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What is Achilles tendinopathy?

 

Achilles tendinopathy is a common overuse soft tissue injury with incidence rates reported to be between 1.85-2.16 per 1000 people in the general population (de Jonge et al., 2011, Albers et al., 2016).

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Achilles tendinopathy is common in running populations, with prevalence rates up to 9.5% (Lopes et al., 2012). Additionally, Achilles tendinopathy affects inactive populations with 1 in 3 people with the condition leading a sedentary lifestyle (de Jonge et al., 2011).

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Increased age and obesity are contributing factors for the condition as it is reported most frequently by people aged between 40 and 59 years (Yasui et al., 2017) (de Jonge et al., 2011).

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Achilles tendinopathy is characterised by pain in the middle of the tendon, which is 2-6cm higher (see blue circle) than the heel bone (calcaneum) (Rompe et al., 2009, Furia, 2008). Patients also present with swelling and report morning stiffness of the tendon (Cook & Purdam., 2009).

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What causes Achilles tendinopathy?

 

mid portion Achilles tendinopathy is associated with injury and/or overuse.

The precise cause is often unknown, but there are certain factors and sports such as running, tennis and football which can provoke the condition. Mid portion Achilles tendinopathy is particularly common in runners who have:

• increased their mileage too quickly

• are running too frequently

• very old and/or new running shoes

• have reduced ankle range of motion

• have reduced calf strength (Van Der Vlist et al., 2019)

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How do we treat Achilles tendinopathy?

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Most Achilles tendon issues resolve with a course of physiotherapy. It is however common for Mid portion Achilles tendinopathy to take 6-12 weeks if the condition is chronic (if you have had it greater than 12 weeks). Research shows that treatment should involve heavy loading/strengthening for the calf muscle and Achilles tendon.

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If you are not improving with rehabilitation and physiotherapy, shockwave therapy or an ultrasound guided injection may be an appropriate adjunct to your treatment.

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Shockwave is a safe, well-tolerated and non-invasive approach to the management of Achilles tendinopathy (Stania et al., 2019) 

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Ultrasound guided injections are generally utilised for the problematic cases that have failed physiotherapy and shockwave therapy.

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Is shockwave therapy effective for mid portion Achilles tendinopathy?

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Yes, shockwave is a very effective treatment modality for the treatment of mid portion Achilles tendinopathy.

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Furia (2008) reported 34 patients with mid portion Achilles pain were treated with shockwave therapy and 34 patients with were treated with another type of therapy (control group). After the treatment, the shockwave group had a statistically significant pain reduction and reported an excellent or good recovery.

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A randomised controlled trial of 75 patient split into three different groups:

a) Tendon loading
b) Shockwave therapy and
c) wait and see, demonstrated positive results.

The tendon loading and shockwave therapy groups had improved function and less pain. 60% of the tendon loading and 52% of the shockwave therapy groups testified they were “completely recovered” or “much improved” (Rompe et al., 2009). At Complete we use a combination of both the tendon loading and shockwave therapy to get our clients out of pain and back to full function.

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We believe it is the combination of therapies that is the key to our success.

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These conclusions were reinforced and developed in a study of 68 patients, which involved combining the tendon loading and shockwave therapy, and the results demonstrated an increase in the proportion of “completely recovered” or “much improved” patients to 82% (Rompe et al., 2009).

 

Finally, Santamato et al ‘s (2019) results revealed a significant pain reduction in patients with mid portion Achilles tendinopathy along with improvements in ankle range of movement both short and long term. Furthermore, there was improved functionality and a positive clinical impression with patients reporting an excellent/good clinical picture.

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At Prime we treat a large number of clients every year with Achilles tendinopathy and the combination of shockwave therapy and rehabilitation exercises has improved our clinical outcomes.

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The use of shockwave therapy for Achilles tendinopathy is well supported by the National Institute for Health and Care Excellence (NICE). NICE  provides evidence based recommendations to guide best practice within healthcare.

 

Scientific evidence undoubtedly supports the role of shockwave therapy in mid portion Achilles tendinopathy.  The combination of shockwave and rehabilitation/tendon loading provides the best treatment outcome for this condition.

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How many sessions and how often do you need shockwave therapy for mid portion Achilles tendinopathy?

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At Prime we are guided by the latest evidence-based research for our shockwave protocols.  A minimum of three shockwave sessions roughly one week apart is recommended. Some patients require additional sessions, but this will depend on how long you have had your symptoms and how you respond to treatment.

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How long does it take to recover from mid portion Achilles tendinopathy?

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This varies from individual to individual depending on the type and severity of the tendinopathy. Some patients feel an instant decrease in their pain following the first shockwave session.

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If you would like to book an appointment or would like more information before booking, please call 01949 485084 or email info@primeperformancephysio.co.uk