How to Grow Your Practice tPRF Therapy and Stimpod NMS460 – Dr. Richard Kowal

If you want to help your patients with the power of tPRF therapy, make sure to order your Stimpod NMS460 here. 

Webinar Transcript

Dr. Freddy Garcia:
Hello, everybody. My name is Dr. Freddy Garcia. Today, I am joined by Dr. Richard Kowal.

Dr. Kowal, thanks so much for joining me today.

Dr. Richard Kowal:
Hi. How are you, Freddy? It’s good to see you.

Dr. Freddy Garcia:
I’m doing great. We’re recording a quick webinar today, and the topic is how to grow your practice using transcutaneous pulsed radiofrequency and the STIMPOD NMS460.

I’m excited to learn from you because you are a bit of a legend.

Dr. Richard Kowal:
Thank you. I have been using STIMPOD for about 10 years, and I can say that it is a tool that grows in importance as you develop technically.

Dr. Freddy Garcia:
That’s incredible, and that is exactly why I wanted to record this video with you. You have over 10 years of experience using transcutaneous pulsed radiofrequency.

Before we jump into some of the clinical applications you started exploring with the STIMPOD, can you tell us a little bit about yourself, your interests, and your practice?

Dr. Richard Kowal:
I studied human development at Cornell for my undergraduate studies. I have a master’s degree in clinical nutrition from the University of Bridgeport, and I have been practicing as a chiropractor for over 40 years. I received my chiropractic degree from New York Chiropractic College.

My interests outside of practice are varied, but they are often related to the kind of work we do as chiropractors and physical therapists. I am a black belt in Taekwondo, and I have been studying and practicing yoga for over 25 years. So I have a big interest in physical practices that relate very much to the kind of work we do as chiropractors and physical therapists.

Dr. Freddy Garcia:
That’s incredible, especially the Taekwondo. You caught me by surprise there.

What about your practice? Can you share a little bit about what your practice is like, the types of patients you treat, and your favorite conditions to work with?

Dr. Richard Kowal:
I treat a broad variety of musculoskeletal problems, probably similar to most clinicians watching this webinar. There is, of course, arthritic-related neck pain and low back pain, and then all the interesting extremity problems people have either from aging or from exercise-related injury.

I use a wide variety of musculoskeletal techniques, including myofascial techniques, non-force spinal manipulation, and of course, STIMPOD is central to much of what I do in practice.

Dr. Freddy Garcia:
That’s excellent. The fact that you have this much experience and that STIMPOD is central to what you do is exactly why I’m eager to learn from you.

Before we get into the main topic, I want to ask you this: if somebody is hearing about the STIMPOD for the first time, how do you describe what it is? If someone says, “What is this thing? What is the STIMPOD NMS460?” how do you answer?

Dr. Richard Kowal:
If you look up pulsed radiofrequency, most of the articles you are going to read, and there is a large literature around the use of pulsed radiofrequency stimulation, will be about percutaneous pulsed radiofrequency.

That means practitioners, mostly physiatrists and anesthesiologists, are using needles injected toward a nerve and then applying pulsed radiofrequency directly to that nerve.

But STIMPOD, which can be used by physical therapists and chiropractors, is transcutaneous pulsed radiofrequency. That means we are not puncturing the skin. We are using the STIMPOD device, which has a stylus with a soft tip, much like the end of a ballpoint pen, to stimulate points.

Those points can be over peripheral nerves, or they can be over areas of pain. That is generally how we approach using STIMPOD.

Dr. Freddy Garcia:
Excellent. Let’s get right into it. Can you speak about why clinicians need a STIMPOD NMS460 in their practice?

Dr. Richard Kowal:
Patients occasionally ask me, “How did you develop your techniques? Do they teach all of this at school?”

The way I usually respond is that you learn a good foundation for patient care at school. But over time in practice, you encounter problems in patients that do not respond to your typical approach, whatever that approach may be.

So, at least for that patient, you have to figure out a better approach. Often, we do. Then, when we figure out an approach for a patient with that kind of problem, we try the same approach with every patient who comes in with a similar problem.

In that way, you slowly improve. Five percent, another five percent, another five percent. You get better and better, and your techniques become more specific and effective.

What is great about STIMPOD is that with almost any patient, even with a little bit of training, you are going to get 10% or 20% better with that patient, and often quite a bit more than that.

It is not a “me too” device that simply replaces something you are already doing. It actually expands your practice. It allows you to treat problems that you are not currently treating.

Dr. Freddy Garcia:
That’s interesting, and those are the things I really want to dive into.

Let’s go deeper and get more specific. Can you speak to how you use the STIMPOD in your practice? I definitely want to hear about the applications that may be more innovative for people who are only looking at the literature and seeing where it currently fits.

With 10 years of experience, I think it is really interesting that you have been exploring new ways to apply it.

Dr. Richard Kowal:
I wanted to discuss four important and unique ways that STIMPOD can be used in practice. This is how I use it in my practice, although if you get a STIMPOD, you will discover things that I do not know, and then we can talk about that and all get a little better.

The first way I use STIMPOD is directly over areas of pain. It will almost always have an immediate analgesic effect by reducing pain signals being sent to the brain.

These areas of pain in the soft tissue are almost always palpable as densities. Those densities can come from spasm, myofascial tension, post-surgical or post-injury adhesions, or inflammation. Some of the analgesic effect is also a direct effect on nerve tissue, either free nerve endings or actual peripheral nerves.

Let me give you some examples.

One example is SI joint pain. I am talking about pain above the waist, not into the buttock and not down the legs. In this case, when we use STIMPOD, we are treating inflammation. You cannot see it because it is deep in the SI joint, and you cannot really feel it, but we know from experience that STIMPOD can be used directly over the SI joints.

Typically, I treat both SI joints for about five minutes each, and there will usually be an immediate and very significant improvement in SI joint pain. That is an example of treating inflammation with STIMPOD.

Another example is buttock pain. It could be from gluteal tendinopathy, a sprain, or overuse. In this case, you are palpating dense areas in the glutes. They will be painful with pressure, and often extremely painful. The patient will report that clearly.

We can treat those points directly. Those dense areas in the glutes will soften and become immediately less painful, both to palpation and when the patient moves.

Another example is scapular pain. In this case, we are generally treating pain that is referred from cervical nerve roots. But once it is in the muscle, it is living in the muscle. We can treat the scapular pain and upper back pain directly with STIMPOD.

So those are three examples of treating areas of pain directly with STIMPOD. With the SI joints, you are treating inflammation. In the buttocks, you are treating dense areas that may represent what we used to call trigger points. In the scapula, you are treating referred pain coming from the cervical spine or cervical nerve root compression.

Dr. Freddy Garcia:
That’s excellent.

Dr. Richard Kowal:
Another completely different way of using STIMPOD, and this may be something that many clinicians are not currently doing at all, is treating neuropathic pain.

For example, you can treat patients with diabetic foot neuropathy, which is entirely neuropathic and does not really respond to typical rehabilitation strategies.

Before I had STIMPOD, I would get calls from patients with diabetic foot neuropathy asking whether they could come in. I did not let them come in because I had nothing to offer them. Once I had STIMPOD, I could treat diabetic foot neuropathy.

Do I win 100% of the time? No. But I win a significant amount of the time. Even if I cannot clear it out completely, I can often reduce it to a degree that makes the patient much more comfortable and allows them to sleep at night. Patients will generally be happy that they came to you for that kind of treatment.

Another example of neuropathic pain is something I have only recently begun doing. I read an article about percutaneous PRF being used to treat post-surgical knee pain after total joint replacement. That was interesting to me.

Recently, I had a patient referred by an orthopedist with what the orthopedist thought was iliotibial band syndrome. It was more complicated than that, although it did include the ITB. After I did the myofascial work and stretching that I would usually bring to that kind of patient, I decided, in the context of the article I had just read, to treat the points associated with sensation in the knee using STIMPOD.

In this case, I treated the femoral nerve in the inguinal region and the tibial nerve just above the popliteal space. I got another 50% improvement in pain relief after treating just those two points.

Now, of course, with every patient who comes in with knee pain, even if it is clearly a mechanical issue, I always treat the neuropathic component because I can do it with STIMPOD.

I think that is a terrific example of using this device to expand your practice and help patients.

Dr. Freddy Garcia:
That is excellent. So we have spoken about treating pain directly and treating neuropathic pain.

Dr. Richard Kowal:
Yes. STIMPOD can also be used, and I think this is very interesting, to treat neuropathic weakness.

Briefly, what I have learned is that pulsed radiofrequency modulates calcium levels in local tissue around nerves. There are many calcium-dependent peptides and proteins that play roles in nerve regeneration and synaptic communication. For those who want to learn more about this, we can leave a link at the bottom of the webinar.

What does this mean in practice?

With STIMPOD, you can now treat patients who have residual foot drop, for example after surgery for central stenosis in the lumbar spine. In the past, before STIMPOD, I would never have let those patients come into my practice, although I did receive calls from them, because I had nothing to offer them.

Now, with STIMPOD, I can at least begin to try to treat the residual foot drop. You will not win every time, but you will win many times. Patients may begin to have improvement in foot strength, sometimes to the point where they are able to stop using a brace or even a cane.

I have had some patients with complete resolution and, as with many things, others improve on a spectrum.

Dr. Freddy Garcia:
When I first started hearing about you, these were some of the stories I heard. You had a reputation for helping patients with foot drop who had gone everywhere else, and then you were able to find them a solution. That is so cool to hear directly from you.

Dr. Richard Kowal:
In the last year, another example of treating neuropathic weakness that I had not even thought of before has come from watching my older patients walk into the office.

I always watch how patients come in, how they sit, and how they stand. Often, you will see older patients who wobble a little. They have a weaker leg. They may not be using a cane, but they do not look steady to us with the kind of eyes we have as clinicians. Other people might look at them and think they look fine, but we can see that they are wobbling.

What I have recently begun to do is try to strengthen the quadriceps on the weaker side by treating the femoral nerve. Interestingly, in older patients who did not even come in with that as their major complaint, they can sometimes have improvement in the quality of their walking simply by treating the femoral nerve on the weak-leg side.

I have had patients come in wobbling and then leave walking with much more steadiness and a better gait.

Dr. Freddy Garcia:
That is incredible. I cannot think of another way to do that that is not STIMPOD. If that were the only thing you got from STIMPOD, that would already be significant.

Dr. Richard Kowal:
It would make you feel pretty good.

The last way I use STIMPOD is for cervical spine arthritic facet joint inflammation. This is a type of patient I think we all see frequently in practice. It is someone who is 70, 80, or 90 years old with severe cervical spine arthritis and painful rotation.

They may have less than 10 degrees of rotation. They may even have only five degrees of rotation, with strong pain throughout that tiny range. These are fragile patients. They may have osteoporosis. These are patients where you feel, “I have to be really careful. I do not want to hurt this person.”

With STIMPOD, you can treat directly over the posterior cervical facet joints. During the treatment or right after the treatment, you may get 20 to 40 degrees of rotation and immediate pain relief.

Then the patient may ask, “Do I get to keep it?”

The answer is: you will keep some of it. You may lose a little bit, but you are not going to go back to where you were. Then, like many things, it becomes a stair-step improvement as you continue to treat.

Again, it is an example of using STIMPOD to treat a problem that you really cannot treat that well right now. That is why we use the title of how to use STIMPOD to expand your practice.

Dr. Freddy Garcia:
That’s awesome. Just those applications alone are really valuable.

I want people to understand what STIMPOD can easily knock out of the park, but also to start exploring other ideas. That is why your experience is so important.

Let me ask you this. As I listen to the way you apply the STIMPOD NMS460 in your practice, many times you are saying that you expect changes that seem fairly dramatic. I am interpreting here, but I want to hear directly from you: these changes seem to happen very quickly.

Am I ambitious to think that? How quickly do you expect patients to perceive a decrease in pain? Sometimes you are saying up to 50% in a treatment. How quickly do you expect that to happen?

Dr. Richard Kowal:
It depends, like many things, on how old the patient is, how long they have had the problem, and the underlying issue causing the problem.

In the case of the patient with severe low back pain coming from the SI joints, you will get an immediate, very strong improvement. I mean 80% to 100% right after treatment.

With the older patient who had surgery for central stenosis five years ago and has been left with foot drop, you are not going to get an immediate improvement. You may see that patient eight to 20 times, although typically, if I do not get at least some improvement after six treatments, I will not continue.

So depending on the problem you are treating, you can get very quick results. Another example of very quick results is the 80-year-old with cervical spine arthritis and almost no range of motion. That is immediate improvement. They will walk out the door with immediate improvement.

Diabetic foot neuropathy is different. That is going to improve over time, and hopefully you will see incremental improvements that become significant over time.

So again, it depends on what you are treating, how long it has been there, the underlying condition of the patient, and so on. We all know that.

Dr. Freddy Garcia:
Excellent. This is a gift that you are sharing your experience with everybody.

Dr. Kowal, is there anything else you want to add about how to grow your practice using technology like the STIMPOD NMS460?

Dr. Richard Kowal:
The most important point I want to make is that this will not just replace some of the techniques you are currently using and make you 5% better.

There are some problems you can treat with STIMPOD that you could not treat with any of the approaches you have been using up until now. I think that is very exciting.

In that way, it expands your practice. You will feel more comfortable allowing patients to come in for issues that you could not treat in the past.

Where does it shine? Our bread-and-butter patients: neck and upper back pain, scapular pain, reduced range of motion, low back and buttock pain, sciatic-line pain, paresthesia, neuropathic weakness, and neuropathic foot pain.

The key point that everybody should walk away with is that it is safe, immediate, and painless. I urge you to consider bringing STIMPOD into your practice.

I have no doubt that within a few years, we will be learning things from you because it is a creative tool. You will have patients come in where you are stuck, and you will decide, “I have not used STIMPOD this way before, but I am going to see if I can get a little more improvement by adding STIMPOD to the treatment.”

Inevitably, that will happen. Then you will share your results with us, and we will all grow.

Dr. Freddy Garcia:
That’s excellent. It will undoubtedly happen, especially since I think you are going to inspire people to bring on the STIMPOD and explore the way you have over the last 10 years.

Dr. Kowal, if somebody wants to learn more about you or contact you, how can they do that?

Dr. Richard Kowal:
Please attach my email, and I will be happy to get back by phone and speak with anybody who has an interest. If they want to discuss a patient or talk about how they might quickly start integrating STIMPOD into practice, we can talk about that.

I can talk about how to use it in the easiest way on Monday after you get it on Friday, and then help guide people to use it in a more comprehensive way as they become more skilled and confident with it.

So yes, please put my email on the webinar page.

Dr. Freddy Garcia:
We will do that.

Dr. Kowal, I want to personally thank you on behalf of Algiamed for spending some time with us today and sharing your more than 10 years of experience using tPRF therapy with the STIMPOD NMS460.

I am glad I finally got to connect with you because, as I said, I have been hearing amazing stories about the results and outcomes you have been delivering for your patients.

I want to thank you for exploring, thinking outside the box, and I hope you inspire other people to explore in the same way, so that we can all get better together and serve the patients who need our help around the world.

Thank you so much for your time today.

Dr. Richard Kowal:
Thank you for hosting me.

Dr. Freddy Garcia:
To everybody watching, I hope you enjoyed this quick webinar. We will leave Dr. Kowal’s email address somewhere on this page or in the email, and we will catch you at the next one.

Thank you again, Dr. Kowal. Have a great day.