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Abstract
The hypothesis that the H-Wave® 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® device stimulation (H-WDS) is the stimulation of “red-slow-twitch” skeletal muscle fibers. The authors propose, based on the unique waveform, that the H-Wave® 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 In unpublished rat studies, it has been observed that HWDS induces protein clearance.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® 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® 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® 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® 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® 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® 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® 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 the field.