Thunder and Lightning: The new rehab modalities to treat pain.

Thunder and Lightning: The new rehab modalities to treat pain.

By David Bertone, PT, DPT, OCS


Every few years, technology advances in the world of physical therapy and rehabilitation have a profound effect on treatment options for pain and injury.  The latest advancement involves the combination of delivering mechanical stress to the injured area and then using the bodies natural healing properties to speed recovery.  This is delivered in the form of Radial Pulsed Shockwave Therapy and Class IV Laser light.  The mechanical energy delivered to the chronically irritated tissue in the form of shockwave therapy works by generating a wave of energy to the tissue by using a handheld projectile accelerator.  The force created by this device will deform structures enough to realign scarred and fibrotic tissue that develops from injury.  In addition, the added blood flow from the mechanical projectile, repetitive energy will bring the benefits of increased circulation to the damaged area.

So what is really happening to the tissue during shockwave treatment?  Pressure waves are created within the injured tissue causing microtrauma.  This sets off the release of a neuropeptide substance P which stimulates an inflammatory response, as well as an increase in vascularity which can promote the stimulation of stem cells within the tissue, which are required for repair. This mechanical energy can not be produced by any other means without causing significant injury to the already damaged tissue.  The repetitive microtrauma is delivered over a short time frame, 3-6 minutes, and is measured in the number of total impacts to the tissue.

Most of the scientific studies involving Radial Pulsed Shockwave therapy has focused on the benefit to chronically painful tissue such as that present in plantar fasciitis, tennis and pitcher’s elbow and rotator cuff pain.  All of these conditions have been identified as not being inflammatory in nature but more thickened tendon structures from overuse and repetitive injury.  Getting to these structures with mechanical energy can be very effective in changing the tissue make up, and reducing pain.

What is the role of light or laser therapy for these conditions?  This is the lightning component of thunder and lightning model for successfully treating chronic pain from structures that have been repetitively stressed over many years.  Laser light has been used for years to penetrate the skin and stimulate tissue and pain receptors.  The wavelength delivered using the Opton Class IV Laser is 980 and 810nm which is combined with 7W of power ensuring depth of penetration to levels needed to heal damaged and irritated tissue.

The Class IV Laser is used following the thunder application of Radial Pulsed Shockwave to begin the healing process following realignment and tissue changes from the mechanical energy.  This one-two punch is supported by several studies that have examined the combination for the injuries described above that have not responded to more traditional treatments such as steroid injections, massage, acupuncture and exercise.

Dr. Bertone is a doctoral trained physical therapist and board-certified in orthopedic rehabilitation by the American Board of Physical Therapy Specialties. He is President of db Orthopedic Physical Therapy with locations in Lincroft and Manalapan, NJ.  Dr. Bertone can be reached at 732-747-1262 or via e-mail at

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