Me: For me this is quite possibly the biggest find I have encountered in a long time and a major breakthrough. I know that the LIPUS technology used low intensity pulsed sound waves but this approach is the exact opposite, which uses high intensity shockwaves to get bones to heal. The amount of research and information out there is very high and it’s application for bone remodeling is high as well.
From study 1…
What we are seeing is that the ESWT technology has been around and acknowledged by medical professionals for at least 2 decades. This study shows that just like the PEMF and LIPUS technology, it can cause bone fractures or non-unions to heal together. The amount of high intensity pulsed wave is 6000 at 28kV in one session. A amall sample of blood was taken to test for NO level, TGF-Beta 1, VEGF, and BMP2, as well as calcium, alkaline phosphatase, calcitonin, and parathyroid hormone during 5 time zones, before the treatment, 1 day afterwards, and 1,3,and 6 months afterwards. In over 3/4th of the patients, there was union of the fracture. It seems that shockwaves caused an increase in the NO level and other osteogenic growth factors.
From study 2...
It seems that the ESWT technology has been used quite extensively in recent years as an alternative treatment from surgery. There are success in clinical and in vitro studies. The final conclusion…”FGF-2, an important growth factor in new bone formation, was shown to be produced by human fibroblasts and osteoblasts after treatment with ESWT. These findings demonstrate that ESWT is able to cause bone healing through a molecular way by inducing growth factor synthesis.”
From study 3…
Apparently the researchers have already looked into how to increase the long bong longitudinal growth rate by “We have studied several possibilities in order to stimulate longitudinal growth by means of enhancement of the vascular supply to the growth plate through perforations, implants or electromagnetic pulses.” So they looked into make a distraction, adding implants, and trying out E&M pulses like the PEMF technology. In this specific study it is stated…”we explored the effects of Extracorporeal Shockwave Therapy (ESWT) in the same animal model, to determine a possible longitudinal bone growth stimulation“. This is huge!! It is almost very much like the noninvasive electrical device patent we looked at a month back. The performed it on 24 rabbits putting the ESW stimulation on the tibia and femur using both a mid level pulse and a high level pulse. The left limbs were treated with 2000 pulses. There doesn’t seem to be any differences in cell count, fracture formation, periosteal reaction. However the longitudinal increase was 4.1% on average for all the limbs.
From PubMed study 1 link HERE…
Nitric Oxide. 2009 Jun;20(4):298-303. Epub 2009 Mar 10.
The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions.
Source
Department of Orthopedic Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.
Abstract
This study investigated the effects of extracorporeal shockwave treatment (ESWT) on bone healing and the systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Forty-two patients with 42 established non-unions of the femur and tibia were enrolled in this study. Each long bone non-union was treated with 6000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood were obtained for measurements of serum NO level and osteogenic growth factors including TGF-beta1, VEGF and BMP-2; serum levels of calcium, alkaline phosphatase, calcitonin and parathyroid hormone before treatment and at 1 day, 1, 3 and 6 months after treatment. The evaluations for bone healing included clinical assessments and serial radiographic examinations. At 6 months, bony union was radiographically confirmed in 78.6%, and persistent non-union in 21.4%. Patients with bony union showed significantly higher serum NO level, TGF-beta1, VEGF and BMP-2 at 1 month after treatment as compared to patients with persistent non-union. Shockwave-promoted bone healing was associated with significant increases in serum NO level and osteogenic growth factors. The elevations of systemic concentration of NO level and the osteogenic factors may reflect a local stimulation of shockwave in bone healing in long bone non-unions.
- PMID: 19281856 [PubMed – indexed for MEDLINE]
From study 2 link HERE…
- March 2011, Volume 131, Issue 3, pp 303-309
Stimulation of bone growth factor synthesis in human osteoblasts and fibroblasts after extracorporeal shock wave application
- Joerg Hausdorf, Birte Sievers, Marcus Schmitt-Sody, Volkmar Jansson, Markus Maier, Susanne Mayer-Wagner
Abstract
Background
Nonunion is a common problem in Orthopedic Surgery. In the recent years alternatives to the standard surgical procedures were tested clinically and in vitro. Extracorporeal shock wave therapy (ESWT) showed promising results in both settings. We hypothesized that in target tissue cells from nonunions like fibroblasts and osteoblasts ESWT increases the release of bone growth factors.
Methods
Fibroblasts and osteoblasts were suspended in 3 ml cryotubes and subjected to 250/500 shock waves at 25 kV using an experimental electrohydraulic lithotripter. After ESWT, cell viability was determined and cells were seeded at 1 × 105 cells in 12 well plates. After 24, 48, and 72 h cell number was determined and supernatant was frozen. The levels of growth factors FGF-2 and TGF-β1 were examined using ELISA. A control group was treated equally without receiving ESWT.
Results
After 24 h there was a significant increase in FGF-2 levels (p < 0.05) with significant correlation to the number of impulses (p < 0.05) observed. TGF-β1 showed a time-dependent increase with a peak at 48 h which was not significantly different from the control group.
Conclusions
FGF-2, an important growth factor in new bone formation, was shown to be produced by human fibroblasts and osteoblasts after treatment with ESWT. These findings demonstrate that ESWT is able to cause bone healing through a molecular way by inducing growth factor synthesis.
From ISMST.com study 3 link HERE…
Bone Growth Stimulation with Extracorporeal Shockwaves – Experimental Animal Model
Authors: Carlos Leal, Juan C. Lopez, Oscar E. Reyes
Institution:
Orthopaedic Research Laboratory, Bosque University Orthopaedics Program, Bogota DC, Colombia
Discrepancy in limb lengths is a common orthopaedic problem arising from either shortening or overgrowth of one or more bones of the limb. Minor discrepancies due to assimetry are very common, and these differences under 20 mm are well compensated, being almost one third of the normal asimptomatic population. Differences between 20 and 50 mm cause biomechanical problems in gait, spine deformities and early osteoarthrosis due to limb malalignement. However, these discrepancies are too small to consider major surgical procedures such as lengthenings, osteotomies or epiphisiodesis. We have studied several possibilities in order to stimulate longitudinal growth by means of enhancement of the vascular supply to the growth plate through perforations, implants or electromagnetic pulses.
In the present study we explored the effects of Extracorporeal Shockwave Therapy (ESWT) in the same animal model, to determine a possible longitudinal bone growth stimulation. We based our study in the literature reports that show femoral overgrowth after shaft fractures in children. Even though this side effect has been reported by many authors like Aitken in 1940, Shapiro in 1981 and Murray in 1996, the precise mechanism of vascular and humoral stimulation is still unknown. The microfractures caused by ESWT could generate the same effects and produce longitudinal overgrowth.
We studied 24 NewZealand Rabbits of 2 months of age and 2 Kg of weight, performind ESWT stimulation on tibial and femoral shafts. The specimens were divided in two groups: One using mid level ESWT (0.2 mj/mm2) and one using high level ESWT (0.5 mj/mm2). We treated the left limbs with 2000 shockwaves under sedation, and used the contralateral femurs and tibias as controls. The specimens were followed for 12 weeks, and after sacrifice longitudinal measurements were performed with milimetrical gauges. We also studied the X Rays on every specimen in order to describe any pathological finding, and performed a histomorphometric analysis to measure celularity and vascular patterns.
Our results showed that all femurs and tibias treated with ESWT grew more than their contralateral controls, but no statistically significant differences were found in the 2 way anova analysis comparing groups (P>0.05).No radiological differences were found, and the blind analysis did not show signs of periosteal reaction, macroscopic fractures or physeal changes.
The histomorphometric analysis did not show any differences in cell counts, physeal size or vascular patterns between groups. A normalized analysis was performed in order to determine the amount of growth comparing the differences between treated bones and their contralateral controls. We found that the overall growth was of 4.11% in average for femurs, tibias and whole limbs. Our results showed a very significant effect of ESWT on growing bone, in all of our treated specimens. However the comparison between groups is not significant, probably due to biological variability. We need to validate the overgrowth effect in terms of histologic and biologic ethiology, and current studies that include bone scanning and molecular biology are being performed to determine the precise cause of this ESWT growth stimulation.
FGF-2 along with Cyr61 with Retinoic Acid Receptor A decrease and FGF-4 decrease is key for chondroinduction to form new growth plates. That is this these are the growth factors to get stem cells to primitive chondrocyte cells to form new growth plates so this is an interesting find.