Case Study – Shockwave Therapy for Chronic Achilles Tendinopathy
Symptoms
A 72 year old patient came into the clinic presenting with sharp pain in their right Achilles Tendon, which gradually started 3 weeks prior whilst walking their dog. The following morning the Achilles was swollen, tender and stiff, it had become painful to walk. The main things that aggravated their tendon was going down stairs and lifting their toes up which put their irritated Achilles Tendon on stretch.
They had previously injured their Achilles. It was first injured when playing rugby 53 years ago and then again 17 years ago, there was also a history of reoccurring calf strains in the same leg. Due to this it is clinically appropriate to assume there are some chronic changes in the tendon.
Noticing the symptoms were not improving with self-management he booked into the clinic to see one of our Physiotherapists, who he had seen before for a previous, now resolved injury
Assessment
The initial appointment consisted of a thorough history and questions about their injury and past medical history, followed by testing of the joint, muscles and tendons. Using several ankle specific tests our therapist was able to rule out joint problems such as osteoarthritis and came to the conclusion of acute flare of Chronic Achilles Tendinopathy.
Achilles tendons have been shown to become painful due to age related changes, overuse and change to activity levels. Intrinsic risk factors include those who are diabetic or have high cholesterol, joint stiffness, flat feet, stiffness in the ankle joint or hips and/or a leg too.
On questioning, the patient had a few rick factors for Achilles Tendinopathy. Such as age related changes, a history of reoccurring Achilles injuries (overuse/chronicity), total hip replacement in 2018, pre-diabetic and high cholesterol.
Treatment
After the initial assessment our therapist used deep tissue massage to release some of the tension in his calf. The patient and therapist also worked together to create a simple rehab plan that worked with his schedule. This involved tailored at home exercises to strengthen the musculature in a controlled way using slow resistance exercises avoiding over-stretching plus gentle joint glides to help improve range of movement. These created the right conditions for the Achilles to positively adapt and recover.
Alongside the active treatment, Shockwave therapy was used. Shockwave was appropriate due to the chronic condition of the tendon. Chronic conditions are ones that have stalled in a healing phase, therefore unable to fully recovery or return to the tendons original state. Tendons need to store energy, be elastic and responsive to movement; this tendons structure had become thickened and stiff.
Shockwave Treatment helps to improve chronic musculoskeletal conditions (tendons and osteoarthritis too). Tissue in a chronic state of injury when subject to mechanical stress from Shockwaves will adapt to the stimulus. When administered into the tissue, the waves have effects on a cellular level that regenerate healing; Increased blood flow, formation of new vessels, tissue regeneration, pain relief, pro inflammation and inflammation regulator.
It’s the best my Achilles has felt in years!
Outcome
Research recommends 6 sessions of Shockwave Therapy, which are administered 5-10 days apart depending on condition, tissue tolerance and response.
After the first Shockwave session the patient described an instant pain relief when performing the post treatment test, and stated it was the best the Achilles had felt in years. There are some common short lived side effects to this treatment, including slight swelling which this patient experienced for 1 day post treatment.
With each session the symptoms were improving and the rehab plan was able to be progressed.
Evidence suggests that Shockwave Therapy is effective when treating lower limb conditions such as Achilles tendinopathy, plantar fasciitis, greater trochanteric pain syndrome and medial tibial stress syndrome within all phases of rehabilitation. (Korakakis, 2018)
If you are suffering from a reoccurring injury or feel that a long term injury is taking longer to heal than anticipated, then we would be happy to help and discuss treatment options with our Stansted Park Clinical Specialist Therapists, Physiotherapists and Sports Therapist.
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