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Alternative Treatments for Pelvic Dysfunction: How new technology is changing rehabilitation


We have started using a non-invasive therapy treatment called Shockwave or Low Intensity Softwave Therapy (LiSWT). Sounds a bit scary with the word shock. It is not! This is a high level therapy for treatment of soft tissue, reducing pain and promoting healing by stimulating your body's own ability to heal. There is an amazing body of research for the use of shockwaves, not only with musculoskeletal issues like bursitis, tendonitis, chronic muscle spasms, but for pelvic health! This includes and is not limited to incontinence, interstitial cystitis, chronic pelvic pain, prostatitis, erectile dysfunction, BHP, peyronie's disease, and painful periods to name a few.


You know pelvic health is our passion at Breathe Life PT. Emerging research with positive and sustainable outcomes using a non-invasive device, not required to be administered by a physician while improving pelvic health outcomes is AMAZING. This type of treatment seemed so far out of reach as it is not a common tool used in everyday physical therapy offices. But thanks to the adventurous pioneers Drs. Kelli and David, the owners and Chiropractors of Active Life Project, we have a rare opportunity to experience this therapy first hand.


What is Softwave Therapy?

  • Softwave therapy is the delivery of “shock waves” to an injured or dysfunctional tissue.

  • Think of a shockwave like a lightning bolt which generates energy and pushes energy through the ground. This is a grand scale shockwave.

  • The same energy administered by the softwave device is similar. The energy moves through a water based transducer that looks like an ultrasound head, and generates a quick pressure wave stimulating the area.

  • Cells are “cavitated” or shaken up to create a mechanical stimulation to start or restart tissue healing. The cells are not broken down or damaged, like other types of therapies like lysis. This unfocused application covers larger surface areas with penetrating depths of waves from 4-6 inches. It is used to treat local areas and diffuse areas.

  • This tricks the body into thinking there is a new injury without damaging the tissue. Your body's cells are stimulated to increase your natural stem cell production, promote anti-inflammation, increase tissue regeneration, reduce pain and improve tissue health!

  • The best part is that research suggests this treatment stimulates your OWN STEM CELLS within 45 minutes of this treatment. Remember, stem cells are able to repair and restore different parts of the body. When stem cells start to repair, this attracts other helper cells to begin working on soft tissue over the next few weeks, ultimately restarting the healing process to the damaged tissue.


Is LiSWT painful?

With each treatment, the softwaves are electro-hydraulically produced sound waves that exit the applicator at 3,355 miles per hour. The softwave does produce a quick bruise like pain or tenderness as it moves over the soft tissue you are treating. It is fascinating because many times, we find a spot that we expect to be painful is not. But a nearby spot may actually be the culprit. There is a therapeutic diagnostic quality to the treatment as well.


Why is this important to my pelvic health?

Many of us know and understand the healing qualities and outcomes of pelvic therapy. We understand the pelvic floor muscles do not live in isolation from other valuable systems in the pelvis like our bladder, bowels, prostate, uterus and ovaries. But unfortunately, therapies on the surface can be limiting.


Here’s what the research says:


Erectile dysfunction: LiSWT improved ED in part by enhancing erectile tissue health, increasing arterial peak systolic velocity and decreasing end velocity. Big terms for improved blood flow to the penis with incr erection rates, penile harness, increase in spontaneous morning erections.


PGAD aka Persistent Genital Arousal: LiSWT decreased the distressing symptoms or itching, pain or arousal with some reporting resolution of symptoms at 6 month follow up.


Vulvodynia/Vaginismus: Self report of pain decreased by at least 30%, ability to enjoy successful intercourse and improvement in pelvic floor strength. Research shows for vestibulodynia, women who received shock wave reported decreased pain and increased sexual function scores, compared to no change in the placebo group that hadn’t received the therapy at 1 month and 3 months post treatment.

Incontinence: LiSWT appears to increase smooth muscle tissue around urethra and vagina improving pelvic floor strength and minimizing leakage with 53% of clients being completely dry and no longer using incontinence pads at 1 month follow up.


Peyronie’s Disease: LiSWT changes pain associated with erections and improves blood flow, yet curvature of the penile shaft remains the same. Ultrasound in addition to SW changes shape.

Testicular Function: LiSWT has shown to improve testosterone blood levels by 45%, increasing libido and decreasing erectile dysfunction. This was also done without medications like viagra and cialis.


To quote another provider who utilizes LiSWT, the amazing Dr. Rachel Rubin, Urologist and Sex Medicine physician in the DC area has shared “ We don’t believe in magic, so we are excited to help further the research to see which patients' shockwave helps the most, and how best to incorporate this therapy in her multi-disciplinary and comprehensive approach to patient care. This is unlikely to be a miracle cure for all pain and all types of erectile dysfunction or pelvic pain. However, research has shown promise that it may be considered a tool in our toolbox that can help with tissue regeneration and pain alleviation. You have been an inspiration to walk with while enduring and navigating the difficulties of pelvic pain, erectile dysfunction and bladder change related to age changes, injury or plain stress. After reviewing the research, I see shockwave therapy to be promising. Having the ability to move the marker of progress from 50% to 75% or 75%-99%. Speaking with other pelvic therapists who use shockwave, they have shared significant improvements in pain and function once adding softwave therapy to treatment."

What does a treatment look like?

Treatments are 15 minute sessions focusing on direct application of LiSWT. A little bit of ultrasound gel, a few clicks and its done! If you want to read more about the Softwave unit available to our office check out https://softwavetrt.com/patients/ Typically, most treatments require a visit once per week for 6 weeks. Typically, after the third treatment, we should see a 60-75% reduction in pain. After 5-6 treatments, we should have the maximum stem cell production that will continue to migrate and repair the tissue over the next 8-12 weeks. Research shows a success rate for musculoskeletal disorders of 65-91%.


It is my hope we can work together and see new changes for your health and the entire field of pelvic health! Are you ready?


Feel free to reach out with any questions or interest in scheduling!


 

Dr. Amanda Heritage, PT, DPT, PRPC is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She has been practicing physical therapy for 11 years with a strong focus on pelvic health. She enjoys encouraging women about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.


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