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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Representative Results
  • Discussion
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

Achilles tendinopathy is a common musculoskeletal condition for which loading programs are currently the standard of care. However, the treatment protocols vary. We therefore propose a protocol for Achilles tendinopathy treatment using extracorporeal shockwave therapy.

Abstract

Achilles tendinopathy is a common musculoskeletal condition characterized by pain, lower muscle strength, gait abnormality, and reduced quality of life. There are two categories of Achilles tendinopathy: insertional Achilles tendinopathy and mid-portion Achilles tendinopathy. Currently, mechanical loading programs are considered the standard of care for the population with Achilles tendinopathy.

Extracorporeal shockwave therapy (ESWT) is considered a secondary conservative treatment for tendinopathy as it is effective and safe. It can be used either as a monotherapy or as part of a multimodal treatment plan. ESWT has been extensively studied in orthopedics, where it was shown to intensify fracture healing and successfully treat overuse conditions of tendons and fascia. It is believed that shockwaves have both mechanical and cellular effects that ultimately result in the repair of damaged tendinous tissue and improved function of the Achilles tendon. However, there is a lack of consistency in the literature surrounding the effectiveness, especially the protocols. Therefore, we enrolled 36 patients with a diagnosis of Achilles tendinopathy, using radial ESWT (0.48 mJ/mm2, 2,000 shockwaves, 10 Hz, 1.6 bars, 2 sessions once a week). Freedom from pain was experienced by 16.7% of these participants, and there was a significant decrease in pain in all of them.

Introduction

The Achilles tendon is one of the most robust tendons in the body, yet it is highly susceptible to injuries. Tendons play a crucial role in enabling joint motion and stability by transmitting tensile loads produced by muscles onto bones1. Tendinopathy is a concept describing chronic tendon degeneration and deconditioning, also called tendinitis2. However, the exact cause of Achilles Tendinopathy2 remains unclear. It is believed to result from a combination of factors, including overuse stresses, impaired blood flow, and lack of flexibility2. One of the major contributo....

Protocol

This protocol was approved by our institution's human research ethics committee and received informed consent from the subjects. Individuals older than 18 years old, both sexes, with a definite diagnosis of Achilles tendinopathy, were enrolled. Participants who received ankle surgery recently or were diagnosed with any conditions that were contraindications to the treatment were excluded.

1. Patient evaluation

  1. Clinical examination
    1. Before implementin.......

Representative Results

A retrospective study of patients with Achilles tendinopathy was performed on individuals older than 18 years old, with a definite diagnosis of Achilles tendinopathy. Exclusion criteria were recent ankle surgery or any condition that is a contraindication of ESWT.

This study included 36 participants. diagnosis with Achilles tendinopathy, 18 females and 18 males. Of these patients, their average age was 43.7 years, ranging between 18 and 64 years. All the patients complained of pain; 11 out of .......

Discussion

This protocol outlines a standardized treatment protocol for Achilles tendinopathy utilizing radial-ESWT to reduce pain and improve lower extremity function and mobility. It is crucial to closely monitor the patient's response during treatment to avoid any potential adverse effects. In our study, we observed positive results when we used low-energy ESWT plus eccentric exercise. Table 2 lists the intervention methods and major conclusions of studies on the effectiveness of ESWT for Achilles tendinopat.......

Acknowledgements

None

....

Materials

NameCompanyCatalog NumberComments
ESWT deviceChattanooga Intelect RPW 2074-INTincorporate touch screen technology to ensure a high degree of simplicity. The easy-to-use menu-drive user interface guarantees reliable selection of all necessary parameters for treatment set-up as well as during patient treatment.
GelKeppLerKL-250 type IIIn order to obtain the best treatment results, it is necessary to ensure good contact between shock wave transducers and the patient's skin during treatment. 
HandpieceChattanoogaD-ACTOR ApllicatorThe handle of the therapeutic apparatus can be used with a variety of transmitters, each of which is specially designed to achieve optimal efficacy.
Mark pengeneral
Tissuegeneral
transmittersChattanoogaR15,D20Each type of transmitter has its own unique therapeutic effect and scope of application.In our study, we use R15 and D20.

References

  1. Wang, J. H., Guo, Q., Li, B. Tendon biomechanics and mechanobiology-a minireview of basic concepts and recent advancements. Journal of Hand Therapy. 25 (2), 133-141 (2012).
  2. Li, H. Y., Hua, Y. H.

Explore More Articles

Achilles TendinopathyExtracorporeal Shockwave TherapyESWTMechanical Loading ProgramsMusculoskeletal ConditionTreatment ProtocolTendon RepairPain ReductionMultimodal TreatmentRadial ESWTOrthopedicsPatient OutcomesFracture HealingOveruse Conditions

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