Tendons are strong, fibrous bands of connective tissue that attach muscles to bones, formed by tightly interwoven collagen fibers. When these tendons become irritated or damaged, focused shockwave therapy has proven to be an effective, non-invasive treatment that stimulates healing, reduces pain, and improves function.
What is Tendinopathy?
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse
Tendinitis: Tendinitis is defined as tendon inflammation. Acute injuries, such as minor or partial tearing, can cause an inflammatory response and pain, especially if the affected area is moved. The rate at which this condition heals is one way to identify it. These kinds of injuries heal quickly because they progress from inflammation to tissue repair.
Tendinosis: Tendinosis describes a dysfunctional tendon without elaborating on the pathological process. It is commonly used to describe overuse conditions. It is important to note that overuse tendon disorders frequently take a long time and are a slow process to heal.
Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal anti-inflammatory medications (NSAIDS) may not be the most effective options.
Is it difficult to treat tendon pathology, and why?
Yes, tendon and ligament injuries can be challenging to treat, especially with general physical therapy alone. One of the main reasons is that tendons and ligaments have poor blood supply, which slows down the natural healing process. Additionally, dense adhesions and scar tissue often form around the tendon’s attachment to bone. These are difficult to break down with manual therapy or stretching alone, making full recovery more difficult without advanced interventions.
Can FSWT (Focused Shockwave Therapy) Improve Tendon Pathologies?
Focused shockwave is one of the most effective tools to break up adhesion (scar tissue) in the tendon and ligament around its bone attachment area. FSWT delivers the pressure wave converging into the focused area resulting in greater effect in the precise target tissue. Moreover, FSWT has a diagnostic function. When it is applied to the treatment area, only dysfunctional tissues cause a discomfort sensation so the patient can communicate with the practitioner during the treatment session.
A randomized controlled trial published by Gatz et al. (2021) demonstrated that both point‑focused and line‑focused shockwave therapy significantly improved symptoms in patients with Achilles tendinopathy, with point‑focused ESWT showing the greatest effect. Read the full study here.
Which Tendon Injuries Respond Best to Focused Shockwave Therapy?
Achilles tendinopathy, Patella tendinitis, Achilles tendonitis, Tennis Elbow (Lateral Epicondylitis), Golfer’s elbow (Medial Epicondylitis), Rotator Cuff Tendinopathy, Calcific Shoulder Tendinitis, Plantar Fasciitis, Greater trochanteric hip pain, Pes Anserinus knee pain, any pain/adhesion in the tendon attachment over the bone
Additional injuries where FSWT is effective
Toe pain, finger pain: small joint area pain is difficult to treat with general treatment, FSWT increase circulation, attract stem cells and transform the tissue quality.
Stress Fractures/Nonunion Avulsion Fracture: Shockwave therapy may aid in the healing of stress fractures, especially in areas where blood supply is limited.
Non-Healing Wounds: In certain cases, it may be used to improve blood flow and stimulate the healing of non-healing wounds.
How does it work?
Improve local microcirculation leading to improved tissue metabolism
Increase production of collagen
Reduce local muscle tension
Help dissolve calcified tissues
Stimulate the “washing away” of Substance-P (a pain producing chemical)
What is the benefit of using Focused Shockwave Versus Radial Shockwave Therapy for tendon pathology?
Mechanical forces created by radial ESWT over the tendon attachment around the bone are uncomfortable and sometimes it causes irritation. Focused ESWT is the most effective in releasing adhesion/scar tissues on the muscle/ tendon insertion area over the bone. Radial Shockwave is most effective in the muscle belly treatment.
What is the best treatment protocol with ESWT (Extracorporeal shockwave therapy) for fast recovery?
- Assessment: in the first session, we will check the location of dysfunctional tissues, underlying causes, and movement dysfunction
- Manual Therapy: manual therapy can be performed before applying ESWT. Skilled practitioner can release myofascial trigger points which help reduce discomfort level and increase efficiency of ESWT
- Radial ESWT can be applied to treat adhesion in muscle belly
- Focused ESWT can be applied to break up adhesion in tendon/ ligament
- Eccentric exercise and stretching program to lengthen the shortened tissues
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