaves for internal stones, clinicians and surgeons began to wonder if this shockwave energy could be utilized in other systems of the body with the same positive effects. This curiosity is what guided the development of Softwave TRT (Tissue Regenerative Technology) which is now a treatment options for dozens of indications. Shockwave treatments are being used daily around the world to stimulate nerve and tissue regeneration, as well as decreasing healing times from various musculoskeletal pain and injury conditions. You can read more about the technology here.
My first known awareness of this technology came from reading research articles early in my career as a physical therapist. These articles were reporting on the effects of ESWT (Extracorporeal Shockwave Therapy) treating Plantar Fasciitis which is well known stubborn musculoskeletal condition that many will experience in their lifetime. ESWT has gained significant interest in many soft tissue indications due to the less invasive nature of the treatment compared to medications, injections, and surgery as well as the clinically significant improvements that have been repeatedly demonstrated in the clinic and in research papers.
One day, I happened to stumble upon a business card in the building that currently houses VanSlyke Physical Therapy.
I was, of course, immediately curious about this treatment and this was my opportunity to find out more. So, I contacted Tim Blanc, owner and Operator of Apollo Wave, and we got together to discuss shockwave technology. Tim ultimately explained to me the various indications that he has successfully used softwave to treat.
Tim offered to show me how the device worked. He asked me if I had any pain or current injuries and I denyingly told him just the occasional and very short lived stiffness that I blame on turning 40 last year. He asked about older injuries and I proceeded to tell him about my ankle sprain from the Fall of 2007 and how it led me to have a lengthy running injury resume for a while. It ultimately came to be a catalyst for me changing careers and becoming a physical therapist but I had run 3 marathons on that ankle and was still going on it 16 years later. I did think about the occasional times that my right ankle would start to bother me without any justifiable reason. It would be fine after a 6 mile run but would be sore if I wore a pair of work style shoes during the day. I have always been very diligent about ensuring I keep the ankle mobile and strong regularly and this always seems to improve my ankle when I have this occasional nuisance. It certainly is way better than the period of time that I used a comedy bit from Louis C.K to talk about my ankle. (See "Incurable Shitty Ankle"). Be sure to go check that out as there are many who have very relatable experiences.
When I told this story to Tim he said, "Alright, let's treat your ankle then". Tim proceeded to show me the machine and the process of how he powers it up, how it primes itself by pumping water from the machine's main unit through the treatment line up to the end of the sound head, and finally runs a series of diagnostic tests before it indicates to you that the machine is ready. Tim explained to me what was about happen with the treatment so that I would be as ready as I could for the pulsing sensation of the device's sound waves.
When Tim first applied the sound head and turned the treatment on, I could hear an audible tap/pop pulsing sound and could feel what felt like someone flicking me moderately on the side of my lower right leg. The pulse remained constant throughout the treatment. The Shockwave device has a dual purpose where 1) it provides a therapeutic level of unfocused energy that has the ability to help your body and it's tissues heal itself from acute, subacute, and chronic tissue injuries and 2) it can be utilized as an assessment of injured tissue. The case and point for #2 is that during my Shockwave Therapy Treatment experience, when Tim moved the sound head closer to the ligaments that were likely overstretched, deformed, and partially torn back in 2007, my level of discomfort rose dramatically. The sensation of the pulse came to feel more like a small hammer and a mini chisel reaching areas and depths of my ankle I was not aware could be reached without having an arthroscopic procedure. Though I will admit the treatment of the tissue from this "old" injury was very uncomfortable at first, the discomfort level reduced nearly to pre treatment levels within just a couple of minutes of the treatment. This was a sign I would later learn to mean that healing had begun. Tim made sure to check in with me throughout the procedure to ensure I was tolerating the treatment.
I was more sore that evening and then less sore the following day. By the 3rd day my ankle was the best it has felt in as far as I could remember. I no longer had that dull ache on the outside of my right ankle bone. I went for a run and felt the right calf powering me on every leg push off as confident as it had ever been. The total treatment time was a round 15 minutes and within 2-3 days later was feeling no signs and symptoms of an Incurable Shitty Ankle.
This technology and treatment modality continues to spread through the professional sports world with teams such as the Atlanta Braves, Dallas Cowboys, Pittsburgh Steelers, Chicago Cubs, Los Angelos Lakers, New York Knicks, as well as PGA Golfer Graham McDowell are all using the Shockwave to get back in the game faster following an injury and they are staying in the game longer. I have heard personal stories of runners who have utilized this technology to get back to running following a bone stress injury as it is indicated for both non-union fractures as well as bone stress injuries. While training for the 2020 Olympic Games in Tokyo, US Olympic track coach Rose Monday treated her runners with Shockwave or what she referred to as a "secret weapon” because it helped them recover from injuries and push themselves to run faster, with less pain.