Have you heard that there is an alternative to invasive surgical management for treating chronic tendon pain? The answer lies in Extracorporeal (meaning outside the body) Shockwave Therapy (ESWT). The treatment was originally used to effectively treat kidney stones, and so the idea of also applying shockwaves to treat calcification within soft tissues (commonly the shoulder rotator cuff) came about. It proved very effective, and further research identified other applications, specifically in the treatment of chronic plantar fasciitis (painful heel), tennis elbow (extensor tendinopathy), achilles tendinopathy, patellar tendinopathy, quadriceps tendinopathy etc.
So what is tendinopathy?
You have probably heard the terms "tendinitis", "tendinopathy" or "tendinosis" - but what is the difference, and why is it important to know?
When you have an acute injury to a tendon, where the pain is primarily caused by an inflammatory response, this is known as tendinitis. At this stage your condition should respond well to anti-inflammatory medication and relative rest from any aggravating activities - recovery time is normally quite short.
Tendon pain which persists for a long period, and which comes on gradually, is normally due to overuse where the tissue tolerance or conditioning is not adequate for the task that it needs to perform - not necessarily in sport training, but even with tasks as simple as repetitive mouse clicks! We know that degeneration of the tendon structure occurs with associated weakness, pain and dysfunction - there is no inflammation within the damaged tissue, but the tissue is disorganised and thickened. Recovery time is usually much longer.
Treatment for tendinitis and tendinopathy is quite different, and it is therefore important that an accurate diagnosis is made. At Advanced Rehabilitation Parkmore we are skilled at assessing your conditioning and implementing the best treatment protocol.
Shockwave therapy is an effective treatment for tendinopathy, and can considerably reduce healing time.
What does ESWT do?
The research suggests that ESWT works on a number of biological levels to encourage healing of degenerative tissue. ESWT is thought to:
- Provide pain relief through hyperstimulation of sensory nerves
- Directly stimulate healing and collagen formation through the increased release of growth factors, as well as encouraging the formation of new capillaries (small blood vessels) within the damaged tissue
- Mechanically disintegrate calcific deposits
What to expect during treatment
Your physiotherapist will first do a full assessment to confirm the diagnosis clinically. If there is any uncertainty about the diagnosis, ultrasound imaging may be recommended, however most tendinopathies can accurately be identified through clinical evaluation. The pressure and frequency at which the shockwaves are delivered can be adjusted to make the treatment more tolerable, however a therapeutic dosage has to be reached in order to be effective, and you will therefore likely experience some discomfort at the site of your tendon pain. At Advanced Rehabilitation Parkmore our therapist is highly skilled at administering the treatment, having trained under the leading shockwave clinician and lecturer in the UK. ESWT treatment should not last longer than around 10 minutes, however the physiotherapist will also treat the surrounding soft tissues and joints as appropriate, and will give you rehabilitation exercises which are absolutely vital for tendon recovery. You can therefore expect to have a full 45 minute treatment session. There should not be much pain immediately after treatment, however a dull pain may be experienced later on the day of treatment, which may last for a day or two.
What should I do after treatment
One of the functions of ESWT is to cause an inflammatory response which helps to trigger the body's natural healing cascade. It is therefore recommended that you do not use anti-inflammatory medication or ice. You should also refrain from doing any intensive exercise or activity using the affected tendon for about 48 hours after treatment.
Is it safe for me?
For most indications as discussed above, the treatment is totally safe, with minimal side effects. Your physiotherapist will however take a full medical history prior to your treatment, as there are a number of contra-indications including:
- Use of anti-coagulant medication (eg. warfarin, aspirin etc.)
- Heart conditions such as pacemakers etc.
- Open wounds
- Active/acute inflammation
Will it work for me?
As with any treatment modality, a 100% success rate cannot be guaranteed. At Advanced Rehabilitation Parkmore we provide you with the best evidence available, and discuss your condition with you so that you can make an informed decision on your treatment. There is a large body of research evidence showing that the effectiveness of ESWT in chronic tendinopathies is in the 75-80% range at long term follow up - this is comparable, and for some conditions superior to, surgical intervention, but without any of the associated risks. It is vital that the treatment is administered by an experienced clinician for best results. We believe that with thorough assessment, good clinical application of the treatment, and a full rehabilitation protocol, shockwave therapy will be effective in the majority of cases.
If you are unsure about whether shockwave therapy could help your condition, please contact us to discuss your condition with the physiotherapist.