Understanding Tendinopathy
What is Tendinopathy?
Tendinopathy is a broad term referring to changes in the composition of tendons (strong fibrous collagen tissues that attach muscle to bone). This often occurs due to an overload mechanism. You may have heard of tendinitis, the ‘itis’ implying inflammation.
Causes and Risk Factors
Several factors may contribute to the development of tendinopathy:
- Overuse or repetitive strain on the affected tendon
- Aging and degenerative changes in the tendon
- Decreased blood supply to the tendon
- Hormonal imbalances, such as thyroid disorders or estrogen deficiency
- Genetic predisposition
- Metabolic disorders, such as diabetes
What is Shockwave Therapy?
Shockwave therapy, or extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that stimulates healing in the affected tendon. The shockwaves are generated by a handheld device and applied to the skin over the affected area, targeting the tendon composition.
The National Institute for Health and Care Excellence (NICE)—the national governing body providing guidance on health to improve care in the NHS and private care—supports the use of shockwave therapy for tendon-related injuries. Multiple randomized, double-blinded clinical trials also now support the use of shockwave therapy for tendinopathy management. The evidence is most robust around lateral epicondylalgia (tennis elbow) and plantar fasciopathy.
How Does Shockwave Therapy Work?
Shockwave therapy promotes healing and pain relief through several mechanisms:
- Stimulating blood flow: Shockwaves can increase blood circulation in the treated area, bringing oxygen and nutrients to the damaged tendon and promoting healing.
- Activating cellular processes: The mechanical stimulation provided by shockwaves can trigger the release of growth factors and other biochemicals that promote tissue repair and regeneration.
- Reducing pain and inflammation: Shockwave therapy can modulate nerve impulses and decrease sensitivity, leading to pain relief and reduced inflammation in the affected tendon.
The Shockwave Therapy Procedure
Shockwave therapy for tendinopathy is performed as an outpatient procedure, typically taking 10-15 minutes per session. The process involves the following steps:
- The patient is positioned comfortably, with the affected area exposed.
- A gel is applied to the skin to facilitate shockwave transmission.
- The physiotherapist positions the handheld device on the skin and delivers the shockwaves to the targeted area.
- Some discomfort or pain may be experienced during the procedure, but this is generally well-tolerated.
- After the session, the patient can usually return to normal activities, although temporary soreness or swelling may occur.
Treatment Protocol and Expected Outcomes
The number of shockwave therapy sessions needed for tendinopathy varies according to symptoms and the individual’s response to treatment. A typical treatment protocol may include:
- 4-6 sessions, scheduled at weekly intervals.
- Progressive improvement in symptoms over the course of treatment.
- Follow-up imaging to assess changes in the tendon composition.
- Continuation of a rehabilitation program to restore strength and mobility in the affected joint.
It has been stated that shockwave therapy has a 70% success rate for tendinopathies (Moya et al., 2018; Dedes et al., 2018).
Complementary Treatments and Prevention Strategies
Combining Shockwave Therapy with Other Treatment Modalities
While shockwave therapy can be a powerful tool in managing tendinopathy, it is often most effective when combined with other treatment modalities, such as:
- Physical therapy to address muscle imbalances, improve flexibility, and restore joint function.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or ice therapy to manage pain and inflammation.
- Gradual return to activity, with modifications as needed to prevent further injury.
- In some cases, ultrasound-guided needle aspiration or surgery may be necessary where pain is persistent.
Preventing Tendinopathy
While some risk factors for tendinopathy, such as age and genetics, cannot be modified, several strategies may help reduce the risk of developing this condition:
- Maintain flexibility and strength in the muscles surrounding the affected joint through regular stretching and exercise.
- Gradually increase training intensity and duration, allowing the body time to adapt.
- Use proper form and technique during activities that stress the tendons, such as overhead or repetitive motions.
- Take breaks and allow for adequate rest and recovery between activities.
- Address any underlying health conditions that may contribute to the development of tendinopathy, such as thyroid disorders or diabetes.
At MSK Clinic, we offer shockwave therapy as part of our comprehensive approach to treating tendinopathy and other musculoskeletal conditions