U.S. National Library of Medicine
National Institutes of Health
Articles about H-Wave
lJ Strength Cond Res. 2009 Dec;23(9):2560-7.
Comparison of swim recovery and muscle stimulation on lactate removal after sprint
Neric FB, Beam WC, Brown LE, Wiersma LD.
Exercise Physiology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, California, USA.
Competitive swimming requires multiple bouts of high-intensity exercise, leading to elevated blood lactate. Active
exercise recovery has been shown to lower lactate faster than passive resting recovery but may not always be practical. An
alternative treatment, electrical muscle stimulation, may have benefits similar to active recovery in lowering blood lactate
but to date is unstudied. Therefore, this study compared submaximal swimming and electrical muscle stimulation in
reducing blood lactate after sprint swimming. Thirty competitive swimmers (19 men and 11 women) participated in the
study. Each subject completed 3 testing sessions consisting of a warm-up swim, a 200-yard maximal frontcrawl sprint,
and 1 of 3 20-minute recovery treatments administered in random order. The recovery treatments consisted of a passive
resting recovery, a submaximal swimming recovery, or electrical muscle stimulation. Blood lactate was tested at baseline,
after the 200-yard sprint, and after 10 and 20 minutes of recovery. A significant interaction (p < 0.05) between recovery
treatment and recovery time was observed. Blood lactate levels for the swimming recovery were significantly lower at 10
minutes (3.50 +/- 1.57 mmol.L-1) and 20 minutes (1.60 +/- 0.57 mmol.L-1) of recovery than either of the other 2
treatments. Electrical muscle stimulation led to a lower mean blood lactate (3.12 +/- 1.41 mmol.L-1) after 20 minutes of
recovery compared with passive rest (4.11 +/- 1.35 mmol.L-1). Submaximal swimming proved to be most effective at
lowering blood lactate, but electrical muscle stimulation also reduced blood lactate 20 minutes postexercise significantly
better than resting passive recovery. Electrical muscle stimulation shows promise as an alternate recovery treatment for
the purpose of lowering blood lactate.
PMID: 19910818 [PubMed - in process]
BMC Musculoskelet Disord. 2009 Oct 29;10:132.
Repetitive H-Wave device stimulation and program induces significant increases in the
range of motion of post operative rotator cuff reconstruction in a double-blinded
randomized placebo controlled human study.
Blum K, Chen AL, Chen TJ, Waite RL, Downs BW, Braverman ER, Kerner MM, Savarimuthu SM, DiNubile N.
Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Winston -Salem, North Carolina, USA.
BACKGROUND: Albeit other prospective randomized controlled clinical trials on H-Wave Device Stimulation (HWDS),
this is the first randomized double-blind Placebo controlled prospective study that assessed the effects of HWDS on range
of motion and strength testing in patients who underwent rotator cuff reconstruction. METHODS: Twenty-two patients
were randomly assigned into one of two groups: 1) H-Wave device stimulation (HWDS); 2) Sham-Placebo Device
(PLACEBO). All groups received the same postoperative dressing and the same device treatment instructions. Group I
was given HWDS which they were to utilize for one hour twice a day for 90 days postoperatively. Group II was given the
same instructions with a Placebo device (PLACEBO). Range of motion was assessed by using one-way ANOVA with a
Duncan Multiple Range Test for differences between the groups preoperatively, 45 days postoperatively, and 90 days
postoperatively by using an active/passive scale for five basic ranges of motions: Forward Elevation, External Rotation
(arm at side), External Rotation (arm at 90 degrees abduction), Internal Rotation (arm at side), and Internal Rotation (arm
at 90 degrees abduction). The study also evaluated postoperative changes in strength by using the Medical Research
Council (MRC) grade assessed strength testing. RESULTS: Patients who received HWDS compared to PLACEBO
demonstrated, on average, significantly improved range of motion. Results confirm a significant difference for external
rotation at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), active at 90 days
postoperatively (p = 0.007). Internal rotation also demonstrated significant improvement compared to PLACEBO at 45
and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), and active range at 90 days
postoperatively (p = 0.006). There was no significant difference between the two groups for strength testing.
CONCLUSION: HWDS compared to PLACEBO induces a significant increase in range of motion in positive
management of rotator cuff reconstruction, supporting other previous research on HWDS and improvement in function.
Interpretation of this preliminary investigation while suggestive of significant increases in Range of Motion of Post -
Operative Rotator Cuff Reconstruction, warrants further confirmation in a larger double-blinded sham controlled
PMID: 19874593 [PubMed - in process]
J Orthop Res. 2009 Sep;27(9):1248-51.
H-Wave induces arteriolar vasodilation in rat striated muscle via nitric oxide-mediated
Smith TL, Blum K, Callahan MF, DiNubile NA, Chen TJ, Waite RL.
Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
H-Wave electrical device stimulation (HWDS) is used clinically to expedite recovery from soft tissue injuries. We
hypothesized that HWDS induces arteriolar dilation, a mechanism involved in the healing process. Acute effects of
HWDS on striated muscle arteriolar diameters were studied. Arteriolar diameters were measured in the cremaster muscle
of 57 male anesthetized rats using intravital microscopy before and after HWDS or sham stimulation (SS) at 1 or 2 Hz for
periods of 30-60 min. In a separate cohort, the role of nitric oxide (NO) in the response to HWDS was assessed by
blocking NO synthase using topical L-NAME at 10(-5) M. Maximal arteriolar responses to stimulation were compared to
prestimulation diameters. HWDS both at 1 and 2 Hz resulted in significant arteriolar vasodilation (p < 0.05). The
arterioles in SS animals demonstrated no changes in diameter. Similarly, microvascular diameters did not change with
HWDS following blockade of NO production. Because of Poiseuille's Law, the significant arteriolar dilation induced by
HWDS would translate into increases in blood flow of 26-62%. In addition, lack of arteriolar dilation following HWDS
with blockade of NO production suggests that NO plays a role in the microvascular response to HWDS. These studies
suggest that arteriolar vasodilation accompanying HWDS may result in increased perfusion, contributing to the observed
therapeutic effects of HWDS. (c) 2009 Orthopaedic Research Society.
PMID: 19204915 [PubMed - indexed for MEDLINE]
Phys Sportsmed. 2008 Dec;36(1):103-14.
The H-Wave((R)) Device Induces NODependent Augmented Microcirculation and
Angiogenesis, Providing Both Analgesia and Tissue Healing in Sports Injuries.
Blum K, Ho CK, Chen AL, Fulton M, Fulton B, Westcott WL, Reinl G, Braverman ER, Dinubile N, Chen TJ.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA. email@example.com.
The hypothesis that the H-Wave(R) device (Electronic Waveform Lab, Inc., Huntington Beach, CA), a small-diameter
fiber stimulator, is a paradigm shift of electrotherapeutic treatment of pain associated with human neuropathies and sports
injuries is based on a number of its properties. The primary effect of H-Wave(R) device stimulation (HWDS) is the
stimulation of "red-slow-twitch" skeletal muscle fibers. The authors propose, based on the unique waveform, that the H-
Wave(R) device specifically and directly stimulates the small smooth muscle fibers within the lymphatic vessels
ultimately leading to fluid shifts and reduced edema. In unpublished rat studies, it has been observed that HWDS induces
protein clearance. The H-Wave(R) device was designed to stimulate an ultra low frequency (1-2 Hz), low tension,
nontetanizing, and nonfatiguing contraction, which closely mimics voluntary or natural muscle contractions. The H-
Wave(R) device can stimulate small fibers due in part to its exponentially decaying waveform and constant current
generator activity. The main advantage of these technologies over currently applied electrical stimulators (eg,
transcutaneous electrical nerve stimulator [TENS], interferential [IF], neuromuscular electrical stimulation [NMES], high-
volt galvanic, etc.) is that H-Wave\'s(R) small fiber contraction does not trigger an activation of the motor nerves of the
large white muscle fibers or the sensory delta and C pain nerve fibers, thus eliminating the negative and painful effects of
tetanizing fatigue, which reduces transcapillary fluid shifts. Another function of the H-Wave(R) device is an anesthetic
effect on pain conditions, unlike a TENS unit which in the short term activates a hypersensory overload effect (gate
theory) to stop pain signals from reaching the thalamic region of the brain. When the H-Wave(R) device is used at high
frequency (60 Hz), it acts intrinsically on the nerve to deactivate the sodium pump within the nerve fiber, leading to a
long-lasting anesthetic/analgesic effect due to an accumulative postsynaptic depression. Moreover, HWDS produces a
nitric oxide (NO)-dependent enhancement of microcirculation and angiogenesis in rats. Thus, the authors hypothesize that
because of these innate properties of the H-Wave(R) device, it may provide a paradigm shift for the treatment of both
short- and long-term inflammatory conditions associated with pain due to sports injuries. A recent meta-analysis found a
moderate-to-strong effect of the H-Wave(R) device in providing pain relief, reducing the requirement for pain medication,
and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-
Wave(R) device may facilitate a quicker return to the field. Keywords: H-Wave(R) device; sportsmedicine, nitric oxide-
dependent blood flow; analgesia; angiogenesis.
PMID: 20048478 [PubMed - in process]
Adv Ther. 2008 Jul;25(7):644-57.
The H-Wave device is an effective and safe non-pharmacological analgesic for chronic
pain: a meta-analysis.
Blum K, Chen AL, Chen TJ, Prihoda TJ, Schoolfield J, DiNubile N, Waite RL, Arcuri V, Kerner M, Braverman ER, Rhoades P, Tung H.
Department of Physiology and Pharmacology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina 27157, USA.
INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave
(Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic
treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief,
reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis.
Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in
effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes
measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across
various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and
the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also
decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain
conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553,
0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70,
and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes
found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality
relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects
associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-
Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most
robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return
to work and other related daily activities.
PMID: 18636234 [PubMed - indexed for MEDLINE]
Adv Ther. 2006 Sep-Oct;23(5):739-49.
The H-Wave small muscle fiber stimulator, a nonpharmacologic alternative for the
treatment of chronic soft-tissue injury and neuropathic pain: an extended population
Blum K, Chen TJ, Martinez-Pons M, Dinubile NA, Waite RL, Schoolfield J, Blum SH, Mengucci J, Downs BW, Meshkin B.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
In a previous study, the H-Wave small-muscle fiber stimulator significantly reduced chronic pain and restored physical
function among patients with pain in the lower and upper extremities and spine. In this extended population observational
study, a cross-sectional,computer-administered 10-item survey was administered to 6774 patients (3367 men [49.7%],
3406 women [50.3%], and 1 sex not reported [<1%]; mean+/-SD age, 45.28+/-10.08 y; range, 18-65 y) with chronic soft-
tissue injury or neuropathic pain to assess their therapeutic response. The mean+/-SE duration of self-administered H-
Wave treatment before the survey was completed was 87.35+/-1.39 d. Sixty-five percent of study participants reported a
reduced or eliminated need for pain medication; 79% reported improved functional capacity or activity; and 78% reported
25% or greater reduction of pain. This cross-sectional evaluation represents the largest outcome study on the benefits of
the H-Wave device in patients with chronic soft-tissue injury or neuropathic pain. The results suggest that this
nonpharmacologic approach may provide an important alternative to standard pharmacologic treatment.
PMID: 17142209 [PubMed - indexed for MEDLINE]
Adv Ther. 2006 May-Jun;23(3):446-55.
H-Wave, a nonpharmacologic alternative for the treatment of patients with chronic soft
tissue inflammation and neuropathic pain: a preliminary statistical outcome study.
Blum K, DiNubile NA, Tekten T, Chen TJ, Waite RL, Schoolfield J, Martinez-Pons M, Callahan MF, Smith TL, Mengucci J, Blum SH, Meshkin B.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
The burden of chronic soft tissue inflammation and neuropathic pain on individuals and society is substantial. This study
was conducted to evaluate the H-wave device--an innovative form of treatment for chronic pain and inflammation--in
patients with persistent pain associated with injuries or conditions affecting the upper or lower extremities or the back.
Patients with at least moderate pain despite conventional therapy were included in a systematic survey after they had been
given 2 to 6 wk of treatment with the H-wave device. Measures of improvement involved the proportion of patients with
diminished medication requirements, improved function, or pain relief greater than 25%. More than 60% of patients with
pain in the lower extremities, upper extremities, or back experienced pain relief exceeding 25%. The proportion of
patients whose function improved and who were able to perform a new activity was consistently greater than 50% across
the 3 anatomic subgroups. More than 40% of patients in each group were able to reduce or completely eliminate the use of
pain medications. These benefits of treatment were independent of the type of pain therapy administered previously. In
each anatomic subgroup, the proportion of patients who reported improvement on more than 1 of the 3 endpoints was
significantly higher than the expected response to placebo therapy (P<.001). Results suggest that the H-wave device
provided important benefits to patients with chronic soft tissue inflammation and neuropathic pain.
PMID: 16912027 [PubMed - indexed for MEDLINE]
Diabetes Technol Ther. 1999 Spring;1(1):77-80.
Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain.
Alvaro M, Kumar D, Julka IS.
California College of Podiatric Medicine, San Francisco, California, USA.
Diabetes Technol Ther. 1999 Spring;1(1):81-3.
Three independent studies utilizing transcutaneous electrical nerve stimulation to relieve diabetic peripheral neuropathic
pain were reviewed. The proprietary equipment, an H-wave machine, administered all electrotherapy. The first two
studies assessed the efficacy of electrotherapy alone and electrotherapy with amitriptyline. The treated electrotherapy
group reported an overall greater reduction of symptoms, 52% with 2-3 weeks of active treatment. Amitriptyline alone
produced a 26% reduction of pain after 4 weeks. The addition of active electrotherapy to amitriptyline produced a 66%
reduction of pain. The final study looked at patients who have utilized electrotherapy for over one year. A reported 44%
improvement of symptoms was attained with continuous electrotherapy treatment. The data also suggested that a
maintenance treatment protocol for long-term pain relief would have to be developed.
PMID: 11475308 [PubMed - indexed for MEDLINE]
Diabetes Care. 1998 Aug;21(8):1322-5.
Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for
Kumar D, Alvaro MS, Julka IS, Marshall HJ.
Department of Medicine, Los Angeles County University of Southern California Medical Center 90033, USA.
OBJECTIVE: To evaluate the efficacy of combining electrotherapy with amitriptyline for the management of chronic
painful peripheral neuropathy in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Patients (n = 26)
with peripheral neuropathy were treated with amitriptyline. After 4 weeks, those patients (n = 23) who failed to respond to
amitriptyline or who only had partial relief were randomized between a sham treatment group (control) or an
electrotherapy group. Transcutaneous electrotherapy was given for 12 weeks by a portable unit (H-wave machine) that
generated a biphasic exponentially decaying waveform (pulse width 4 ms, 25-35 V, > or = 2 Hz). The degree of pain and
discomfort was graded on a scale of 0-5. An analog scale was used to record the overall change in symptoms. RESULTS:
Amitriptyline produced some degree of symptomatic relief in 15 (60%) of the 26 patients by the 4th week; pain scores
decreased from 3.8 +/- 0.1 to 2.9 +/- 0.2 (P < 0.1) and the overall reduction in pain was 26 +/- 5% on an analog scale. In
the amitriptyline plus sham treatment group (n = 9), pain scores declined from 2.8 +/- 0.3 to 1.9 +/- 0.5 (P < 0.03) and the
overall reduction in pain was 55 +/- 12%, suggesting a procedure-related placebo effect. In the group receiving combined
electrotherapy and amitriptyline (n = 14), symptomatic improvement occurred in 12 (85%) patients. Five (36%) of the
patients in this group became asymptomatic. Pain scores declined from 3.2 +/- 0.2 to 1.4 +/- 0.4 (P < 0.01) and the overall
reduction in pain was 66 +/- 10%. The degree of reduction in pain scores and the incremental relief (above the
amitriptyline effect) were significantly greater (P < 0.03) with electrotherapy as compared with sham treatment. The
outcomes indicate a substantial beneficial effect of electrotherapy over and above any placebo influence.
CONCLUSIONS: Our clinical observations suggest that transcutaneous electrotherapy is effective in reducing the pain
associated with peripheral neuropathy. This form of therapy may be a useful adjunctive modality when it is combined
with a pharmacological agent, such as amitriptyline, to augment symptomatic relief.
PMID: 9702441 [PubMed - indexed for MEDLINE]
J Foot Ankle Surg. 1998 May-Jun;37(3):191-4.
Beneficial effects of electrical stimulation on neuropathic symptoms in diabetes patients.
Julka IS, Alvaro M, Kumar D.
Department of Medicine, Los Angeles County University of Southern California Medical Center, University of Southern California School of
Medicine 90033, USA.
Transcutaneous electrical nerve stimulation is utilized for relieving pain in the diabetes peripheral neuropathy. Previous
studies were short-term and did not document sustained beneficial effects. In this study, the authors evaluated long-term
effectiveness of electrotherapy administered by proprietary equipment, an H-wave machine. A detailed questionnaire
concerning patients' symptoms prior to and following electrotherapy was mailed to the users of H-wave machine. The
responses of 34 individuals who had diabetes mellitus were analyzed (age 74.1 +/- 1.6 SEM years, body mass index 28.5
+/- 0.8 kg/m2, duration of diabetes 15.8 +/- 2.0 years and duration of neuropathic symptoms 8.0 +/- 1.8 years). Telephone
interviews were conducted with 20 additional diabetes patients selected randomly from the persons who did not return the
questionnaire. Forty-one (76%) patients reported a 44.0 +/- 4.0% subjective improvement in their neuropathic pain. The
overall improvement in pain was also significant on an analog scale of 10 (p < .01), and correlated well with the percent
amelioration data (r2 = .65). These data suggest an effectiveness of electrotherapy in managing neuropathic pain as an
adjunct to the analgesics. It appears to provide continued benefit as the responders have used this nonpharmacological
treatment modality for an average period of 1.7 +/- 0.3 years.
PMID: 9638542 [PubMed - indexed for MEDLINE]
Diabetes Care. 1997 Nov;20(11):1702-5.
Diabetic peripheral neuropathy: amelioration of pain with transcutaneous
Kumar D, Marshall HJ.
Department of Medicine, Los Angeles County University of Southern California Medical Center 90033, USA.
OBJECTIVE: To evaluate the efficacy of transcutaneous electrotherapy for chronic painful peripheral neuropathy in
patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Thirty-one patients with symptoms and signs of
peripheral neuropathy were randomized to the electrotherapy or sham treatment (control) group. The electrostimulation
was given by a portable unit (H-Wave machine) than generated a biphasic, exponentially decaying waveform (pulse width
4 ms, 25-35 V, > or = 2 Hz). Patients treated each of their lower extremities for 30 min daily for 4 weeks at home. Nine
patients from the sham-treatment group participated for a second period, during which all of them received the active
electrotherapy. Patient's degree of pain and discomfort was graded on a scale of 0 to 5. RESULTS: In the sham-treated
group (n = 13), the neuropathic symptoms improved in five (38%) patients, and the pain score declined from 2.92 +/- 0.13
to 2.38 +/- 0.26 (P < 0.04), suggesting a procedure-related placebo effect. In the electrotherapy group (n = 18),
symptomatic improvement was seen in 15 (83%) cases, 3 of which were completely asymptomatic; the pain score
declined from 3.17 +/- 0.12 to 1.44 +/- 0.25 (P < 0.01) and the posttreatment pain scores were considerably lower (P <
0.03), indicating a substantial treatment effect over and above any placebo influence. Patients in the electrotherapy group
reported greater reduction in symptoms (52 +/- 7% vs. 27 +/- 10% in control subjects, P < 0.05) on an analog scale.
Moreover, the electrotherapy decreased pain scores (from 3.0 +/- 0.62 to 1.56 +/- 0.32, P < 0.02) in nine patients who had
received sham treatment earlier. CONCLUSIONS: A form of transcutaneous electrotherapy ameliorated the pain and
discomfort associated with peripheral neuropathy. This novel modality offers a potential non-pharmacological treatment
PMID: 9353612 [PubMed - indexed for MEDLINE]
Submitted for Publication
Cases Journal (accepted … publication date pending)
Healing enhancement of chronic venous stasis ulcers utilizing h-wave® device therapy: a
Kenneth Blum1, 4, 6, 7,9*, Amanda LH Chen 2, Thomas JH Chen 3, B William Downs 4, Eric R Braverman 5, 6 , Mallory Kerner 6, Stella
Savarimuthu,6Anish Bajaj,6 Margaret Madigan 7, Seth H Blum 7, Gary Reinl 8, John Giordano,9 Nicholas DiNubile 10
1Department of Psychiatry, University of Florida College of Medicine, Gainesville, Fl. USA, ,2Engineering & Management of Advanced
Technology, Chang Jung University, Taiwan, Republic of China, 3 Department of Occupation Health and Safety, Chang Jung University, Taiwan,
Republic of China, 4 Department of Nutrigenomics, LifeGen, Inc. La Jolla, CA, USA, 5 Department of Neurosurgery, Weill Cornel School of
Medicine, New York, NY, USA, 6 Department of Clinical Research, Path Research Foundation, New York, NY USA, 7 Department of Personalized
Medicine, Synaptamine, Inc. San Antonio, Texas, USA, 8Nautilus, Inc. Vancouver, WA, USA, 9Department of Holistic Medicine, G&G Holistic
Addiction Treatment Center (Pain Track) North Miami Beach, Florida, USA, 10Department of Orthopedic Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, USA
Approximately 15% (more than 2 million individuals, based on these estimates) of all people with diabetes will develop a
lower-extremity ulcer during the course of the disease. Ultimately, between 14% and 20% of patients with lower-
extremity diabetic ulcers will require amputation of the affected limb. Analysis of the 1995 Medicare claims revealed that
lower-extremity ulcer care accounted for $1.45 billion in Medicare costs. Therapies that promote rapid and complete
healing and reduce the need for expensive surgical procedures would impact these costs substantially. One such example
is the electrotherapeutic modality utilizing the H-Wave® device therapy and program.
It has been recently shown in acute animal experiments that the H-Wave device stimulation induces a nitric oxide-
dependent increase in microcirculation of the rat Cremaster skeletal muscle. Moreover, chronic H-Wave device
stimulation of rat hind limbs not only increases blood flow but induces measured angiogenesis. Coupling these findings
strongly suggests that H-Wave device stimulation promotes rapid and complete healing without need of expensive
Hospital Practice (in final review)
H-Wave Device® Augments Healing by Inducing Cellular Mechanisms Responsible For
Increased Blood Flow and Loading of Injured Tissue: A hypothesis Having implications
for Clinical Practice.
Kenneth Bluma,b.f,g,I,n, Thomas JH Chenb, Gary Reinlc, Amanda LH Chend, Nicholas DiNubilee, Margaret Madiganf, B. William Downsg, Abdalla
Bowirrath, Anish BajajI Siohban Morsej, John Giordanok, Wayne Westcottl, Leonard Smithm, Mallory Kerner,n Uma Damlen and Eric R.
aDepartment of Psychiatry, University of Florida, College of Medicine & McKnight Brain Institute , Gainesville, Florida, USA. b Department of
Health and Occupational Safety ,Chang Jung Christian University, Taiwan, Republic of China cNautilus Inc., Vancouver, WA d Department of
Advanced Engineering , Chang Jung Christian University, Taiwan, Republic of China e Department of Orthopedic Surgery, Hospital of the University
of Pennsylvania, Philadelphia, Pennsylvania . f Department of Molecular Nutrition, Synaptamine, Inc. San Diego, California. g Department of
Nutrigenomics and Personalized Medicine, LifeGen, Inc, San Diego, California h Clinical Neuroscience and Population Genetics, Ziv Government
Medical Center, Safed, Israel, I Department of Executive Health, Path Research Foundation NY, New York, New York. j Department of Holistic
Rehabilitation, National Institute of holistic Studies, North Miami Beach, Florida jk Department of Holistic Medicine and Pain Track, , G & G
Holistic Addiction Treatment Center, North Miami Beach, Florida ll Department of Exercise Science, Quincy College, Quincy, Massachusetts m
Department of Surgery, University of Miami School of Medicine, Miami, Florida., nDepartment of Neurological Surgery, Weil Cornel College of
Medicine, New York, New York., oPath Research Foundation NY, New York, Ne w Yo rk
S U M M A R Y
The hypothesis is that the H-Wave ® device (Electronic Waveform Lab, Inc., Huntington Beach, CA) a small diameter
fiber stimulator, is a paradigm shift in electrotherapeutic treatment used to augment tissue healing associated with human
neuropathies and injuries. Its effect is based on known cellular mechanisms, which increase blood flow and loading of
injured loci. The primary effect of H-Wave ® device stimulation (HWDS) is the stimulation of “red –slow-twitch” skeletal
muscle fibers. We are proposing that HWDS directly stimulates the smooth muscle fibers within the lymphatic vessels.
This leads to reduced edema, the induction of nitrous oxide (NO)-dependent augmented microcirculation and
angiogenesis. It is further hypothesized that these cellular mechanisms coupled with the unique ability of HWDS to load
healing injured muscle tissue by inducing small muscle contraction will lead to accelerated healing. Since unlike others
(TENS, IF, NMES etc) the device does not trigger an activation of the motor nerves of large white muscle fibers or the
sensory delta and C pain nerve fibers. Thus, the negative and painful effects of tetanizing fatigue, which reduces trans-
capillary fluid shifts are eliminated and healing is accelerated. Accordingly clinical scientists correctly suggest that
patients with musculoskeletal injuries and those who have recently undergone surgery should be treated with controlled
physical activity that loads their healing tissues. Once a decision to introduce activity that loads the healing tissue is made,
techniques that help calm irritated muscles and nerves and/or around the healing tissue like: lymphatic massage,
accupressure, trigger point release, muscle activation (i.e. ankle pumps, non-tetanizing powered muscle stimulation) will
assist in this process. The H-Wave ® device was designed using a unique waveform, to stimulate an ultra low frequency
(1-2Hz), low tension, non-tetanizing and non-fatiguing contraction, which closely mimics voluntary muscle contractions.
In support of the beneficial outcome of HWDS a recent meta-analysis found a moderate–to-strong-positive effect of the
H-Wave ® device in providing pain relief, reducing requirement for pain medication, and increasing functionality. The
most robust effect observed was for improved functionality, suggesting that HWDS may facilitate a quicker return to work
and thus warrants further intense investigation. In agreement with Buckwalter and Grodzinsky  and others, the
promotion of healing of bone, fibrous tissue and muscle should include consideration of the effects of loading on tissue
repair and remodeling. Utilizing controlled intensity the HWDS approach provides the basis for early induction of loading
potentially even before the repair process occurs. In this hypothesis we intend to show the relevance of loading derived
from HWDS (repetitive muscle contractions) coupled with increased blood flow (increased perfusion due to NO and
angiogenesis) as an important electrotherapeutic approach to treat musculoskeletal disorders, tissue and sports injuries,
neuropathies and for enhancement of overall performance.
H-wave® electrical device stimulation (HWDS) is used clinically to expedite recovery from soft tissue injuries. The
process of healing tissues involves many factors predominantly: (a) Loading of bone, fibrous tissue and muscle; (b) Nitric
–oxide dependent increase in blood flow (c) increased formation of new blood vessels or angiogenesis and (d) increase in
protein clearance at injured loci. While loading in by itself may promote healing through these known elements and the
loading of injured tissue seems parsimonious (when the injury reaches stability), we hypothesize that since HWDS
accomplishes all of these required healing elements, it may become a frontline approach to promote soft tissue healing.
Support of this hypothesis, albeit the need for more intensive research, is derived from both animal and human studies
delineated in this hypothesis article. It is further hypothesized that genotyping for certain genetic antecedents for pain and
tissue healing may significantly increase positive outcomes (e. g. mu-opioid receptor, dopamine D2 receptor, TNF-alpha,
interluekens and eNOs) of the utilization of the HWDS [see schematic figure 1].
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