From Shock to AHH!! – Why it’s taken a bunch of penis-owners to bring shockwave therapy to the masses

Shockwave therapy has been around for decades, but if you’re like most people, you’ve only heard about it in the last few years as part of a campaign to get men to treat their penises with these high intensity sound waves as a means of improving the symptoms of erectile dysfunction.  And, let’s be clear, I’m a big fan of low intensity extracorporeal shockwave therapy (LIEWST) for improving blood flow to the penis. I’ve treated hundreds of men with this shockingly effective modality and have seen improvements in symptoms in more than 80% of my patients. It’s good stuff, for sure.  But, it’s not just for penises. It never has been.

LIEWST (I’ll just refer to it as shockwave therapy) got its start in the 1980’s when it was developed as a way to treat kidney stones non-invasively.  My husband used to get kidney stones and I remember waiting for him to come out of the surgery center after his first lithotripsy procedure. They loaded him up with pain medications and used real-time imaging to find the stones in his ureter, then applied the lithotripsy machine to his back, directing the pressure waves in such a precise way that an 8 mm kidney stone was turned to dust.  

Back in 1985 when urologists first found success treating kidney stones, they became worried that this blast of shock waves could damage the hip bone, which was often in the blast radius as they searched for stealthy ureteral stones.  What they learned changed everything.

Not only were hip bones left undamaged, further animal experiments showed that shock waves delivered to bone actually helped the bones heal faster from injury. The waves helped the body create more healthy bone through the activation of osteoblasts (bone-building cells).  This lead to a number of studies that demonstrated that shockwave therapy could help non-union fractures heal. Imagine applying a device to the skin over the site of a broken bone that hasn’t healed and seeing the two bone segments beginning to come together in 60-90% of patients.  These treatments weren’t a “one and done” kind of thing – they required multiple sessions over the course of weeks to months, but they were non-invasive (no needles or surgery), relatively non-painful and very safe (bruising and swelling occurred for a few days in some patients but were short-lived). 

If these superstar shockwaves can activate bone healing, what else can they do?  Well, it turns out, they can do a lot. By creating micro-trauma in the tissue, these sound waves set off a cascade of biological reactions that result in improved blood flow and better healing in whatever area is being treated.  The exact mechanism involves an increase in VEGF (which induces angiogenesis, meaning new blood vessel formation), increase in local nitric oxide (causing blood vessels to vasodilate, or open up, allowing more blood flow to the area), and recruitment of various types of stem cells to the area (which leads to active tissue regeneration).  All of this from some sound waves under pressure coming out of a hand-held device that sounds a bit like a jackhammer, but is otherwise completely benign. 

Studies showing efficacy of shock waves for musculoskeletal pain and injury number into the thousands.  Tennis elbow, plantar fasciitis, shin splints, muscle strain, ankle sprain, stress fracture, patellar tendonitis, and rotator cuff injury are some of the common indications for shock wave therapy, but the list is as long as my arm (and my “ape index” is high, if any of you know what that means”).  

Orthopedics isn’t the only world where shockwave therapy could be put to more use than it currently is.  Cardiology is another big one. Several studies in both pigs and humans have shown that shockwave therapy (delivered through the chest in a non-invasive way) can improve blood flow to the heart in cardiac disease patients.  Patients with severe angina have seen significant improvements in chest pain, less need for nitroglycerine, better blood flow to the heart, better ability to walk further in 6 minutes and stronger ejection fraction (pumping power) of the heart after just nine sessions of cardiac shockwave therapy (CSWT) over three months.  Similarly, cardiac shockwave therapy has been shown in studies to improve the rate of healing and heart tissue remodeling after myocardial infarction (heart attack). These positive benefits for patients with coronary artery disease are not short-lived. In fact, heart patients who occasionally get sessions of CSWT have fewer symptoms and improved long term quality of life compared to those who don’t. Oh, and did I mention the lack of serious side effects?  

I could go on and on:  Healing of chronic wounds in diabetic patients, better blood flow and improved walking distance in peripheral arterial disease, treatment of spastic paralysis and neuropathy in sufferers of post-traumatic diseases. And, of course, increasing blood flow and tissue regeneration in men with erectile dysfunction.

Despite the thousands of studies that have shown shockwave therapy to be beneficial for healing any number of different types of tissue, its widespread adoption by traditional physicians has been slow.  Like, snails’ pace on the Saharan Desert floor slow. Why? I suspect it’s at least partially a money thing.  

In the United States, it’s somewhat difficult to obtain insurance reimbursement for shockwave therapy.  Also, this treatment takes time – multiple sessions over weeks to months. It can be performed by a medical assistant or other non-physician, but it’s still a 10-30 minute treatment several days a week in a physician or physical therapist’s office.  Even if insurance did happen to cover the treatment, it’s not going to bring in nearly as much revenue to the doctor as doing a surgical procedure.  

For example, the cost of treatment for one particular rotator cuff problem (calcifying tendinopathy of the shoulder – CTS) with shockwave therapy was shown to be between 2700-4300 euros per patient in one study, compared with 13,400-23,450 euros for surgery.  The cost of cardiac shockwave therapy is probably similar, although I couldn’t find specific numbers. The most common current procedure for coronary artery disease (narrowed or blocked heart blood vessels) is the placement of a stent. This procedure, which is performed on 600,000 patients per year in the U.S., costs around $30,000.  

If you’re an orthopedic surgeon or an interventional cardiologist, a quick look at the numbers tells you that 5-10 times more money can be made by doing a quick shoulder surgery or throwing in a couple of cardiac stents than by adopting a more conservative approach that uses mystical sound waves to heal tissue.  This is not to say that shockwave therapy can or should be a replacement for surgery, because it definitely can’t in many cases. And, as a medical doctor myself, this is also not to say that doctors are money-grubbing dirtbags (because most of them are not). But, there’s no denying that flashy, expensive, invasive therapies and surgeries often catch our attention, distracting us from looking around for alternative, safer, and potentially just-as-effective options. 

Given its extreme safety and good overall effects in promoting blood flow and healing tissues, shockwave therapy should at least be on the list of therapies to consider when treating some of these common injuries and medical diseases.  

So why is shockwave therapy for the penis popping up everywhere these days when it hasn’t yet found its foothold in other specialties?  Yes, it works. Yes, it’s easy and painless. Yes, men like that it’s non-invasive and doesn’t require needles or medicines or surgeries.  But, it’s also because men are willing to spend money to keep their prized possessions in good working order. And, because men will spend their own money on this treatment (vs waiting for insurance to eventually cover their sessions at a much lower rate) doctors have found ways to bring this technology out from the dusty backroom of academic labs and into the warm, reassuring glow of their cash-pay clinics.  

Companies like GAINSWave, which really popularized this treatment for ED in the U.S., have garnered media attention for this “pill-free fix for erectile dysfunction.”  Magazines, morning talk shows, and celebrity biohackers have all come forward, talking about this incredible new therapy. Incredible, yes. It’s one of my favorite things.  But new? Not in the least.  

If you have erectile dysfunction (or “erectile less function” as I like to say) I absolutely recommend talking to your doctor about low intensity extracorporeal shockwave therapy.  To me, it’s a no-brainer if you can afford it. I treat men (and women!) daily with this technology and I’m pretty confident that they’re toasting their buddy, Mr Shockwave Therapy, each time they dive under the covers.  

It’s a fantastic technology and I’m happy to admit that my bedside table at home is often decorated not with a vase of fresh flowers or pretty candles, but with my office’s shockwave therapy machine.  That way, I can make sure all persons and parts in my household who need it or want it can get in a “quickie” (shockwave session, that is) anytime of the day or night. But, this is not the norm and most people don’t have access to their own shockwave therapy machines.  And, even if they did, there’s some education required to use them correctly.  

All of this is to say that shockwave therapy needs to come out of the shadows.  It’s not a “Woo Woo” or “New Age” therapy that magically heals without any actual evidence to support it.  It’s a complex, extremely well-studied treatment modality that has been shown (over and over and over again) to improve blood flow and regenerate tissue. 

It may not be as sexy as surgery or as lucrative as pharmaceuticals but the fact that we can repair our own bodies using something as safe as waves of sound is just about the coolest thing in the world. Just for fun, ask your doctor if he/she knows about shockwave therapy.   If not, I know a girl who has a blog (and a shockwave therapy machine on her bedside table) who’s happy to share her enthusiasm on the matter with just about anyone who asks.   

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