The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion, and Strength in Patients with Insertional Achilles Tendinosis
Increased physical fitness participation has been
paralleled by increasedoveruse injuries such as insertional Achilles
tendinosis (AT). Treatment has provided inconsistentresults. The use
of extracorporeal shockwave therapy (ECSWT) offers a new
treatment consideration.The purpose of this study was to assess the
effects of ECSWTon pain, function, range of motion (ROM), joint
mobility and strength in patients with AT. Thirty subjects were
treated with ECSWT and measures were takenbefore and three
months after treatment. There was significant differences in visual
analog scale (VAS) scores for pain at rest (p=0.002); after activity
(p= 0.0001); overall improvement(p=0.0001); Lower Extremity
Functional Scale (LEFS) scores (p=0.002); dorsiflexion range of
motion (ROM) (p=0.0001); plantarflexion strength (p=0.025);
talocrural joint anterior glide (p=0.046); and subtalar joint medial and
lateral glide (p=0.025).ECSWT offers a new intervention that may
limit the progression of the disorder and the long term healthcare
costs associated with AT.
[1] L. M. Gottschlich, S. W. Sherwin, "Achilles tendonitis," Retrieved from
http://emedicine.medscape.com/article /85115-overview#showall, 2012.
[2] American Academy of Orthopedic Surgeons, "Achilles tendonitis,"
Retrieved from http://orthoinfo.aaos.org/ topic. cfm ?topic=A00147,
2012.
[3] R. S. Adler, K. C. Finzel, "The complementary roles of MR imaging and
ultrasound of tendons," Radiol Clin North A,vol. 43,no. 4, pp. 771-807,
2005.
[4] A. Gardin, T. Movin,L. Svensson, A. Shalabi, "The long-term clinical
and MRI results following eccentric calf muscle training in chronic AT,"
Skeletal Radiology, vol. 39, no. 5,pp. 435-442, 2010.
[5] N. L. Grigg, S. C. Wearing, J. E. Smeathers, "AT has an aberrant strain
response to eccentric exercise," Medicine and Science in Sports and
Exercise, vol. 44, no. 1, pp.12-17, 2012.
[6] K. Nilsson-Helander, K. G. Silbernagel, R. Thomeé, E. Faxén, N.
Olsson, B. I. Eriksson, "Acute Achilles tendon rupture: A randomized,
controlled study comparing surgical and nonsurgical treatments using
validated outcome measures, "Am J Sports Med, vol. 38, no. 11, pp.
2186-2193, 2012.
[7] K. G. Silbernagel, K.Nilsson-Helander, R.Thomee, "A new
measurement of heel-rise endurance with the ability to detect functional
deficits in patients with Achilles tendon rupture," Knee Surg Sports
Traumatol Arthrosc, 2009.
[8] National Institute of Health. "Achilles tendonitis," Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/ 001 072. htm, 2012.
[9] A. Abbassian, R.Khan, "AT: Pathology and management strategies,"
British Journal of Hospital Medicine, vol. 70, no. 9, pp. 519-523, 2009.
[10] J. Alvarez-Nemegyei, J. J. Canoso, "Heel pain: diagnosis and
treatment,"Cleve Clin J Med, vol. 73, no. 5, pp. 465-471, 2006.
[11] R. Chester, M. L. Costa, L. Shepstone, A. Cooper, S. T Donell,
"Eccentric calf muscle training compared with therapeutic ultrasound for
chronic Achilles tendon pain--a pilot study," Manual Therapy, vol. 13,
no. 6, pp. 484-491, 2008.
[12] M. Fahlstrom, P. Jonsson, R, Lorentzon, H. Alfredson, "Chronic
Achilles tendon pain treated with eccentric calf-muscle training," Knee
Surgery, Sports Traumatology, Arthroscopy : Official Journal of the
ESSKA, vol. 11, no. 5, pp. 327-333, 2003.
[13] R. Kearney, M. L.Costa, "Insertional Achilles tendonitis management: A
systematic review," Foot & Ankle International /American Orthopaedic
Foot and Ankle Society and Swiss Foot and Ankle Society, vol. 31, no. 8,
pp. 689-694, 2010.
[14] N. Maffulli, G. Walley, M. K, Sayana, U. G. Longo, V.Denaro,
"Eccentric calf muscle training in athletic patients with Achilles
tendonitis," Disability and Rehabilitation, vol. 30, no. 20-22, pp. 1677-
1684, 2008.
[15] H. Alfredson, "Eccentric calf muscle training - the story,"
Sportverletzung Sportschaden: Organ Der Gesellschaft Fur
Orthopadisch-Traumatologische Sportmedizin, vol. 24, no. 4, pp. 188-
189, 2010.
[16] R. A. Magnussen, W. R.Dunn, A.B. Thomson, "Nonoperative treatment
of midportion Achilles tendinopathy: a systematic review,"Clin J Sport
Med, vol. 19, no. 1, pp. 54-64, 2009.
[17] M. K. Sayana, N.Maffulli, "Eccentric calf muscle training in non-athletic
patients with Achilles tendonitis," Journal of Science and Medicine in
Sport / Sports Medicine Australia, vol. 10, no. 1, pp. 52-58, 2007.
[18] A. van der Plas, S. de Jonge, R. J. de Vos, H. J. van der Heide, J. A.
Verhaar, A.Weir, "A 5-year follow-up study of Alfredson's heel-drop
exercise programme in chronic midportion Achilles tendonitis," British
Journal of Sports Medicine, vol. 46, no. 3, pp. 214-218, 2012.
[19] J. D. Rompe, "Shock wave therapy for chronic Achilles tendon pain: A
randomized placebo-controlled trial," Clinical Orthopaedics and Related
Research, vol. 445, pp. 276-277, 2006.
[20] R. Seil, P., Wilmes, C. Nuhrenborger,"Extracorporeal shock wave
therapy for tendinopathies," Expert Review of Medical Devices, vol. 3,
no.4, pp. 463-470, 2006.
[21] H. van der Worp, I. van den Akker-Scheek, H.van Schie, J.Zwerver,
"ESWT for tendinopathy: Technology and clinical implications," Knee
Surg Sports Traumatol Arthrosc. DOI 10.1007/s00167-012-2009-3,
2012.
[22] Z. Korhan, M. Alper, Y. Akman, O. Yavuz, A. Yalciner, "An
experimental study on the application of extracorporeal shock waves in
the treatment of tendon injuries: Preliminary report,"J Orthop Sci, vol. 6,
no. 6, pp. 566-570, 2001.
[23] S. K. Shrivastava, Kailash, "Shockwave treatment in medicine,"J
Biosci,vol. 30, no. 2, pp. 269-275, 2005.
[24] Basic Physical Principles. Retrieved from http://www.
ismst.com/history_basic_ physical_principles.htm, 2012.
[25] Basic Physics. Retrieved from http://www.ismst.com/
principles_basic_physics.htm, 2012.
[26] L. Gerdesmeyer, C. Frey, J. Vester, M. Maier, L. Weil, M. Russlies, et
al.,"Radial extracorporeal shock wave therapy is safe and effective in the
treatment of chronic recalcitrant plantar fasciitis. Results of a
confirmatory randomized placebo-controlled multicenter study,"
American Journal of Sports Medicine," vol. 10, no. 10, pp. 1-10, 2008.
[27] M. L. Costa, L. Shepstone, S. T. Donell, T. L. Thomas, "Shock wave
therapy for chronic Achilles tendon pain: A randomized placebocontrolled
trial," Clinical Orthopaedics and Related Research, vol. 440,
pp. 199-204, 2005.
[28] R. Fridman, J. D. Cain, L. Weil Jr., L. WeilSr., "Extracorporeal
shockwave therapy for the treatment of Achilles tendinopathies: a
prospective study,"J Am Podiatr Med Assoc, vol. 98, no. 6, pp. 466-468,
2008.
[29] J. P. Furia, "High-energy extracorporeal shock wave therapy as a
treatment for insertional Achilles tendinosis," The American Journal of
Sports Medicine, vol. 34, no. 5, pp. 733-740, 2006.
[30] J. P. Furia, "High-energy extracorporeal shock wave therapy as a
treatment for chronic noninsertional Achilles tendinopathy," Am J Sports
Med, vol. 36, no. 3, pp. 502-508, 2008.
[31] S. Rasmussen, M. Christensen, I. Mathiesen, O. Simonson, "Shockwave
therapy for chronic Achilles tendinopathy: a double-blind, randomized
clinical trial of efficacy," Acta Orthop, vol. 79, no. 2, pp. 249-256, 2008.
[32] J. D. Rompe, J. Furia, N.Maffulli, "Eccentric loading compared with
shock wave treatment for chronic insertional Achilles tendonitis. A
randomized, controlled trial," The Journal of Bone and Joint
Surgery.American Volume, vol. 90, no. 1, pp. 52-61, 2008.
[33] J. D. Rompe, J. Furia, N.Maffulli, "Eccentric loading versus eccentric
loading plus shock-wave treatment for midportion Achilles tendonitis: A
randomized controlled trial," The American Journal of Sports Medicine,
vol. 37, no. 3, pp. 463-470, 2009.
[34] J. D. Rompe, B. Nafe, J. Furia, N.Maffulli, "Eccentric loading, shock
wave treatment, or a wait-and-see policy for tendinopathy of the main
body of tendo Achillis: A randomized, controlled trial," Ortho Trauma
Clinic, vol. 35, no. 7, pp. 1216, 2007.
[35] M. C. Vulpiani, D. Trischitta, P. Trovato, M. Vetrano, A. Ferretti,
"Extracorporeal shockwave therapy in Achilles tendinopathy. A longterm
followup observational study,"J Sports Med Phys Fitness, vol. 49,
no. 2, pp. 171-176, 2009.
[36] R. A. Swinkels, L. M. Bouter, R. B. Oostendorp, C. M. Van den Ende,
"Impairment measures in rheumatic disorders for rehabilitation medicine
and allied health care: A systematic review,"Rheumatol Int, vol. 25, pp.
501-512, 2005.
[37] K. A. Herr, K. Spratt, P. R. Mobily, G. Richardson, "Pain intensity
assessment in older adults: Use of experimental pain to compare
psychometric properties and usability of selected pain scales with
younger adults," Clin J Pain, vol. 20, no. 4, pp. 207-219, 2004.
[38] J. Binkley, P. W. Stratford, S.A. Lott, D.L. Riddle, D.L. "The lower
extremity functional scale: Scale development, measurement properties
and clinical application," Phys Ther, vol. 79, no. 4, pp. 371-383, 1999.
[39] C. L. Chung Wei, A. M. Moseley, K.M., Reshauge, A. C. Bundy, "The
lower extremity functional scale has good clinimetric properties in
people with ankle fracture,"Phys Ther, vol. 89, no. 6, pp. 580-588, 2009.
[40] S. S. Yeung, E. W. Yeung, L. D. Gillespie, "Interventions for preventing
lower limb soft tissue running injuries," Cochrane Database of
Systematic Reviews, vol. 10, 2011.
[1] L. M. Gottschlich, S. W. Sherwin, "Achilles tendonitis," Retrieved from
http://emedicine.medscape.com/article /85115-overview#showall, 2012.
[2] American Academy of Orthopedic Surgeons, "Achilles tendonitis,"
Retrieved from http://orthoinfo.aaos.org/ topic. cfm ?topic=A00147,
2012.
[3] R. S. Adler, K. C. Finzel, "The complementary roles of MR imaging and
ultrasound of tendons," Radiol Clin North A,vol. 43,no. 4, pp. 771-807,
2005.
[4] A. Gardin, T. Movin,L. Svensson, A. Shalabi, "The long-term clinical
and MRI results following eccentric calf muscle training in chronic AT,"
Skeletal Radiology, vol. 39, no. 5,pp. 435-442, 2010.
[5] N. L. Grigg, S. C. Wearing, J. E. Smeathers, "AT has an aberrant strain
response to eccentric exercise," Medicine and Science in Sports and
Exercise, vol. 44, no. 1, pp.12-17, 2012.
[6] K. Nilsson-Helander, K. G. Silbernagel, R. Thomeé, E. Faxén, N.
Olsson, B. I. Eriksson, "Acute Achilles tendon rupture: A randomized,
controlled study comparing surgical and nonsurgical treatments using
validated outcome measures, "Am J Sports Med, vol. 38, no. 11, pp.
2186-2193, 2012.
[7] K. G. Silbernagel, K.Nilsson-Helander, R.Thomee, "A new
measurement of heel-rise endurance with the ability to detect functional
deficits in patients with Achilles tendon rupture," Knee Surg Sports
Traumatol Arthrosc, 2009.
[8] National Institute of Health. "Achilles tendonitis," Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/ 001 072. htm, 2012.
[9] A. Abbassian, R.Khan, "AT: Pathology and management strategies,"
British Journal of Hospital Medicine, vol. 70, no. 9, pp. 519-523, 2009.
[10] J. Alvarez-Nemegyei, J. J. Canoso, "Heel pain: diagnosis and
treatment,"Cleve Clin J Med, vol. 73, no. 5, pp. 465-471, 2006.
[11] R. Chester, M. L. Costa, L. Shepstone, A. Cooper, S. T Donell,
"Eccentric calf muscle training compared with therapeutic ultrasound for
chronic Achilles tendon pain--a pilot study," Manual Therapy, vol. 13,
no. 6, pp. 484-491, 2008.
[12] M. Fahlstrom, P. Jonsson, R, Lorentzon, H. Alfredson, "Chronic
Achilles tendon pain treated with eccentric calf-muscle training," Knee
Surgery, Sports Traumatology, Arthroscopy : Official Journal of the
ESSKA, vol. 11, no. 5, pp. 327-333, 2003.
[13] R. Kearney, M. L.Costa, "Insertional Achilles tendonitis management: A
systematic review," Foot & Ankle International /American Orthopaedic
Foot and Ankle Society and Swiss Foot and Ankle Society, vol. 31, no. 8,
pp. 689-694, 2010.
[14] N. Maffulli, G. Walley, M. K, Sayana, U. G. Longo, V.Denaro,
"Eccentric calf muscle training in athletic patients with Achilles
tendonitis," Disability and Rehabilitation, vol. 30, no. 20-22, pp. 1677-
1684, 2008.
[15] H. Alfredson, "Eccentric calf muscle training - the story,"
Sportverletzung Sportschaden: Organ Der Gesellschaft Fur
Orthopadisch-Traumatologische Sportmedizin, vol. 24, no. 4, pp. 188-
189, 2010.
[16] R. A. Magnussen, W. R.Dunn, A.B. Thomson, "Nonoperative treatment
of midportion Achilles tendinopathy: a systematic review,"Clin J Sport
Med, vol. 19, no. 1, pp. 54-64, 2009.
[17] M. K. Sayana, N.Maffulli, "Eccentric calf muscle training in non-athletic
patients with Achilles tendonitis," Journal of Science and Medicine in
Sport / Sports Medicine Australia, vol. 10, no. 1, pp. 52-58, 2007.
[18] A. van der Plas, S. de Jonge, R. J. de Vos, H. J. van der Heide, J. A.
Verhaar, A.Weir, "A 5-year follow-up study of Alfredson's heel-drop
exercise programme in chronic midportion Achilles tendonitis," British
Journal of Sports Medicine, vol. 46, no. 3, pp. 214-218, 2012.
[19] J. D. Rompe, "Shock wave therapy for chronic Achilles tendon pain: A
randomized placebo-controlled trial," Clinical Orthopaedics and Related
Research, vol. 445, pp. 276-277, 2006.
[20] R. Seil, P., Wilmes, C. Nuhrenborger,"Extracorporeal shock wave
therapy for tendinopathies," Expert Review of Medical Devices, vol. 3,
no.4, pp. 463-470, 2006.
[21] H. van der Worp, I. van den Akker-Scheek, H.van Schie, J.Zwerver,
"ESWT for tendinopathy: Technology and clinical implications," Knee
Surg Sports Traumatol Arthrosc. DOI 10.1007/s00167-012-2009-3,
2012.
[22] Z. Korhan, M. Alper, Y. Akman, O. Yavuz, A. Yalciner, "An
experimental study on the application of extracorporeal shock waves in
the treatment of tendon injuries: Preliminary report,"J Orthop Sci, vol. 6,
no. 6, pp. 566-570, 2001.
[23] S. K. Shrivastava, Kailash, "Shockwave treatment in medicine,"J
Biosci,vol. 30, no. 2, pp. 269-275, 2005.
[24] Basic Physical Principles. Retrieved from http://www.
ismst.com/history_basic_ physical_principles.htm, 2012.
[25] Basic Physics. Retrieved from http://www.ismst.com/
principles_basic_physics.htm, 2012.
[26] L. Gerdesmeyer, C. Frey, J. Vester, M. Maier, L. Weil, M. Russlies, et
al.,"Radial extracorporeal shock wave therapy is safe and effective in the
treatment of chronic recalcitrant plantar fasciitis. Results of a
confirmatory randomized placebo-controlled multicenter study,"
American Journal of Sports Medicine," vol. 10, no. 10, pp. 1-10, 2008.
[27] M. L. Costa, L. Shepstone, S. T. Donell, T. L. Thomas, "Shock wave
therapy for chronic Achilles tendon pain: A randomized placebocontrolled
trial," Clinical Orthopaedics and Related Research, vol. 440,
pp. 199-204, 2005.
[28] R. Fridman, J. D. Cain, L. Weil Jr., L. WeilSr., "Extracorporeal
shockwave therapy for the treatment of Achilles tendinopathies: a
prospective study,"J Am Podiatr Med Assoc, vol. 98, no. 6, pp. 466-468,
2008.
[29] J. P. Furia, "High-energy extracorporeal shock wave therapy as a
treatment for insertional Achilles tendinosis," The American Journal of
Sports Medicine, vol. 34, no. 5, pp. 733-740, 2006.
[30] J. P. Furia, "High-energy extracorporeal shock wave therapy as a
treatment for chronic noninsertional Achilles tendinopathy," Am J Sports
Med, vol. 36, no. 3, pp. 502-508, 2008.
[31] S. Rasmussen, M. Christensen, I. Mathiesen, O. Simonson, "Shockwave
therapy for chronic Achilles tendinopathy: a double-blind, randomized
clinical trial of efficacy," Acta Orthop, vol. 79, no. 2, pp. 249-256, 2008.
[32] J. D. Rompe, J. Furia, N.Maffulli, "Eccentric loading compared with
shock wave treatment for chronic insertional Achilles tendonitis. A
randomized, controlled trial," The Journal of Bone and Joint
Surgery.American Volume, vol. 90, no. 1, pp. 52-61, 2008.
[33] J. D. Rompe, J. Furia, N.Maffulli, "Eccentric loading versus eccentric
loading plus shock-wave treatment for midportion Achilles tendonitis: A
randomized controlled trial," The American Journal of Sports Medicine,
vol. 37, no. 3, pp. 463-470, 2009.
[34] J. D. Rompe, B. Nafe, J. Furia, N.Maffulli, "Eccentric loading, shock
wave treatment, or a wait-and-see policy for tendinopathy of the main
body of tendo Achillis: A randomized, controlled trial," Ortho Trauma
Clinic, vol. 35, no. 7, pp. 1216, 2007.
[35] M. C. Vulpiani, D. Trischitta, P. Trovato, M. Vetrano, A. Ferretti,
"Extracorporeal shockwave therapy in Achilles tendinopathy. A longterm
followup observational study,"J Sports Med Phys Fitness, vol. 49,
no. 2, pp. 171-176, 2009.
[36] R. A. Swinkels, L. M. Bouter, R. B. Oostendorp, C. M. Van den Ende,
"Impairment measures in rheumatic disorders for rehabilitation medicine
and allied health care: A systematic review,"Rheumatol Int, vol. 25, pp.
501-512, 2005.
[37] K. A. Herr, K. Spratt, P. R. Mobily, G. Richardson, "Pain intensity
assessment in older adults: Use of experimental pain to compare
psychometric properties and usability of selected pain scales with
younger adults," Clin J Pain, vol. 20, no. 4, pp. 207-219, 2004.
[38] J. Binkley, P. W. Stratford, S.A. Lott, D.L. Riddle, D.L. "The lower
extremity functional scale: Scale development, measurement properties
and clinical application," Phys Ther, vol. 79, no. 4, pp. 371-383, 1999.
[39] C. L. Chung Wei, A. M. Moseley, K.M., Reshauge, A. C. Bundy, "The
lower extremity functional scale has good clinimetric properties in
people with ankle fracture,"Phys Ther, vol. 89, no. 6, pp. 580-588, 2009.
[40] S. S. Yeung, E. W. Yeung, L. D. Gillespie, "Interventions for preventing
lower limb soft tissue running injuries," Cochrane Database of
Systematic Reviews, vol. 10, 2011.
@article{"International Journal of Medical, Medicine and Health Sciences:59374", author = "P. Sanzo", title = "The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion, and Strength in Patients with Insertional Achilles Tendinosis", abstract = "Increased physical fitness participation has been
paralleled by increasedoveruse injuries such as insertional Achilles
tendinosis (AT). Treatment has provided inconsistentresults. The use
of extracorporeal shockwave therapy (ECSWT) offers a new
treatment consideration.The purpose of this study was to assess the
effects of ECSWTon pain, function, range of motion (ROM), joint
mobility and strength in patients with AT. Thirty subjects were
treated with ECSWT and measures were takenbefore and three
months after treatment. There was significant differences in visual
analog scale (VAS) scores for pain at rest (p=0.002); after activity
(p= 0.0001); overall improvement(p=0.0001); Lower Extremity
Functional Scale (LEFS) scores (p=0.002); dorsiflexion range of
motion (ROM) (p=0.0001); plantarflexion strength (p=0.025);
talocrural joint anterior glide (p=0.046); and subtalar joint medial and
lateral glide (p=0.025).ECSWT offers a new intervention that may
limit the progression of the disorder and the long term healthcare
costs associated with AT.", keywords = "Extracorporeal shockwave therapy, shockwave therapy, Achilles tendinosis, range of motion, strength, joint mobility", volume = "7", number = "6", pages = "273-7", }
