Shockwave Therapy for Lower Limb Tendinopathy Disorders
Tendinopathy is a general term used to describe painful conditions occurring in and around the tendons in response to overuse or wear and tear. Lower limb tendinopathy disorders are typically caused by repetitive strain. Soft tissue structures such as tendons and ligaments can be overloaded by repeated movements, this may be the result of sporting activity, an occupation, poor posture, biomechanics or direct injury. At the physiotherapy clinic, we regularly treat lower limb and tendinopathy disorders including achilles tendinopathy, patella tendinopathy and plantar fasciitis, with a combination of physiotherapy and shockwave therapy.
What Is Shockwave Therapy?
Also known as Extracorporeal shockwave therapy (ESWT), shockwave therapy is a non-surgical and minimally invasive type of treatment applied to soft tissue injuries. The therapy works by delivering impulses of acoustic energy, rather than electrical energy, to the desired treatment area. The mechanical shockwaves essentially cause deliberate, but minor damage to the affected tissue, breaking down cells and scar tissue which may have formed in response to the initial injury. This prompts the body to reinitiate the healing process, as it sends blood and nutrients to repair the damage, pain relief is improved, and the recovery rate accelerated.
Achilles tendinopathy describes damage to the achilles tendon, it is a relatively common disorder that impacts thousands of men and women in the UK. The achilles tendon connects the calf muscles to the heel bone; it is one of the strongest tendons in the body and is heavily used, making it prone to wear and tear and subsequent overload injuries. This can cause painful symptoms which can interfere significantly with everyday life. Symptoms are generally characterised by pain and tenderness upon palpation, morning stiffness, pain that gets worse during exercise, and sometimes a creaking noise can be heard when moving the ankles.
The disorder is more prevalent in those that regularly participate in sporting activities such as running, football, basketball, gymnastics, dance, racquet sports etc. Other factors may also increase the likelihood of developing this type of pathology, this includes flat feet with lower arches, high arched feet, repetitive strain caused by habits or sporting activities (as listed above); other factors may include inappropriate footwear, genetics, obesity, diabetes or arthritis.
There are several different forms of treatment for this disorder, such as pain relief medication, shockwave therapy and targeted physiotherapy. The latter includes specific exercises and manipulation, and this will help to correct any other issues such as poor biomechanics or posture.
Shockwave treatment is highly effective and can help to accelerate the healing process. It can be combined with physiotherapy and pain relief medication to form a robust treatment plan. The number of shockwave therapy treatment sessions required for Achilles tendinopathy will depend on the severity of the condition itself, and the patient’s individual reaction to the treatment.
Often referred to as jumper’s knee, this is a relatively common condition that affects the tendon at the front of the knee. It is more common in people that participate in specific sports that involve lifting both feet off the ground at the same time, e.g., jumping, running, football, badminton, basketball, and other types of exercise. It is generally considered to be an overuse disorder that occurs when the tendon is unable to adapt to sudden, increased levels of strain. This causes damage within the tendon fibres, pain, and subsequent inflammation.
Symptoms are typically characterised by stiffness in the morning and tenderness upon palpation. Pain generally gets worse following exercise. Some people are more at risk than others of developing patella tendinopathy, risk factors include age, weight, gender, poor flexibility and repetitive strain during movements and exercise.
Patella tendinopathy is generally treated with conservative treatment techniques such as rest, pain relief medication and physiotherapy. In recent years shockwave therapy has been successfully used in the treatment of patella tendinopathy to provide effective pain relief and improved function.
This type of repetitive strain disorder is characterised by heel pain and involves inflammation of the plantar fascia, a thick band of connective tissue that runs across the bottom of the foot connecting the heel to the toe. It is also responsible for supporting the longitudinal arch of the foot and taking much of the load during walking and running. Plantar fasciitis (PF) is believed to be the result of excessive strain to the plantar fascia, a condition that causes pain on the inside of the heel. It occurs more frequently in runners and those that engage in other types of sports that involve running such as football.
An increased load to the plantar fascia is generally caused by exercise-related activities, it can, however, also occur in people that are overweight and more sedentary. Individual biomechanics such as low or high arched feet may also contribute, as can tissue tightness, inappropriate footwear that doesn’t support the fascia, muscle weakness (weak calf and foot muscles) and poor posture.
Pain is often worse first thing in the morning, with the first few steps feeling acutely sore, the sole of the foot may feel tender upon palpation and around the heel. Movements such as running, walking upstairs or on the toes may aggravate painful symptoms.
PF is generally diagnosed by a medical history and a physical examination however sometimes other types of diagnostic tests may be needed to eliminate other types of disorder. X-ray can be useful to show the presence of heel spurs. Treatment typically includes rest and not further aggravating the symptoms and pain relief medication. Physiotherapy treatment involves targeted stretches, exercise and manipulation. It is often combined with shockwave therapy helping to relieve pain and improve general function.
What To Expect During Shockwave Therapy Treatment
Each treatment takes around 10 minutes, a topical gel is applied to the skin above the area being treated and shockwaves are delivered via a handheld probe. As the treatment is delivered it is likely that a tapping noise will be heard, and some mild discomfort experienced.
Shockwave therapy increases the blood circulation and activity to the cells, this speeds up the body’s own healing process. Following treatment, several side effects may be experienced including pain around the treatment area and possible localised swelling. Following treatment, we recommend relative rest for 24 hours, avoiding any strenuous activities which may impact the healing such as strenuous exercise and following any instructions for physiotherapy.
ProPhysiotherapy offers comprehensive physiotherapy and related services, including shockwave therapy, to treat a vast array of physical disorders. To find out more about our services and how we can help you, get in touch today to talk to a member of the team.