performing extracorporeal shockwave therapy (ewst) to treat achilles tendinopathy

Using Extracorporeal Shockwave Therapy (ESWT) for Treating Achilles Tendinopathy

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&#160;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 contributors to the development of Achilles tendon injuries is the excessive load force applied during intense activities such as running, without allowing sufficient time for proper tendon repair1. This continuous stress on the tendon can lead to the gradual accumulation of microtraumas and ultimately result in injury progression3. This highlights the importance of proper management, rest, and adequate rehabilitation periods in preventing such injuries and maintaining the health of the Achilles tendon. The diagnosis of Achilles tendinopathy relies mainly on a comprehensive patient history and clinical examination4. A typical symptom is the occurrence of morning stiffness or limited range of motion after prolonged inactivity, accompanied by gradually increasing pain during physical activity2. Athletes often go through pain at the beginning and end of the training, with a period of decreased discomfort in between. However, since the condition worsens, even slight exertion can lead to the onset of pain, greatly affecting daily activities. In severe cases, individuals may even experience pain while at rest5.
The management of Achilles tendinopathy primarily involves conservative approaches, even though approximately 25%-29% of patients may eventually require surgery for the condition5. Cardoso et al.6 summarized an overview of the current treatment of Achilles tendinopathy, including medications, exercise, corticosteroid injections, platelet-rich plasma injections, manual therapy, and modalities. Among these treatments, the most widely recommended is exercise, which targets the injured tendons, especially mechanical loading exercises; eccentric exercise has been considered a better intervention. Even though it has been proven useful to decrease pain and improve function in the short term, a significant portion of patients have not responded to this strategy in a long-term study7, and some patients seek other treatments.
In recent years, extracorporeal shockwave therapy (ESWT) has demonstrated beneficial effects on musculoskeletal disorders and has become an effective treatment for tendinopathy8,9. There is now increasing evidence supporting the effectiveness of ESWT for lower extremity tendinopathy10 and upper extremity tendinopathy11. Originally used in urology for kidney stone treatment, ESWT has found therapeutic application in a wide range of medical and musculoskeletal conditions, making it a major innovation in the field of regenerative medicine12. There are two types of ESWT: focused shock waves and radial pressure waves13,14; the main difference between them is their physical characteristics. As a result, they stimulate diverse regenerative biological reactions in musculoskeletal tissue, activating proteins that play a role in chondroprotection15, vessel regeneration16,17, reducing inflammatory18, anti-apoptosis19, immunomodulation20, neurophysiological mechanisms, and pain relief11. ESWT also triggers the initiation of the healing processes, which facilitates the proliferation, differentiation, and migration of diverse cell types such as mesenchymal stem cells, endothelial cells, fibroblasts, and tendon cells. Additionally, it promotes the synthesis of collagen21. Furthermore, ESWT has been found to induce several tendon-specific responses that facilitate the healing progress22.
Although radial-ESWT is considered effective in Achilles tendinopathy treatment, there are various reports on the technique of radial ESWT without any consensus on the parameters. In this paper, we present a detailed treatment protocol for treating Achilles Tendinopathy using ESWT.

Author Spotlight: Effectiveness of Extracorporeal Shockwave Therapy in Achilles Tendinopathy Treatment

A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy

Although extracorporeal shockwave therapy, or ESWT, is considered effective in Achilles tendinopathy treatment, there are various reports on the technique of radio ESWT without any consensus on the parameters. Here, we present a detailed treatment protocol for treating Achilles tendinopathy with using ESWT. Recent developments in this field focus on high-quality clinical research and the more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.Combine ESWT with other therapies, especially eccentric exercise, may further enhance his effectiveness in improving patient outcomes and pain relief.

Performing Extracorporeal Shockwave Therapy (EWST) to Treat Achilles Tendinopathy

To begin, place the patient in a comfortable prone position with the target area exposed. After the physical examination, locate the area that requires treatment and mark these points using a felt-tip pen. Use the conductor R15 for tendinopathy and D20 for tendinopathy and the trigger point of the deep muscle.After drying the skin thoroughly, apply an adequate amount of gel to the target area as a coupling agent. To set up the device, press the power on or off button, or touch the liquid crystal display, or LCD. Inspect parameter options on the display and press the buttons directly on the LCD to make a selection.Adjust the parameters using the up and down buttons. Press the pause or stop buttons located on the operator interface to stop the output. To edit the treatment screen and parameters, press the edit button and wait for the edit treatment screen to display.Increase and decrease the parameters on the edit treatment screen by pressing the up and down buttons as needed during the treatment process, based on the patient's tolerance and response. Select the intensity to be used, which is 1.6 Bar in this study. Starting at a lower intensity of the therapy, gradually increase the intensity as high as the patient can tolerate.Set the frequency of the treatment to about 10 hertz here. Establish the desired number of shocks to be applied, which is 2, 000 in this study, and set the number of shocks per treatment within 800 to 3, 000. Begin the treatment by pressing the start button on the user interface and activate the handpiece by pressing the trigger button on the handpiece.During the treatment, maintain the contact between the conductor and the skin tissue and move the handle by drawing a small circle. To pause the therapy at any time, press the pause button on the user interface or the trigger button on the handpiece. To stop the therapy, press the stop button on the user interface.After the treatment, remove any residual coupling gel from the treated area. Plan three sessions spaced one week apart. Outcomes of the treatment protocol applied to patients across both genders showed a significant decrease in pain.The Roles and Maudsley score, which subjectively describes a patient's pain, also significantly decreased after the treatment.

performing-extracorporeal-shockwave-therapy-ewst-to-treat-achilles

Research

JoVE Journal

Medicine

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&#160;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.

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.

Achilles tendinopathy is a common musculoskeletal condition characterized by pain, lower muscle strength, gait abnormality, and reduced quality of life. ...