TREATMENTS FOR BLOOD SUGAR LEVELS AND MUSCLE TISSUE OPTIMIZATION USING EXTRACORPOREAL ACOUSTIC SHOCK WAVES

Abstract

A method of treating red blood cells of a human patient has the steps of activating an acoustic shock wave generator or source to emit acoustic shock waves and subjecting a vascular system containing red blood cells and surrounding muscle tissue peripherally through an extremity of a patient to the acoustic shock waves by stimulating the extremity wherein the extremity is positioned within a path of the emitted shock waves and away from a geometric focal volume or point of the emitted shock waves. The methods also treat muscle tissue of aging patients, from muscle regeneration or athletes for legal performance enhancement without drugs.

Claims

1. The method of preventive shock wave therapy comprises the steps of: identifying a diabetic at risk patient, the patient having an at risk baseline blood sugar level; and subjecting the at risk extremity to shock waves to lower said baseline sugar level.

2. The method of preventive shock wave therapy of claim 1 wherein the step of identifying an at risk patient includes one or more indications of risk based on family history, genetic disposition, physical condition, or blood or extremity analysis.

3. The method of preventive shock wave therapy of claim 1 further comprises the step of testing the at risk extremity to establish measured the baseline condition pre shock wave therapy.

4. The method of preventive shock wave therapy of claim 1 further comprises the step of post shockwave therapy testing the blood sugar level for comparison to the baseline condition.

5. The method of treating red blood cells of a human patient of claim 1 wherein repeating the method periodically a plurality of times over a period of weeks to lower said baseline level of blood sugar.

6. A method of treating skeletal muscle tissue of an aging human patient comprises the steps of: activating an acoustic shock wave generator or source to emit acoustic shock waves; and subjecting surrounding muscle tissue peripherally to the acoustic shock waves by stimulating the muscle tissue wherein the muscle tissue is positioned within a path of the emitted shock waves and away from a geometric focal volume or point of the emitted shock waves.

7. The method of treating an aging human patient of claim 6 wherein the emitted shock waves are divergent or near planar.

8. The method of treating an aging human patient of claim 6 wherein the emitted shock waves are convergent having a geometric focal volume or point at a distance of at least X from the generator or source, the method further comprising positioning the extremity at a distance less than the distance X from the source.

9. The method of treating an aging human patient of claim 6 wherein the patient is exhibiting one or more impairments such as: age related skeletal muscle atrophy and sarcopenia resulting in the loss of muscle capacity and mass, progressive motor neuron degeneration, increases in fat mass, decreases in lean muscle, bone mass, and cellular environmental aberrances are commonly seen alterations of aging muscle, impairments in metabolic rate, aerobic capacity, strength and balance, functional capacity, along with emotional and cognitive distress.

10. The method of treating an aging human patient of claim 6 wherein the emitted shock waves are of a low intensity ranging from 0.10-0.12 mJ/mm.sup.2.

11. A method of treating skeletal muscle tissue of a human patient to optimize athletic performance and muscle resilience comprises the steps of: activating an acoustic shock wave generator or source to emit acoustic shock waves; and subjecting surrounding muscle tissue peripherally to the acoustic shock waves by stimulating the muscle tissue wherein the muscle tissue is positioned within a path of the emitted shock waves and away from a geometric focal volume or point of the emitted shock waves.

12. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the emitted shock waves are divergent or near planar.

13. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the emitted shock waves are convergent having a geometric focal volume or point at a distance of at least X from the generator or source, the method further comprising positioning the extremity at a distance less than the distance X from the source.

14. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the patient is exhibiting one or more impairments such as: age related skeletal muscle atrophy and sarcopenia resulting in the loss of muscle capacity and mass, progressive motor neuron degeneration, increases in fat mass, decreases in lean muscle, bone mass, and cellular environmental aberrances are commonly seen alterations of aging muscle, impairments in metabolic rate, aerobic capacity, strength and balance, functional capacity, along with emotional and cognitive distress.

15. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the emitted shock waves are of a low intensity ranging from 0.10-0.14 mJ/mm.sup.2.

16. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the emitted shock waves cause a quick removal of lactic acid from the cells of the muscle tissue allowing quicker muscle recovery.

17. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the treatment causes rapid recovery from muscle cramping.

18. The method of treating a human patient to optimize athletic performance and muscle resilience of claim 11 wherein the treatment is used for erectile dysfunction or penis performance enhancement.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0037] The invention will be described by way of example and with reference to the accompanying drawings in which:

[0038] FIG. 1 illustrates a diabetic patient or a patient at risk of diabetes being treated with a shock wave apparatus in the leg region of an extremity to stimulate the vascular system and surrounding muscle tissue, the patient being oriented face down and lying on his stomach.

[0039] FIG. 2 illustrates a diabetic patient or a patient at risk of diabetes being treated with a shock wave apparatus in the arm region of an extremity to stimulate the vascular system and surrounding muscle tissue, the patient being oriented face down and lying on his stomach.

[0040] FIG. 3 illustrates a diabetic patient or a patient at risk of diabetes being treated with a shock wave apparatus in the foot region of an extremity to stimulate the vascular system and surrounding muscle tissue, the patient being oriented face down and lying on his stomach.

[0041] FIG. 4A is a simplified depiction of a pressure pulse/shock wave (PP/SW) generator with focusing wave characteristics.

[0042] FIG. 4B is a simplified depiction of a pressure pulse/shock wave generator with plane wave characteristics.

[0043] FIG. 4C is a simplified depiction of a pressure pulse/shock wave generator with divergent wave characteristics.

[0044] FIG. 5A is a simplified depiction of a pressure pulse/shock wave generator having an adjustable exit window along the pressure wave path. The exit window is shown in a focusing position.

[0045] FIG. 5B is a simplified depiction of a pressure pulse/shock wave generator having an exit window along the pressure wave path. The exit window as shown is positioned at the highest energy divergent position.

[0046] FIG. 5C is a simplified depiction of a pressure pulse/shock wave generator having an exit window along the pressure wave path. The exit window is shown at a low energy divergent position.

[0047] FIG. 6 is a simplified depiction of an electro-hydraulic pressure pulse/shock wave generator having no reflector or focusing element. Thus, the waves of the generator did not pass through a focusing element prior to exiting it.

[0048] FIG. 7A is a simplified depiction of a pressure pulse/shock wave generator having a focusing element in the form of an ellipsoid. The waves generated are focused.

[0049] FIG. 7B is a simplified depiction of a pressure pulse/shock wave generator having a parabolic reflector element and generating waves that are disturbed plane.

[0050] FIG. 7C is a simplified depiction of a pressure pulse/shock wave generator having a quasi parabolic reflector element (generalized paraboloid) and generating waves that are nearly plane/have nearly plane characteristics.

[0051] FIG. 7D is a simplified depiction of a generalized paraboloid with better focusing characteristic than a paraboloid in which n=2. The electrode usage is shown. The generalized paraboloid, which is an interpolation (optimization) between two optimized paraboloids for a new electrode and for a used (burned down) electrode is also shown.

[0052] FIG. 8 is a simplified depiction of a pressure pulse/shock wave generator being connected to a control/power supply unit.

[0053] FIG. 9 is a simplified depiction of a pressure pulse/shock wave generator comprising a flat EMSE (electromagnetic shock wave emitter) coil system to generate nearly plane waves as well as an acoustic lens. Convergent wave fronts are leaving the housing via an exit window.

[0054] FIG. 10 is a simplified depiction of a pressure pulse/shock wave generator having a flat EMSE coil system to generate nearly plane waves. The generator has no reflecting or focusing element. As a result, the pressure pulse/shock waves are leaving the housing via the exit window unfocused having nearly plane wave characteristics.

[0055] FIG. 11 is a simplified depiction of a pressure pulse/shock wave generator having a flat piezoceramic plate equipped with a single or numerous individual piezoceramic elements to generate plane waves without a reflecting or focusing element. As a result, the pressure pulse/shock waves are leaving the housing via the exit window unfocused having nearly plane wave characteristics.

[0056] FIG. 12 is a simplified depiction of a pressure pulse/shock wave generator having a cylindrical EMSE system and a triangular shaped reflecting element to generate plane waves. As a result, the pressure pulse/shock waves are leaving the housing via the exit window unfocused having nearly plane wave characteristics.

[0057] FIG. 13 is a simplified depiction of a pressure pulse/shock wave (PP/SW) generator with focusing wave characteristics shown focused with the focal point or geometrical focal volume being on a substance, the focus being targeted on the location X.sub.0.

[0058] FIG. 14 is a simplified depiction of a pressure pulse/shock wave (PP/SW) generator with the focusing wave characteristics shown wherein the focus is located a distance X, from the location X.sub.0 of a substance wherein the converging waves impinge the substance.

[0059] FIG. 15 is a simplified depiction of a pressure pulse/shock wave (PP/SW) generator with focusing wave characteristics shown wherein the focus is located a distance X.sub.2 from the mass location X.sub.0 wherein the emitted divergent waves impinge the substance.

DETAILED DESCRIPTION OF THE INVENTION

[0060] The With reference to FIG. 1, the patient P who has either been diagnosed with diabetes or is at risk of contracting diabetes is positioned on a table T preferably face down lying on the stomach. A shock wave applicator head 43 is brought into contact with the skin P.sub.s of a leg 100T preferably an acoustic gel is used to enhance the transmission of the shock waves 200 through the body down to the subsurface extremity 100 containing a portion of the vascular system 101 surrounded by muscle tissue 102. The shock wave applicator head 43 is connected via cabling 42 to a power generating unit 41 as shown. The shock wave applicator head 43 can be attached rigidly to a fixture or stand 44 as illustrated or alternatively can be hand held and manipulated across the skin P.sub.s to drive the shock waves 200 in the direction the shock wave head 43 is pointed.

[0061] With reference to FIG. 2, the patient P's body is shown with the applicator directly above an arm 100A containing a portion of the vascular system 101 surrounded by muscle tissue 102. As illustrated the vascular system 101 is being bombarded with shock waves 200 that are emitted from the lens 17 directly into the patient P to provide the therapeutic treatment of acoustic shock waves 200 to the extremity 100.

[0062] With reference to FIG. 3, the patient P's body is shown with the applicator directly above a foot 100F containing a portion of the vascular system 101 surrounded by muscle tissue 102. As illustrated the vascular system 101 is being bombarded with shock waves 200 that are emitted from the lens 17 directly into the patient P to provide the therapeutic treatment of acoustic shock waves 200 to the extremity 100. Numerous large blood vessels 122 lie within the extremity 100. When these nerve cells are irritated or not properly producing neuropeptides, it is possible to shut down the islets such that they will no longer properly produce insulin. This is a condition commonly referred to as diabetes and can occur in type 1 or type 2 diabetes. When this condition occurs, it has been determined that shutting the nerve cells down for a period of time will enable the islets to continue to produce insulin in a normal fashion. It has therefore been determined that the analgesic effect of shock waves 200 when bombarding the vascular system 101 can be used to at least partially deactivate the nerve cells surrounding the islet such that these islets can begin to produce insulin properly. After a treatment with shock waves 200 it has further been determined that the damaged nerve cells in the incretin nerve system surrounding the islets 120 can be healed and stimulated to properly secrete neuropeptides which when properly secreted further enhance the ability of the islets to produce insulin normally. After treatment with shock waves 200 the chronic inflammation commonly associated with the vascular system and these extremities 100 can be reduced dramatically indicating that the extremity 100 is being healed in such a fashion that the nerves surrounding are no longer irritated or sensitized and that the entire pancreatic system can now perform properly. The common pain associated with the pancreatic condition can be alleviated in this way and the proper functioning of the vascular system 101 can be stimulated such that the diabetic condition can be eliminated or greatly reduced and the blood cells of the vascular system 101 can operate normally with normal levels of blood sugar. This condition can be conducted on a person already experiencing diabetic indications of type 1 or type 2 or can be used on people with known risk of diabetic conditions. It is preferred that the treatment be used with non focused shock waves to eliminate or minimize hemorrhaging or focused shock waves can be used wherein the wave pattern does not have the focal point generated on the pancreatic extremity 100, otherwise this can create hemorrhaging and potential damage to the vascular system 101 if the intensity level of the focused shock wave is too intense. For these reasons it is preferable to use the divergent or non-planar or planar shock waves for the treatment of a diabetic vascular system 101. These lower energy, lower amplitude shock waves described hereinafter can provide the beneficial effects without creating any trauma to the vascular or muscular skeletal systems, furthermore these treatments can be done on an outpatient basis as will be described.

[0063] A case series by Kenneth Craig Vincent, Medical Director—Kompass Health Associates, Auckland, New Zealand, attempting to improve skeletal muscle function in the older adult population derived some interesting complimentary data. The application of shockwave treatment (SWT) utilizing a DermaGold-100 (TRT LLC, USA) not only improved muscle mass, balance, and stability across the 10 trial subjects, but simultaneously indicated that blood sugar levels of three (3) of the diabetic subjects noticed an improvement in both fasting (Table 1) and postprandial (Table 2) blood sugar levels after 3 sessions of SWT.

[0064] The treatment protocol involved the application of SWT onto the hamstrings, gastrocnemius/soleus complex, and the planter aspect of the foot. Three sessions of SWT were applied onto to each subject over a one week interval.

TABLE-US-00001 TABLE 1 Fasting Blood Sugar levels taken by patient utilizing personal glucometer. Readings are based on the daily average over each week. Wk 2 Wk 4 Wk 8 Fasting Post Post Post Blood Sugar Baseline SWT SWT SWT Subject 1 (62 yr old) 128 mg/dl 126 mg/dl 122 mg/dl 116 mg/dl Subject 2 (56 yr old) 122 mg/dl 119 mg/dl 117 mg/dl 112 mg/dl Subject 3 (58 yr old) 126 mg/dl 123 mg/dl 121 mg/dl 118 mg/dl

TABLE-US-00002 TABLE 2 Blood sugar level 2 hours postprandial levels taken by patient utilizing personal glucometer. Readings are based on the daily average over each week. Wk 2 Wk 4 Wk 8 Postprandial Post Post Post Blood Sugar Baseline SWT SWT SWT Subject 1 (62 yr old) 163 mg/dl 159 mg/dl 157 mg/dl 153 mg/dl Subject 2 (56 yr old) 158 mg/dl 158 mg/dl 155 mg/dl 150 mg/dl Subject 3 (58 yr old) 161 mg/dl 157 mg/dl 154 mg/dl 151 mg/dl

[0065] These figures suggest that the increase in skeletal muscle mass and activity would increase metabolic demand and simultaneously increase blood sugar uptake, improving both fasting and postprandial blood sugar levels in diabetic patients. It is therefore plausible to hypothesize that application of an increased number of SWT impulses over the skeletal muscle of the lower extremity could help improve the control of blood sugar levels in diabetics.

[0066] Accordingly, a periodic treatment regimen of emitting 500 or more shock wave pressure pulses, preferably about 1500 pressure pulses at a low pulse energy of 0.1 mJ/mm.sup.2 or higher up to 1.0 mJ/mm.sup.2, preferably about 0.3 to 0.5 mJ/mm.sup.2 over a period of weeks on the extremity 100 will remotely improve the patient's high baseline blood sugar levels to approach, if not achieve, normal blood sugar levels.

[0067] The following description of the proper amplitude and pressure pulse intensities of the shock waves 200 are provided below along with a description of how the shock waves actually function and have been taken from the co-pending application of the present inventors and replicated herein as described below. For the purpose of describing the shock waves 200 were used as exemplary and are intended to include all of the wave patterns discussed in FIGS. 4A-15 as possible treatment patterns.

[0068] This method of treatment has the steps of, locating a treatment site, generating either convergent diffused or far-sighted focused shock waves or unfocused shock waves, of directing these shock waves to the treatment site; and applying a sufficient number of these shock waves to induce activation of one or more growth factor thereby inducing or accelerating healing.

[0069] The unfocused shock waves can be of a divergent wave pattern or near planar pattern preferably of a low peak pressure amplitude and density. Typically the energy density values range as low as 0.000001 mJ/mm.sup.2 and having a high end energy density of below 1.0 mJ/mm.sup.2, preferably 0.20 mJ/mm.sup.2 or less. The peak pressure amplitude of the positive part of the cycle should be above 1.0 and its duration is below 1-3 microseconds.

[0070] The treatment depth can vary from the surface to the full depth of the human or animal torso and the treatment site can be defined by a much larger treatment area than the 0.10-3.0 cm.sup.2 commonly produced by focused waves. The above methodology is particularly well suited for surface as well as sub-surface soft extremity treatments.

[0071] While one of the benefits of the non-invasive nature of this treatment relates to reducing patient recovery and healing time, the fact that the treatments can be delivered at dosages well below the threshold of pain means that no local or general anesthesia is typically required as a consequence of the treatment. This alone significantly reduces any risk factors or complications associated with pain management during the procedure. The treatments further can reduce the need for a regiment of chemical or drug therapies before or after exposure to this shock wave therapy. Alternatively, ESWT can be used in conjunction with chemical or drug therapies to increase the cellular response permitting an opportunity to lower dosages of such chemicals or drugs while increasing the therapeutic efficiency. This is a particularly useful tool for the physician whose patient is elderly, a smoker or with an immune system deficiency which would complicate if not make unavailable more traditional invasive surgical procedures. In fact the above methodology proposed in this patent may be the first if not only choice of treatment available for patients in this class wherein heretofore conventional procedures were deemed too risky.

[0072] A further clinical benefit of the above methodology is that the procedure can be done either as an outpatient treatment or at a doctor's office assuming the patient's condition does not otherwise require hospitalization.

[0073] The stimulation of growth factors and activation of healing acceleration is particularly valuable to elderly patients and other high risk factor subjects.

[0074] Even more striking as mentioned earlier, early prevention therapies can be employed to stimulate extremity or organ modeling to be maintained within acceptable ranges prior to a degeneration occurring. This is extremely valuable in the prevention of diabetes or heart disease for example. The methods would be to identify at risk patients based on family history or genetic disposition, physical condition, etc. and subjecting that patient to therapeutic shock wave therapy for the purpose of stimulating extremity repair effectively remodeling the patient's susceptible organ to be within accepted functional parameters. The objective being to preventively stimulate cellular extremity repairs to preemptively avoid a degenerative condition from occurring which may require invasive surgical procedures.

[0075] FIG. 4A is a simplified depiction of a pressure pulse/shock wave (PP/SW) generator, such as a shock wave head, showing focusing characteristics of transmitted acoustic pressure pulses. Numeral 1 indicates the position of a generalized pressure pulse generator, which generates the pressure pulse and, via a focusing element, focuses it outside the housing to treat diseases. The diseased organ is generally located in or near the focal point which is located in or near position 6. At position 17 a water cushion or any other kind of exit window for the acoustical energy is located.

[0076] FIG. 4B is a simplified depiction of a pressure pulse/shock wave generator, such as a shock wave head, with plane wave characteristics. Numeral 1 indicates the position of a pressure pulse generator according to the present invention, which generates a pressure pulse which is leaving the housing at the position 17, which may be a water cushion or any other kind of exit window. Somewhat even (also referred to herein as “disturbed”) wave characteristics can be generated, in case a paraboloid is used as a reflecting element, with a point source (e.g. electrode) that is located in the focal point of the paraboloid. The waves will be transmitted into the patient's body via a coupling media such as, e.g., ultrasound gel or oil and their amplitudes will be attenuated with increasing distance from the exit window 17.

[0077] FIG. 4C is a simplified depiction of a pressure pulse shock wave generator (shock wave head) with divergent wave characteristics. The divergent wave fronts may be leaving the exit window 17 at point 11 where the amplitude of the wave front is very high. This point 17 could be regarded as the source point for the pressure pulses. In FIG. 4C the pressure pulse source may be a point source, that is, the pressure pulse may be generated by an electrical discharge of an electrode under water between electrode tips. However, the pressure pulse may also be generated, for example, by an explosion. The divergent characteristics of the wave front may be a consequence of the mechanical setup shown in FIG. 5B.

[0078] FIG. 5A is a simplified depiction of a pressure pulse/shock wave generator (shock wave head) according to the present invention having an adjustable or exchangeable (collectively referred to herein as “movable”) housing around the pressure wave path. The apparatus is shown in a focusing position. FIG. 5A is similar to FIG. 4A but depicts an outer housing (16) in which the acoustical pathway (pressure wave path) is located. In a preferred embodiment, this pathway is defined by especially treated water (for example, temperature controlled, conductivity and gas content adjusted water) and is within a water cushion or within a housing having a permeable membrane, which is acoustically favorable for the transmission of the acoustical pulses. In certain embodiments, a complete outer housing (16) around the pressure pulse/shock wave generator (1) may be adjusted by moving this housing (16) in relation to, e.g., the focusing element in the generator. However, as the person skilled in the art will appreciate, this is only one of many embodiments of the present invention. While the figure shows that the exit window (17) may be adjusted by a movement of the complete housing (16) relative to the focusing element, it is clear that a similar, if not the same, effect can be achieved by only moving the exit window, or, in the case of a water cushion, by filling more water in the volume between the focusing element and the cushion. FIG. 5A shows the situation in which the arrangement transmits focused pressure pulses.

[0079] FIG. 5B is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having an adjustable or exchangeable housing around the pressure wave path with the exit window 17 being in the highest energy divergent position. The configuration shown in FIG. 5B can, for example, be generated by moving the housing (16) including the exit window (17), or only the exit window (17) of a water cushion, towards the right (as shown in the Figure) to the second focus f2 (20) of the acoustic waves. In a preferred embodiment, the energy at the exit window will be maximal. Behind the focal point, the waves may be moving with divergent characteristics (21).

[0080] FIG. 5C is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having an adjustable or exchangeable housing around the pressure wave path in a low energy divergent position. The adjustable housing or water cushion is moved or expanded much beyond f2 position (20) so that highly divergent wave fronts with low energy density values are leaving the exit window (17) and may be coupled to a patient's body. Thus, an appropriate adjustment can change the energy density of a wave front without changing its characteristic.

[0081] This apparatus may, in certain embodiments, be adjusted/modified/or the complete shock wave head or part of it may be exchanged so that the desired and/or optimal acoustic profile such as one having wave fronts with focused, nearly plane or divergent characteristics can be chosen.

[0082] A change of the wave front characteristics may, for example, be achieved by changing the distance of the exit acoustic window relative to the reflector, by changing the reflector geometry, by introducing certain lenses or by removing elements such as lenses that modify the waves produced by a pressure pulse/shock wave generating element. Exemplary pressure pulse/shock wave sources that can, for example, be exchanged for each other to allow an apparatus to generate waves having different wave front characteristics are described in detail below.

[0083] In certain embodiments, the change of the distance of the exit acoustic window can be accomplished by a sliding movement. However, in other embodiments of the present invention, in particular, if mechanical complex arrangements, the movement can be an exchange of mechanical elements.

[0084] In one embodiment, mechanical elements that are exchanged to achieve a change in wave front characteristics include the primary pressure pulse generating element, the focusing element, the reflecting element, the housing and the membrane. In another embodiment, the mechanical elements further include a closed fluid volume within the housing in which the pressure pulse is formed and transmitted through the exit window.

[0085] In one embodiment, the apparatus of the present invention is used in combination therapy. Here, the characteristics of waves emitted by the apparatus are switched from, for example, focused to divergent or from divergent with lower energy density to divergent with higher energy density. Thus, effects of a pressure pulse treatment can be optimized by using waves having different characteristics and/or energy densities, respectively.

[0086] While the above described universal toolbox of the present invention provides versatility, the person skilled in the art will appreciate that apparatuses that only produce waves having, for example, nearly plane characteristics, are less mechanically demanding and fulfill the requirements of many users.

[0087] As the person skilled in the art will also appreciate that embodiments shown in drawings 4A-4C and 5A-5C are independent of the generation principle and thus are valid for not only electro-hydraulic shock wave generation but also for, but not limited to, PP/SW generation based on electromagnetic, piezoceramic and ballistic principles. The pressure pulse generators may, in certain embodiments, be equipped with a water cushion that houses water which defines the path of pressure pulse waves that is, through which those waves are transmitted. In a preferred embodiment, a patient is coupled via ultrasound gel or oil to the acoustic exit window (17), which can, for example, be an acoustic transparent membrane, a water cushion, a plastic plate or a metal plate.

[0088] FIG. 6 is a simplified depiction of the pressure pulse/shock wave apparatus having no focusing reflector or other focusing element. The generated waves emanate from the apparatus without coming into contact with any focusing elements. FIG. 6 shows, as an example, an electrode as a pressure pulse generating element producing divergent waves (28) behind the ignition point defined by a spark between the tips of the electrode (23, 24).

[0089] FIG. 7A is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having as focusing element an ellipsoid (30). Thus, the generated waves are focused at (6).

[0090] FIG. 7B is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having as a focusing element an paraboloid (y.sup.2=2px). Thus, the characteristics of the wave fronts generated behind the exit window (33, 34, 35, and 36) are disturbed plane (“parallel”), the disturbance resulting from phenomena ranging from electrode burn down, spark ignition spatial variation to diffraction effects. However, other phenomena might contribute to the disturbance.

[0091] FIG. 7C is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having as a focusing element a generalized paraboloid (y.sup.n=2px, with 1.2<n<2.8 and n≠2). Thus, the characteristics of the wave fronts generated behind the exit window (37, 38, 39, and 40) are, compared to the wave fronts generated by a paraboloid (y.sup.2=2px), less disturbed, that is, nearly plane (or nearly parallel or nearly even (37, 38, 39, 40)). Thus, conformational adjustments of a regular paraboloid (y.sup.2=2px) to produce a generalized paraboloid can compensate for disturbances from, e.g., electrode burn down. Thus, in a generalized paraboloid, the characteristics of the wave front may be nearly plane due to its ability to compensate for phenomena including, but not limited to, burn down of the tips of the electrode and/or for disturbances caused by diffraction at the aperture of the paraboloid. For example, in a regular paraboloid (y.sup.2=2px) with p=1.25, introduction of a new electrode may result in p being about 1.05. If an electrode is used that adjusts itself to maintain the distance between the electrode tips (“adjustable electrode”) and assuming that the electrodes burn down is 4 mm (z=4 mm), p will increase to about 1.45. To compensate for this burn down, and here the change of p, and to generate nearly plane wave fronts over the life span of an electrode, a generalized paraboloid having, for example n=1.66 or n=2.5 may be used. An adjustable electrode is, for example, disclosed in U.S. Pat. No. 6,217,531.

[0092] FIG. 7D shows sectional views of a number of paraboloids. Numeral 62 indicates a paraboloid of the shape y.sup.2=2px with p=0.9 as indicated by numeral 64 at the x axis which specifies the p/2 value (focal point of the paraboloid). Two electrode tips of a new electrode 66 (inner tip) and 67 (outer tip) are also shown in the Figure. If the electrodes are fired and the tips are burning down the position of the tips change, for example, to position 68 and 69 when using an electrode which adjusts its position to compensate for the tip burn down. In order to generate pressure pulse/shock waves having nearly plane characteristics, the paraboloid has to be corrected in its p value. The p value for the burned down electrode is indicate by 65 as p/2=1. This value, which constitutes a slight exaggeration, was chosen to allow for an easier interpretation of the Figure. The corresponding paraboloid has the shape indicated by 61, which is wider than paraboloid 62 because the value of p is increased. An average paraboloid is indicated by numeral 60 in which p=1.25 cm. A generalized paraboloid is indicated by dashed line 63 and constitutes a paraboloid having a shape between paraboloids 61 and 62. This particular generalized paraboloid was generated by choosing a value of n 2 and a p value of about 1.55 cm. The generalized paraboloid compensates for different p values that result from the electrode burn down and/or adjustment of the electrode tips.

[0093] FIG. 8 is a simplified depiction of a set-up of the pressure pulse/shock wave generator (43) (shock wave head) and a control and power supply unit (41) for the shock wave head (43) connected via electrical cables (42) which may also include water hoses that can be used in the context of the present invention. However, as the person skilled in the art will appreciate, other set-ups are possible and within the scope of the present invention.

[0094] FIG. 9 is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having an electromagnetic flat coil 50 as the generating element. Because of the plane surface of the accelerated metal membrane of this pressure pulse/shock wave generating element, it emits nearly plane waves which are indicated by lines 51. In shock wave heads, an acoustic lens 52 is generally used to focus these waves. The shape of the lens might vary according to the sound velocity of the material it is made of. At the exit window 17 the focused waves emanate from the housing and converge towards focal point 6.

[0095] FIG. 10 is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having an electromagnetic flat coil 50 as the generating element. Because of the plane surface of the accelerated metal membrane of this generating element, it emits nearly plane waves which are indicated by lines 51. No focusing lens or reflecting lens is used to modify the characteristics of the wave fronts of these waves, thus nearly plane waves having nearly plane characteristics are leaving the housing at exit window 17.

[0096] FIG. 11 is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) having an piezoceramic flat surface with piezo crystals 55 as the generating element. Because of the plane surface of this generating element, it emits nearly plane waves which are indicated by lines 51. No focusing lens or reflecting lens is used to modify the characteristics of the wave fronts of these waves, thus nearly plane waves are leaving the housing at exit window 17. Emitting surfaces having other shapes might be used, in particular curved emitting surfaces such as those shown in FIGS. 7A to 7C as well as spherical surfaces. To generate waves having nearly plane or divergent characteristics, additional reflecting elements or lenses might be used. The crystals might, alternatively, be stimulated via an electronic control circuit at different times, so that waves having plane or divergent wave characteristics can be formed even without additional reflecting elements or lenses.

[0097] FIG. 12 is a simplified depiction of the pressure pulse/shock wave generator (shock wave head) comprising a cylindrical electromagnet as a generating element 53 and a first reflector having a triangular shape to generate nearly plane waves 54 and 51. Other shapes of the reflector or additional lenses might be used to generate divergent waves as well.

[0098] With reference to FIGS. 13, 14 and 15 a schematic view of a shock wave generator or source 1 is shown emitting a shock wave front 200 from an exit window 17. The shock wave front 200 has converging waves 202 extending to a focal point or focal geometric volume 20 at a location spaced a distance X from the generator or source 1. Thereafter the wave front 200 passes from the focal point or geometric volume 20 in a diverging wave pattern as has been discussed in the various other FIGS. 4-12 generally.

[0099] With particular reference to FIG. 13 extremity of a subsurface organ 100 is shown generally centered on the focal point or volume 20 at a location X.sub.0 within the extremity of a subsurface organ 100. In this orientation the emitted waves are focused and thus are emitting a high intensity acoustic energy at the location X.sub.0. This location X.sub.0 can be anywhere within or on the extremity of a subsurface organ. Assuming the extremity of a subsurface organ 100 is an extremity having a mass 102 at location X.sub.0 then the focus is located directly on the mass 102. In one method of treating a tumor or any other type mass 102 these focused waves can be directed to destroy or otherwise reduce the mass 102.

[0100] With reference to FIG. 14, the substance 100 is shifted a distance X toward the generator or source 1. The extremity of a subsurface organ 100 at location X.sub.0 being positioned a distance X-X.sub.1 from the source 1. This insures the extremity of a subsurface organ 100 is impinged by converging waves 202 but removed from the focal point 20. When the extremity of a subsurface organ 100 is extremity this bombardment of converging waves 202 stimulates the cells activating the desired healing response as previously discussed, this also is one of the preferred methods to treat an inflamed diabetic pancreatic extremity.

[0101] With reference to FIG. 15, the extremity of a subsurface organ 100 is shown shifted or located in the diverging wave portion 204 of the wave front 200. As shown X.sub.0 is now at a distance X.sub.2 from the focal point or geometric volume 20 located at a distance X from the source 1. Accordingly X.sub.0 is located a distance X+X.sub.2 from the source 1. As in FIG. 10 this region of diverging waves 204 can be used to stimulate the substance 100 which when the substance is a cellular extremity stimulates the cells to produce the desired healing effect or response, this is also one of the preferred methods.

[0102] As shown the use of these acoustic wave forms can be used separately or in combination to achieve the desired therapeutic effect.

[0103] Furthermore such acoustic wave forms can be used in combination with drugs, chemical treatments, irradiation therapy or even physical therapy and when so combined the stimulated cells will more rapidly assist the body's natural healing response.

[0104] The present invention provides an apparatus for an effective treatment of indications, which benefit from low energy pressure pulse/shock waves having nearly plane or even divergent characteristics. For the treatment of those indications, the procedure to locate the area to which the pressure pulses/shock waves are applied often needs to be less accurate than, e.g., when kidney stones are destroyed with focused waves. In fact, sometimes the knowledge of the physique of the subject to be treated is sufficient, so that imaging devices like ultrasound, x-ray or similar, as they are known from devices used in the destruction of kidney stones, may not be required. The area of the focal point/focus volume can be enlarged by reducing the focusing or even by eliminating it all together by using an apparatus according to the present invention which produces waves having wave fronts with nearly plane or divergent characteristics.

[0105] With an unfocused wave having nearly plane wave characteristic or even divergent wave characteristics, the energy density of the wave may be or may be adjusted to be so low that side effects including pain are very minor or even do not exist at all.

[0106] In certain embodiments, the apparatus of the present invention is able to produce waves having energy density values that are below 0.1 mJ/mm.sup.2 or even as low as 0.000001 mJ/mm.sup.2 In a preferred embodiment, those low end values range between 0.1-0.001 mJ/mm.sup.2 With these low energy densities, side effects are reduced and the dose application is much more uniform. Additionally, the possibility of harming surface extremity is reduced when using an apparatus of the present invention that generates waves having nearly plane or divergent characteristics and larger transmission areas compared to apparatuses using a focused shock wave source that need to be moved around to cover the affected area. The apparatus of the present invention also may allow the user to make more precise energy density adjustments than an apparatus generating only focused shock waves, which is generally limited in terms of lowering the energy output.

[0107] The treatment of the above mentioned diabetic indications are believed to be a first time use of acoustic shock wave therapy. None of the work done to date has treated the above mentioned indications with convergent, divergent, planar or near-planar acoustic shock waves of low energy.

[0108] In another treatment therapy, extracorporeal shockwave treatments are used to improve motion integrity and independence in the aging population via the regenerative enhancement of skeletal muscle tissue. The maintenance of balance is an essential task necessary for both static and dynamic stability and motion independence. Age related skeletal muscle atrophy and sarcopenia resulting in the loss of muscle capacity and mass in the elderly negatively impacts physical capacity, daily function, quality of life, and constitutes a growing global healthcare burden. Progressive motor neuron degeneration, increases in fat mass, decreases in lean muscle, bone mass, and cellular environmental aberrances are commonly seen alterations of aging muscle. This leads to impairments in metabolic rate, aerobic capacity, strength and balance, functional capacity, along with emotional and cognitive distress all of which can be improved and the degradation reversed by the use of low energy unfocused acoustic shock waves.

[0109] Method of intervention uses low-intensity extracorporeal shockwave treatment (ESWT) ranging from 0.10-0.12 mJ/mm.sup.2 to introduce a positive biocellular response in aging skeletal muscles. This ESWT can be utilized to reverse the effects of age related skeletal muscle atrophy and sarcopenia due to regenerative enhancement stimulated by shockwaves. These regenerative enhancements target a variety of myogenic transforming and regenerative growth factors via several mechanisms such as: integrin signaling, transforming growth factor beta-1 proliferation, immune-modulations, overt and covert inflammatory regulation, and progenitor cell expression among others. Unlike most interventions that commonly target or influence a narrow spectrum of a given pathology or condition, ESWT has a much boarder spectrum of influence on human tissue, as in the instance of skeletal muscle tissue. In an initial pilot series of Ten (10) older adult subjects, the inventors found that three (3) sessions of ESWT focused on several lower extremity muscle groups helped enhance muscle regeneration, improve postural and dynamic balance, and reduce activity related fatigue, improving quality of life and emotional resilience in our subjects. This occurred interestingly at a narrow optimized energy range. While the early work on tissue shows improvement, this targeted range optimizes the response.

[0110] In a third refinement, extracorporeal shockwave treatments are used to optimize athletic performance and muscle resilience. The pathogenesis of musculoskeletal overuse syndromes have come under much discussion and is commonly accepted to be the consequence of disrepair leading to degenerative syndromes with a constellation of contributory and aberrant propagating co-factors. Despite advances in sports medicine the ability to optimize athletic performance safely while preventing injuries remains elusive and an enigma.

[0111] The treatment method of intervention Low-intensity uses extracorporeal shockwave treatment (ESWT) ranging from 0.10-0.14 mJ/mm.sup.2 to introduce a positive biocellular response in healthy actively competitive athletes to help improve muscle resilience in order to perform a given task with lest exertion due to optimized muscle output levels. These regenerative enhancements target a variety of myogenic transforming and regenerative growth factors via a unique stimulus related biomechano-transduction pathway that positively influences: integrin signaling, transforming growth factor beta-1 proliferation, immune-modulations, overt and covert inflammatory regulation, and progenitor cell expression among others. Unlike most interventions that commonly target or influence a narrow spectrum of a given pathology or condition,

[0112] ESWT has a much boarder spectrum of influence on human tissue, as in the instance of skeletal muscle tissue. In an initial pilot series of eight (8) athletic subjects, the inventors found that three (3) sessions of ESWT focused on several muscle groups helped enhance the energy output of skeletal muscles providing for economics in effort to complete and perform a given task. This further suggests that the ability to prevent overuse and fatigue related syndromes among athletes is made possible by the increased resilience and energy capacity economics influenced by ESWT in skeletal muscle tissue.

[0113] In particular with athletes, this optimized shock wave treatment can be useful to quickly remove lactic acid from cells after a workout. This leads to quicker muscle recovery. This quick recovery in combination with hydration can rapidly diminish muscle cramping in athletes. This is a legal performance enhancing therapy that can achieve the results of “banned” steroid for athletes without introducing any pharmacologically prohibited drugs or stimulants. The therapy achieves everything that steroids do, but legally.

[0114] Certain enzymes prevent the propagation and or satellite stem cells found in striated muscles. ESWT reverse the effects of those enzymes allowing for the immediate replication of striated muscle cells. Enzymes act as a “governor” of sorts limiting cell replication, ESWT removes or reduces the governor or limiting effect. Return to normal cell growth is slow versus ESWT which has an optimized cell response by achieving a rapid optimal reset of the clock. When treating healthy males for erectile dysfunction, improves vitality, increases length and girth of penis, similar to the effects of steroids on muscles. This allows not only a return to normal, better than normal. It is quite normal for adult with bad eating and exercise habits to have increased blood sugar/diabetes, as discussed, these treatments can reverse blood sugar levels to normal, reverse aging and enhance muscle tissue growth in the extremities as well as the penis.

[0115] It will be appreciated that the apparatuses and processes of the present invention can have a variety of embodiments, only a few of which are disclosed herein. It will be apparent to the artisan that other embodiments exist and do not depart from the spirit of the invention. Thus, the described embodiments are illustrative and should not be construed as restrictive