What is the Achilles tendon?
What is Achilles tendinopathy, tendonitis and tendinitis?
What other treatments are available for Achilles tendinopathy?
- Modifying activities of daily living can make a significant difference in the early management of achilles tendinopathy. Reducing activities that are known to aggravate symptoms may be all that is needed in the early stages of the condition. However, complete rest of an injured tendon can be detrimental due to the activation of tenocytes which lead to the release of matrix metallo proteinase (MMP) causing further degradation and permeability of the paratendon to permeating blood veseels.
- Cold therapy has a benefit in the early stages as it slows down the inflammatory reaction in the tendon as well as having an analgesic effect on the afferent nerve fibres/receptors/endings.
- Ultrasound can be used in the acute phase to help reduce swelling and improve healing.
- Laser has also been shown to be beneficial for management of acute and chronic tendinopathy.
- Deep frictions massage can be used in more chronic cases to help increase blood flow and reorgnaisation of collagen fibres, accompanied with stretching.
- Commonly eccentric muscle training is used to reduce pain in chronic achilles tendinopathy, as well as increase the tensile strength of the musculo-tendinous complex.
- Heel lifts are commonly used for the ‘off-loading’ of the achilles tendon during acute phases.
- Several studies have looked at the role of drugs and injection therapy and concluded there is little evidence for the use of pertendinous and intratendinous corticosteroid injection therapy.
- Surgery is an option for more severe cases but the long-term complications and outcome measures are still in question.
- Shockwave therapy provides an alternative to surgery and, in most cases of tendinopathy, will result in a satisfactory outcome.
How is shockwave therapy applied to the area?
- Largely the study of exactly what happens during shockwave therapy is the topic of many research projects. Some proposed mechanisms so far that has good evidence include;
- Direct stimulation of healing (increased TGF-b1, IGF-1, increased GAG’s)
- Direct suppression effects on nociceptors
- Hyper-stimulation (blocking the gait control mechanism)
- Increased NO expression
- Increase PCNA (proliferating cell nuclear antigen), collagen type 1 and collagen type 3
How long will shockwave therapy take to work?
What is the evidence for shockwave therapy and achilles tendon pain/achilles tendinopathy?
Where can I get shockwave therapy for this condition?
How long will shockwave treatments last for?
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