Tendinopathy (inflammation pain) of the Achilles tendon and Focused shockwave therapy

CLFRV pata 700 2Do you suffer from pain in the area of the Achilles tendon? Does this pain appear especially during walking or sport? Have you been diagnosed with inflammation in the area of the Achilles tendon? If yes, then this articles is exactly for you. We will try to explain and describe the causes of the problems, and present you with non-invasive and effective therapy with the help of high-energetic focused shockwave therapy.

THE MOST COMMON CAUSES OF THE ILLNESS

Achilles tendon is the longest and one of the strongest tendons in our body. It connects the calf muscle (triceps surae muscle) with the heel bone and foot muscle. Tendinopathy (painful illness of the ligaments) of the Achilles tendon is considered to be the most frequent injury in the sports medicine. This disorder occurs because of long term overloading of the calf muscle, which is transforming into the Achilles tendon. When you involve pressure on the calf muscle, the tension is transferred onto the attachment of the Achilles tendon, where it can result in inflammatory overload - the so called tendinitis. By the Achilles tendon, this illness is called achillodynia. The inflammation significantly affects the elasticity of the tendon and also the structure itself (anatomical studies described that the tendon tends to fray as a result of inflammation). Ignoring for longer time the warning painful impulses can end up with rupture (torn) of the Achilles tendon. Inflammatory illness of the Achilles tendon occurs usually during sport, where sprinting is accompanied by fast breaking (tennis, volleyball, handball etc…).

Manifestation of the illness

Achillodynia is often manifested by swelling of the soft tissues, local pain and crepitus (crackling popping). Crepitus is resulting from sweating and commonly it occurs in acute phase of the illness, when it’s invoked especially by flexing or stretching of the toes. In the early stages, the swelling and pain are restricted to a smaller area, but it can gradually spread into the area of the heel or calf muscle.

STANDARD TREATMENT PROCESSES DURING ACHILLODYNIA

Classical non-operative therapy includes setting up regime measures, which stops the overloading of the tendon (restricted sport activity, peaceful regime), it is recommended to wear heel pads and passive orthopedic insoles in your shoes, as well as application of non-steroid anti-inflammatory drugs and stretching exercises. This option of treatment rarely helps, because it is not really an functional solution, but more of an effort to remove the pain - but it is not focused on the real source of pain. For that reason the doctor may apply not always the best treatment for your problems, for example cortisone injection. Application of corticosteroids distorts the structure of the tendon alone and it significantly reduces its elasticity, and it doesn’t solve the cause of the problems. Their frequent use can even result in rupture of the Achilles tendon as a result of the lost flexibility.

FOCUSED SHOCKWAVE THERAPY

Research

There were many researches done already which proved the effectivity of the focused shockwave (ESWT) in cases tendinitis (inflammation of the tendon). Doctors Michelle Wilson and Jason Stacy (University of South Carolina, USA) focused on the therapy of tendinitis in the area of the Achilles tendon, they both agree that focused shockwave therapy is very ideal for conservative treatment of the achillodynia. They both came to the this conclusion after studying and evaluating many scientific papers focusing on the effectivity of the treatment with focused shockwave (ESWT) in cases of tendinopathy of the Achilles tendon.

Focused shockwave therapy on our clinic

Frequency and number of the applications is similar as by other types of tendinitis (such as tennis elbow or javelin thrower’s elbow) - so we do 3 - 4 application within 7 - 10 days. After the application of the ESWT directly into the area of the Achilles tendon, we continue to treat the calf muscle area with radial shockwave to release the tension. In the end we perform relaxing massage with the V-Actor headpiece, which supports the effect of the shockwave. You can read detailed description of the focused shockwave therapy in article : Focused shock wave therapy.

In the end, the therapy is supported by the application of the functional kinesio tape (elastic cotton bands), which will keep the calf muscle relaxed even after you leave our clinic, and it will strengthen and support the function of the Achilles tendon.

Video example of simple stretching of the Achilles tendon

Stretching the Achilles tendon

 


Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd. Prague, Czech Republic
Source: Current Reviews in Musculoskeletal Medicine; 2011 March; 4 (1); 6-10.

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