What’s the Evidence?
The Achilles tendon is one of the thickest tendons in the body connecting the muscles of the calf to the heel bone. The purpose of the tendon is to help transmit and absorb muscle forces when the foot points down against resistance for example standing on tip toes, walking and jumping. If the Achilles tendon is subjected to sudden increases in loading for example running, hill walking or jumping over a prolonged duration and is not conditioned to do so, it will become painful, swollen and stiff. If the tendon is not rested and activities are not modified the tendon will not work as well making it harder to undertake activities. Achilles tendinopathy, therefore, is the term often used to describe the symptoms of tendon pain and impaired function.
Achilles Tendinopathy treatment
Physiotherapy intervention for Achilles tendinopathy often depends on symptoms, level of pain and impaired function. Treatment often consists of rest and activity modification, graded exposure to loading activities, heel raises and progressive strengthening. In practice, however, we often see persistent tendon pains that have not responded to treatment in the expected timeframes. Patients often complain of persistent pain preventing them returning to sport and or full function despite rehabilitation. If the tendon has not responded to exercises, shockwave therapy can be used as an adjunct to treatment.
Shockwave therapy is a non-surgical treatment that uses high energy sound waves to transmit energy into a body tissue. The treatment was first developed in the 1970s for the treatment of painful Kidney stones. More recently, Radial Shockwave or Extracorporeal Shockwave Therapy (ESWT) treatment has been shown to be highly effective in the treatment of persistent (more than three months onset of symptoms) tendon problems.
How does it work –
Shockwave therapy has both chemical and physical effects to the tissue it its applied to. There are four main actions that offer patients therapeutic benefit.
- Pain relief. Through a process called hyperstimulation analgesia. Shockwave excites the sensory nerves so much that it causes the pain signals to eventually become blocked. This pain relief usually lasts 1 to 3 days post treatment.
- Release of chemicals. After a shockwave treatment session there are numerous helpful chemicals released by cells within the body that helps improve blood flow, controls inflammation and helps with pain relief.
- Cellular activity is increased promoting healing of injured tendon tissue.
- Cavitation. When shockwaves pass through tissue, it causes small bubbles to form, which then collapse. This process helps to break down stubborn scar tissue.
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Latest Research for shockwave therapy in the treatment of Achilles tendinopathy
A recent study published in 2021 recruited 50 patients who had been diagnosed with non-insertional Achilles tendon pain of 6 months duration that had failed to respond to conservative treatment. Participants were randomised into two groups. The first group received shockwave therapy, stretches and strengthening and the second group received sham shockwave therapy and the same conservative treatment over a four-week period.
What were the results!
4 weeks After treatment –
- Both groups showed improvements in pain scores and function.
- Patients who received shockwave therapy demonstrated significantly better outcomes than those patients who received exercises alone.
16 Months after treatment –
- Pain and function in the group that received shockwave therapy remained better than the group who received just exercises.
- The group who received exercises however, continued to show improvements.
Implementation in current practice
Results from this research support previous studies suggesting Shockwave therapy as an adjunct to strengthening exercises shows significant improvements in pain and functional scores both short and long term. At Fay Pedler physiotherapy clinic we offer Shockwave therapy alongside our expert advice and experience to provide you with an individualised tailored programme to help you achieve your goals.
If you have any questions regarding Shockwave therapy, please get in touch through any of our contact details listed on the website. Should you wish to book in for treatment, follow the link on our website to book online. Shockwave therapy is now registered by most major health insurance companies, including AXA and BUPA.