• Conventional RICE protocol often treats symptoms, not root causes

• Tendons and ligaments have poor blood supply, making them slow to heal naturally

• In-season athletes can't afford extended downtime

• 30-50% recurrence rate for common overuse injuries when underlying imbalances aren't addressed

• Steroid injections may mask pain but weaken tissue long-term

The Problem: Why Athletes Get Stuck

"We cannot get better in the same environment that we got sick"

Your Three-Pronged Approach

Functional Medicine

Shockwave/OmniWave Therapy

• Targeted tissue repair compounds

• BPC-157, TB-500, GHK-Cu options

• Stimulate collagen synthesis

• Improve local circulation

• Non-invasive mechanical stimulation

• 65-91% success rate for common conditions

• 3 sessions × 15 minutes each

• Hormone optimization for recoveryStimulate collagen synthesis

• No downtime, in-Season Compatible

• pairs well with PRP Therapy

• Root cause diagnostics

• Anti-inflammatory nutrition protocols

• Hormone optimization for recovery

• Stimulate collagen synthesis

• Sleep/stress management frameworks

Peptide Interventions

Timeline Expectations (from research):

• Weeks 1-4: Pain reduction, improved range of motion, early blood vessel formation

• Weeks 4-8: Structural repair, increased tendon/ligament strength, joint stability

• Weeks 8-12: Tissue remodeling complete, reassessment

• Conditions You Can Treat:

  • Achilles tendinopathy

  • Plantar fasciitis

  • Patellar tendonitis (jumper's knee)

  • Tennis/golfer's elbow

  • Rotator cuff injuries

  • Hip bursitis/tendinopathy

  • Muscle strains

  • Stress fractures (non-healing)

  • Frozen shoulder

  • Osteoarthritis in weight-bearing joints

"A recent study by Adam Tenforde, MD titled 'Utilizing Extracorporeal Shockwave Therapy for In-Season Athletes' points out that shockwave therapy has been proven effective in treating numerous common athletic injuries... With success rates between 65-91% for various sports injuries."

Shockwave/OmniWave & Athlete Injuries

Why Should I Choose This over Steroid Injections?

Shockwave

• Promotes tissue regeneration

• No known long-term damage

• Long-term resolution

• Safe for in-season use

• Masks pain, weakens tissue

• May increase rupture risk

• Temporary releif only

• Often requires rest afterward

Steroid Shots

Functional Medicine for Athlete Recovery

C. Intervention Strategies

• Personalized anti-inflammatory nutrition plans

• Supplement protocols for connective tissue repair

• Sleep optimization protocols

• Stress management (cortisol impacts healing)

• Detoxification support if indicated

A. Root Cause Analysis

• Environmental factors contributing to delayed healing

• Chronic inflammation drivers (gut health, toxins, food sensitivities)

• Nutrient deficiencies affecting tissue repair (Vitamin D, zinc, magnesium, omega-3s)

• Hormonal imbalances (cortisol, testosterone, growth hormone)

B. Testing You Can Offer

• Comprehensive metabolic panels

• Hormone optimization labs (aligned with your existing service)

• Inflammatory markers (CRP, cytokine profiles)

• Nutritional biomarkers

• Environmental toxin screening (matches your expertise in "environmental diseases")

Promising Peptides for Athletic Injuries

"Peptides can be combined with PRF, shockwave therapy, and ultrasound-guided injection protocols to maximize tissue remodeling."

Commonly Asked Questions

1. Will insurance cover these treatments?

Coverage for shockwave therapy is highly variable. ESWT is billed under Category III CPT codes (0101T for high-energy, 0102T, 0019T for low-energy musculoskeletal applications), which many insurers treat as investigational and deny — though some Medicare contractors cover ESWT for chronic plantar fasciitis when the patient has had symptoms for at least six months and documented failure of conservative care including orthotics, physical therapy, or injections (per Balance Foot & Ankle's Michigan coverage guide and SoftWave's reimbursement overview). Functional medicine lab testing, peptide therapy, and IV/supplement protocols are generally not covered because they fall outside standard medical necessity definitions.

2. How many shockwave sessions do I need?

The International Society for Medical Shockwave Treatment (ISMST) guidelines specify typically 3–5 treatments at 1–2 week intervals, with 1,500–2,500 pulses per session for focused devices and 2,000–3,000 pulses for radial devices. ISMST notes local anesthesia is not recommended, because pain feedback helps the practitioner calibrate energy dosing. Condition-specific ranges reported in clinical practice run wider: plantar fasciitis 3–6 sessions, Achilles tendinopathy 4–6, tennis/golfer's elbow 3–5, rotator cuff 4–7 (Align Spine Center's protocol summary). A peer-reviewed best-practices paper in PMC confirms "time interval between treatments: typically 1 week; total number of treatments: typically 3–5."

3. Are peptides legal and safe?

Peptide therapy is an evolving area. We discuss the current regulatory status, the level of evidence, and the risks with every patient before prescribing, and we source only through licensed channels.

4. Can I train during treatment?

Generally yes — this is one of shockwave's main advantages over steroid injection or surgery. Multiple clinical sources describe ESWT as having no incisions and no downtime, with UT Southwestern noting most patients see long-term results after about three 15-minute treatments. Critically, the evidence shows loading is part of the mechanism, not a violation of it: a 2022 study by Burton et al. found four sessions of focused ESWT combined with eccentric exercise four times weekly produced effective pain and function improvements. The collagen literature reinforces this — a vitamin C-enriched gelatin protocol taken before a jumping protocol doubled collagen synthesis markers versus placebo, and the authors emphasize that mechanical loading and collagen intake were both required; collagen alone without exercise had minimal effect (summarized by NL Physio citing the Shaw/Baar protocol work). So the answer is: you train, but the training is prescribed, dosed, and progressed deliberately.

5. How soon will I see results?

Realistic staging based on the peptide-recovery literature and shockwave evidence: Weeks 1–4 — pain reduction and improved range of motion, driven largely by inflammation modulation and early angiogenesis; Weeks 4–8 — structural repair phase, with tendon and ligament strength and joint stability improving (this is where actual tissue remodeling happens, not just symptom relief); Weeks 8–12 — reassessment and return-to-load progression (Moonshot Medical's recovery timeline). Set expectations that the early pain relief is not the same as tissue repair — a distinction worth stating explicitly on the page because it builds credibility.

6. What if I compete in tested sports?

Certain peptides are on the WADA prohibited list, and the ArmDoc review cites an established 4-year sanction precedent for athletes testing positive. Additionally, iron supplementation protocols must adhere to anti-doping guidelines (per a systematic review on iron deficiency in female athletes in the Journal of Sport and Health Science). Suggested page language: "If you compete in a drug-tested sport, tell us at your first visit. We will screen every recommendation against current WADA guidelines, and we will tell you plainly when a therapy is not available to you."

7. Do you offer telemedicine for follow-ups?

Yes — and this connects naturally to your existing model. Your site already advertises acute care visits, med refills, and specialized functional medicine treatments via telemedicine to patients in South Dakota and Michigan, plus in-person care in Sioux Falls. Frame the athlete page accordingly: in-person for shockwave and hands-on assessment; telemedicine for lab review, protocol adjustments, nutrition coaching, and recovery monitoring.

8. Is this covered under your membership plans? I don't have visibility into your current 2026 membership tier structure — your homepage references "ALL New 2026 Membership Plans NOW Available" but the extract didn't include the tiers. You'll need to fill this in. My suggestion: list exactly which services are bundled (consultations, lab reviews, telemedicine follow-ups) versus which are priced per-session (shockwave series, peptide protocols, IV therapy), and put the free shockwave trial ($200 value) as the entry point since you're already promoting it site-wide.

9. What makes OmniWave different from the older shockwave devices?

This is a strong differentiator if you frame it technically rather than as hype. OMNIWave is described by its manufacturer as an electrohydraulic, focused-energy system delivering acoustic waves to a targeted treatment zone, and the vendor positions it against older radial devices on precision of energy delivery and treatment comfort (OmniWave Systems). Independent comparison coverage notes that the broader shockwave category splits into focused (electrohydraulic, piezoelectric, electromagnetic) and radial technologies, each with different focal zones and energy flux densities — and that these device differences are a documented reason the shockwave literature looks contradictory, since studies vary in energy flux density, impulse count, device type, and treatment frequency (PMC best-practices review). That's actually a compelling, honest selling point: "Device and protocol selection matters — which is why we use focused technology and document energy parameters for every session." ISMST guidelines require clinics to record device name, energy level, impulse count, and coupling medium for each treatment, which supports your credibility if you do it.

10. Are there risks or side effects from shockwave therapy?

Yes, and naming them builds trust. The ISMST guideline lists absolute contraindications as malignant tumor in the shockwave field, a fetus in the shockwave field, and pacemaker/defibrillator in the shockwave field; for high-energy focused treatment, contraindications additionally include lung tissue in the field, significant coagulation disorder, and vertebral bodies, skull bones, and ribs. Relative contraindications include brain/CNS tissue in the field at high energy and epiphyseal plates in the treatment focus. Active infection at the treatment site (such as osteomyelitis) is an absolute contraindication across all energy levels. Notably, ISMST states there is no definite evidence of persistent complications from ESWT, though tendon ruptures have occurred after treatment. Typical side effects are transient soreness resolving within a few days; warning signs to report include worsening rather than improving pain, spreading redness suggesting infection, a growing lump, or numbness persisting beyond a day or two (Nortex Spine & Joint patient safety guidance). One clinic source also lists a steroid injection within the previous six weeks as a contraindication — worth confirming against your own protocol.

11. I had a cortisone injection recently. Can I still do shockwave?

Probably not immediately, and this is a genuinely important screening question. At least one clinical source lists "received a steroid injection within 6 weeks" as a contraindication to shockwave. There's also a mechanistic argument for spacing them: the Sports Injury Bulletin's review of NSAID and corticosteroid evidence notes that in fracture, ligament, and tendon injury, COX-2 inhibition should be avoided because the inflammatory phase is a necessary part of healing. Meanwhile, shockwave works partly by provoking a controlled inflammatory and mechanotransduction response. Stacking an anti-inflammatory steroid on top of a therapy that depends on inflammatory signaling is conceptually counterproductive. Page framing: "Tell us about any injection in the last 6 weeks — we'll adjust your timeline."

12. Is this a replacement for physical therapy and rehab?

No, and saying so clearly will actually strengthen your positioning rather than weaken it. The AAPM&R knowledge base on functional rehabilitation emphasizes that functional restoration is most effectively delivered through an interdisciplinary team — physiatrists, physical therapists, athletic trainers, and strength coaches — with clearly defined roles, and warns that failure to provide adequate functional restoration leads to recurrent injury, suboptimal performance, or delayed return to activity. The peptide literature says the same thing from the other direction: peptides "should complement, not replace, proven treatments: accurate diagnosis, structured physical therapy, pain management, and proper nutrition remain essential" (Ubie Health's clinical summary of tendon repair guidance). Position Next Level MD as the accelerator and diagnostician, not the substitute. Something like: "We don't replace your PT — we remove the obstacles that are slowing your PT down."

13. What lab testing do you run on athletes?

This is where functional medicine genuinely differentiates, and you have strong evidence for a focused panel:

• Vitamin D (25-OH). Blood levels of 40–50 ng/mL are cited as optimal for muscle strength, injury risk reduction, and recovery, while levels below 30 ng/mL are associated with increased risk of muscle weakness, bone injury, and compromised immune function (Forté Orthopedics, citing Owens et al. in Sports Medicine). GrassrootsHealth reports a 13% increase in injury odds for every 5 ng/mL decrease in vitamin D. GSSI notes suboptimal status is linked to stress fracture, muscle pain/weakness, and increased acute illness risk.

• Ferritin and full iron panel. Up to 60% of female athletes experience iron deficiency (systematic review, Journal of Sport and Health Science). Importantly, standard lab ranges miss this: researchers propose 30–99 ng/mL as functional iron deficiency in athletes, with ≥100 ng/mL needed to be considered sufficient (European Society of Medicine summary of Mielgo-Ayuso et al.). USA Triathlon notes that screening with ferritin alone or CBC without ferritin is inadequate.

• Inflammatory markers (hs-CRP, IL-6) — relevant because sleep deprivation elevates both, and they act as pain-facilitating agents (review in PMC on sleep and athletic performance).

• Hormonal panel — cortisol, testosterone, and thyroid, connecting to your existing hormone optimization service line.

14. How do you know when I'm actually ready to return to sport?

This is a high-value question because most clinics answer it badly. The evidence is stark: athletes who did not meet six clinical discharge criteria before returning to sport had a four times greater risk of ACL graft rupture (Kyritsis et al., British Journal of Sports Medicine, 2016), and athletes returning before nine months had a seven times higher re-tear rate, with each month of delay up to nine months associated with a 51% risk reduction — but only when that time was used to meet objective criteria rather than simply waiting (True Sports Physical Therapy's synthesis of the return-to-sport literature). The widely used limb symmetry index threshold of >90% on hop tests has been challenged: Wellsandt, Failla, and Snyder-Mackler showed LSIs can overestimate knee function because the uninvolved limb also declines after injury (JOSPT, 2017). Your page should promise criterion-based clearance, not calendar-based clearance — that's a meaningful differentiator.

15. Can you help with nutrition and supplements for healing?

Yes, and there are three well-supported interventions worth naming specifically:

• Collagen + vitamin C before loading. A systematic review in MDPI's Journal of Functional Morphology and Kinesiology evaluated collagen supplementation for tendon outcomes and found dosing ranging 5–30 g/day with variable timing; the practical evidence-informed protocol that recurs across sources is 15–20 g collagen peptides with at least 50 mg vitamin C, taken 30–60 minutes before tendon loading exercise (Adam Loiacono's clinical guide; Fit For Life PT). The key mechanistic finding: collagen taken before exercise, not after, drove the results — and collagen without mechanical loading had minimal effect.

• Omega-3s. A 2026 meta-analysis summarized by GrassrootsHealth found omega-3 supplementation consistently reduced inflammation (IL-6, CRP, TNF-α) and improved recovery markers, especially at doses ≥2 g/day EPA+DHA for ≥6 weeks. GSSI cautions that evidence for hypertrophy and strength gains is weak — so position it as a recovery and inflammation tool, not a performance enhancer.

• Protein. The International Society of Sports Nutrition position stand recommends 1.4–2.0 g/kg/day for most athletes, with 0.25 g/kg (roughly 20–40 g) of high-quality protein per meal to maximize muscle protein synthesis. A 2025 narrative review in Nutrients adds that masters athletes over 35–40 face anabolic resistance and may need 1.6–2.0 g/kg/day, up to 2.4 g/kg/day in some cases.

16. Do NSAIDs and ice actually help or hurt?

This is a great myth-busting FAQ that showcases functional medicine's mechanistic thinking. Su and colleagues, writing in PMC, concluded that available experimental and clinical evidence indicates NSAID therapy can impair bone fracture healing and tendon-to-bone (enthesis) healing. The Sports Injury Bulletin review states that in muscle injury, NSAID use can significantly delay muscle regeneration and decrease muscle strength and size after repair, because the inflammatory response is a necessary healing phase — and advises that COX-2 inhibitors be avoided entirely in fracture and ligament/tendon injury. A Frontiers systematic review and meta-analysis on bone healing notes the literature is mixed, with some clinical studies showing no effect from short-term use, but long-term NSAID use in fracture being best avoided. On ice: a graded-evidence appraisal found moderate evidence supporting photobiomodulation over cryotherapy for post-exercise muscle recovery, with faster return to baseline muscle torque and lower soreness at 24–96 hours (Fisher et al.). Careful page wording: don't tell patients to abandon prescribed medication — say "we'll discuss timing and duration, because blanket NSAID use during the inflammatory phase may work against you."

17. Does sleep and stress really matter for injury recovery?

More than most athletes realize, and this is arguably the highest-leverage, lowest-cost intervention you can offer. Growth hormone and IGF-1 — which drive tissue repair, regeneration, and muscle growth — are released in large quantities during deep slow-wave sleep, while impaired sleep suppresses GH release and alters cortisol secretion (multiple reviews, including PMC's sleep and athletic performance analysis). Sleep deprivation raises proinflammatory cytokines IL-6 and CRP, which are pain-facilitating agents, meaning sleep loss can literally increase pain sensitivity. And the injury-risk data is striking: adolescent athletes sleeping less than 8 hours per night were 1.7 times more likely to experience a sports injury than peers getting 8+ hours (The Game Plan PT, citing the adolescent athlete literature). Chronic sleep deficiency also elevates cortisol while lowering testosterone and growth hormone, limiting protein synthesis and muscle recovery capacity (Journal of Clinical Medicine, 2025). A 2024 narrative review concludes that any significant sleep shortfall "inhibits muscle recovery" and predisposes athletes to overtraining and injury (AACSM).

18. Is this appropriate for youth and high school athletes?

With caution, and the answer differs by modality. For shockwave, the ISMST guidelines list the epiphyseal plate in the treatment focus as a relative contraindication for high-energy treatments — a critical consideration in skeletally immature athletes. One clinic source notes under-18 patients are generally excluded except in specific indications like Osgood-Schlatter disease. For peptides, the risk calculus is different and stricter: the ArmDoc review notes the absence of Phase 2/3 randomized trials in any population, and the FDA's Category 2 safety concerns center on immunogenicity and impurity characterization. For functional medicine fundamentals — vitamin D status, iron/ferritin, sleep, protein adequacy, gut health — the case is strongest in adolescents, since deficiency prevalence is high and the interventions are low-risk. Suggested page language: "For athletes under 18, we emphasize diagnostics, nutrition, sleep, and loading protocols. Shockwave and peptide decisions are made case by case with parental involvement and a frank discussion of what the evidence does and doesn't show."

19. Can I combine all three approaches in one plan?

Yes — and this is your core differentiator. The orthopedics literature explicitly describes combining therapies: image-guided platelet-rich fibrin tendon repair procedures can be combined with shockwave ultrasound therapy and regenerative peptides targeted around the injury site to further stimulate tissue remodeling (Alpine Spine & Orthopedics). Burton et al. demonstrated ESWT plus eccentric exercise outperforming either alone. The integrative model is: shockwave to restart the healing cascade mechanically, peptides to supply the repair substrate, functional medicine to remove the systemic obstacles (deficiency, inflammation, sleep debt, hormonal imbalance) that keep the cascade from completing.

Modern Medicine Your Way

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Next Level MD

2101 W 41st Street

Suite 45

Sioux falls, SD 57105

T: 605-991-2900

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Clinic Hours - By Appointment

Monday | Closed

Tuesday | 8:30 AM - 6:00 PM

Wednesday | 8:30 AM - 6:00 PM

Thursday | 8:30 AM - 6:00 PM

Friday | 8:00 AM - 3:00 PM

Saturday | Closed

Sunday | Closed

Fasting Phlebotomy Appointments

Tuesday - Friday | 8:30AM - 12:30 PM

MED Spa Hours - By Appointment

Monday | by appt

Tuesday | 8:30 AM - 6:00 PM

Wednesday | 8:30AM - 6:00 PM

Thursday | 8:30AM - 6:00 PM

Friday | 8:00 AM - 3:00 PM

Saturday | Closed

Sunday | Closed

Closed for lunch

1:30 PM - 2:30 PM (Tu-Th)

12-12:30 (Fri)