Shockwave for Achilles Tendinitis→

What Is Achilles Tendonitis?

Tendonitis refers to an overuse injury at the tendon portion of your muscle group. Tendonitis can happen in various areas throughout the body, such as the elbow, shoulder, and knee. Another common area that tendonitis occurs is in the Achilles. 

Your Achilles tendon is the thick band of tissue at the most distal end of your calf muscle. It helps connect the muscles in the calf to your heel. In many Achilles tendonitis cases, injuries happen without any contact. 

Runners and basketball players are prominent groups of athletes that tend to experience Achilles tendonitis. Untreated, this injury can lead to a complete rupture, which requires surgical intervention. 

However, you don’t have to be a professional athlete for this common injury. Since it is an overuse injury, many adults who play pick-up basketball games on the weekends or a quick game of tennis can experience it. There are two main types of Achilles tendonitis, including:

• Insertional

• Noninsertional

As the name sounds, insertional tendonitis happens right at the junction where your Achilles tendon attaches to your heel bone. Noninsertional tendonitis occurs just above the insertion point and can cause swelling and pain. In some instances, it can also cause bone spurs. 

Symptoms of Achilles Tendonitis

The most apparent symptom of Achilles tendonitis is pain. Other common symptoms are:

• Swelling

• Tenderness

• Muscle stiffness

• Burning pain

If you notice pain or tightness when stretching your calf muscle, you might have a case of tendonitis. Typically, this pain or discomfort doesn’t go away suddenly. It can linger for weeks or months and worsen during or after activity. 

You may also notice increased stiffness in the morning after sleeping. People who are most at risk of this injury are:

• Men over 30

• Flat feet

• Bone spurs in your feet

• Suddenly increasing your activity

• Improper footwear

• Other comorbidities

R.I.C.E. is one of the more common treatments and stands for Rest, Ice, Compression, Elevation. It is a quick, simple, and effective tool for helping with pain and inflammation.

It also allows the injury time to heal and recover. However, when resting an injury doesn’t help, it is time to start looking into the next steps. 

These steps are more intensive and include physical therapy, surgery, and medication. Non-surgical treatments can take anywhere from six to 12 weeks. If that sounds like a long time, surgical interventions can take up to six months. 

Even after six months, you may not notice full strength and mobility for up to a year. Are there other options out there? The short answer is yes!

Shockwave Therapy Guide

What is shockwave therapy? It is a non-invasive treatment that has become a more popular option for physical therapists and orthopedic clinics. 

It first started decades ago but has recently been a more commonplace option for patients. These patients want to try other treatments for injury management other than surgical or invasive procedures. It uses acoustic waves emitted from the end of a wand that essentially shocks the muscles, tendons, or other tissues. 

The practitioner uses the shockwave therapy tool over the area of injury that helps kickstart the healing process. There are two primary forms of shockwave therapy, including: 

• Low energy

• High energy

Low energy shockwave therapy mainly focuses on managing inflammation and helping with your pain. It is cost-friendly and provides almost immediate relief from the painful side effects of tendonitis.

For the most effective results, you will want high-energy shockwave therapy. This type of shockwave therapy has shown some of the best benefits of the healing process and getting you back to your favorite activities. What other benefits can you see from shockwave therapy? 

• Increased blood flow

• Reducing chronic inflammation

• Reducing calcium build-up

• Release muscle tension

Studies recommend shockwave therapy treatments for injuries that haven’t responded to other standard care. It is highly recommended for any tendonitis or calcific tendinopathy. Surprisingly, even certain fractures can benefit from shockwave therapy. 

On various musculoskeletal injuries, experts found that shockwave therapy showed positive changes in the tissue. 

Shockwave Therapy Tips

How can you get started with using shockwave therapy? First, make sure you recognize some of the contraindications. For starters, patients who are pregnant or have certain heart diagnoses may not qualify. 

For safety, they should consult with a physician or a qualified specialist that can help determine if they are a candidate for shockwave therapy. Second, there are a few different shockwave therapy tools you can use in a clinic – make sure you consult with an expert on the products your clinic could benefit from the most. 

When administering shockwave therapy, it doesn’t have to be very long. Before starting, gel should be applied to the patient and the area being treated.

The gel acts as a medium that helps the shockwaves permeate the skin. Most chronic pain treatments are around five to ten minutes, while the maximum time can be 18 minutes. 

Immediate Shockwave Therapy Effects

There may be some mild discomfort during treatment, but it should be tolerable for the entirety of the session. After treatment, there are no restrictions, and the patient can resume their daily habits. However, experts suggest that patients undergoing shockwave therapy should avoid high-impact activities or sports.

This restriction would also include running. One of the biggest shockwave therapy tips is to avoid anti-inflammatory medication such as ibuprofen. Ibuprofen is a handy medication to have on hand for most sports or orthopedic injuries, but it can negate the positive effects of shockwave therapy.

After treatment, the inflammation process helps bring nutrients and blood to the area that promotes healing. Ibuprofen can slow this process down. In most cases, the inflammation will start dissipating after one or two days. 

Patients and clinics must remember that shockwave therapy typically requires more than one treatment, and results may not be seen immediately. In many instances, it can still take months for proper healing, but it can help patients avoid surgical interventions and other costly procedures. 

Shockwave Therapy for Achilles Tendonitis

Shockwave therapy to treat Achilles tendonitis is an excellent treatment option for patients who have failed other forms of treatment. It can also be an excellent tool for treating an acute injury since it can help act as a pain reliever and kickstart the healing process. 

But what do the studies show? 

One study looked at extracorporeal shockwave therapy (ESWT) against other non-surgical treatments for Achilles tendonitis. After treatments, they assess pain scores and functional outcomes. 

In both categories, they found that patients reported improvements. It is recommended before surgical consultation. ESWT also showed improvements at the three, six, and twelve-month mark compared to other standard therapies such as eccentric exercises. 

Another study examined ESWT and mesotherapy, a technique that injects small amounts of vitamins, extracts, or other pharmaceutical substances. Two groups of athletes were assigned to each treatment for a total of four weeks. 

They found that both groups showed improvements in pain and inflammation. However, the most significant difference popped up at the twelve-week mark. Even though both treatment groups stopped after a month, they found that the ESWT group had improved Achilles tendon thickness and Doppler signal than the mesotherapy group. 

The researchers also found that there were reduced calcifications after twelve weeks. In the end, the study highlighted more of the long-term effects that ESWT can have for various sports injuries, especially tendonitis injuries that can notoriously take a long time to heal properly. 

Achilles Tendonitis Shockwave Therapy

Shockwave therapy for Achilles tendonitis can help reduce inflammation, promote blood flow, and reduce calcifications. Ultimately, combining the effects of shockwave therapy can improve the body’s natural healing process. 

Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when ...

• ... The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.
• ... Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
• ... Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
  The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
• ... Opioids are prescribed for pain. 
  Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.
• ... Pain lasts 90 days.
  At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

"Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Physical Therapy Journal (PTJ) Special Issue Highlights Effectiveness of Nonopioid Approaches to Pain

ALEXANDRIA, VA, April 16, 2018 — Early utilization of physical therapist treatment can reduce opioid use and downstream health care costs. That's just one important takeaway from the latest edition of Physical Therapy (PTJ), the official scientific journal of the American Physical Therapy Association (APTA), which today published a special issue devoted to nonpharmacological pain management. 

In five original research papers released online ahead of print for the May special issue:

• Patients who received physical therapist treatment immediately following arthroscopic hip surgery were associated with lower downstream costs and lower opioid use.
• People treated by a physical therapist within three days of the onset of low back pain were associated with lower total health care costs and lower opioid use.
• Telehealth physical activity programs for older adults with low back pain improved physical function.
• Analysis of patient screening suggested it may be possible to predict which patients are at risk for long-standing musculoskeletal pain.
• Patient education about pain's link to the brain improved the participation of patients with chronic spinal pain in beneficial physical activity programs.

"This special issue adds new evidence to a growing body of evidence on the important role of nonpharmacological interventions for the management of chronic pain," said Editor in Chief Alan M. Jette, PT, PhD. "The need for this information has never been so urgent."

According to the American Academy of Pain Medicine, 100 million Americans live with chronic pain, and many of them turn to opioids to manage it. The Centers for Disease Control and Prevention (CDC) recommends pursuing nonopioid options like physical therapy for the safe management of chronic pain. Physical therapists treat pain through prescribed movement and exercise, hands-on care and patient education.

APTA's #ChoosePT campaign raises awareness about the risk of opioids for long-term pain management and physical therapy as a safe and effective alternative, consistent with CDC guidelines.

The American Physical Therapy Association represents more than 100,000 physical therapists, physical therapist assistants and students of physical therapy nationwide. Visit MoveForwardPT.com to learn more about the types of conditions physical therapists treat, and find a physical therapist in your area.

Source: APTA