Chronic tendon feels like it can last forever, and it is super frustrating. Here is some research that in addition to resistance training, shockwave therapy (ESWT) can help as well.
Maybe you’ve tried resting. You’ve stretched. You’ve changed your workouts. You’ve done traditional physical therapy. Maybe you’ve even tried injections or other treatments, but that nagging achilles, elbow, shoulder, knee, or heel pain keeps coming back.
Does shockwave therapy actually work for tendon pain?
Research suggests that extracorporeal shockwave therapy (ESWT) can reduce pain and improve function in some types of tendinopathy, particularly when it is combined with an appropriate rehabilitation program (usually including resistance training!)
At Release Physical Therapy in Washington, DC, we use both focal shockwave therapy and radial pressure wave therapy as tools within individualized physical therapy programs.
What Is Tendinopathy?
Tendinopathy refers to pain and dysfunction involving a tendon.
Tendons connect muscles to bones and transfer forces that allow you to move. When a tendon is repeatedly exposed to loads that exceed its current capacity, it can become painful and less tolerant of activity.
Tendinopathy can occur in many areas of the body, including:
- Achilles tendon
- Patellar tendon
- Rotator cuff tendons
- Gluteal tendons
- Common extensor tendon at the elbow (“tennis elbow”)
- Common flexor tendon at the elbow (“golfer’s elbow”)
- Plantar fascia
- Hamstring tendons
Tendon pain isn’t necessarily caused by a single injury. It can develop gradually as the relationship between tendon load and tendon capacity becomes unbalanced.
Why Can Tendon Pain Become Chronic?
One of the most frustrating things about tendinopathy is that simply resting doesn’t always solve the problem.
When pain decreases with rest, it can be tempting to immediately return to your previous activity level. But if the tendon hasn’t regained its capacity to tolerate that load, symptoms may return. This is why strengthening/resistance training is so important.
What Is Shockwave Therapy?
Extracorporeal Shockwave Therapy (ESWT) uses acoustic waves to deliver mechanical energy to a targeted area of the body.
There are two broad types of shockwave treatment commonly used in musculoskeletal care:
Focal Shockwave Therapy
Focal shockwave delivers energy to a specific target and can reach deeper tissues.
This can be useful when the painful structure is located deeper beneath the skin or when a more concentrated treatment is appropriate.
Radial Pressure Wave Therapy
Radial pressure wave therapy delivers pressure waves that disperse outward from the applicator.
It can be useful for treating more superficial tissues and larger areas around a painful tendon.
Despite often being grouped together as “shockwave,” focal shockwave and radial pressure wave therapy are not the same, but can be used together to treat tendinopathies.
A physical therapist can determine which machine, or both machines, makes the most sense based on the individual patient.
How Can Shockwave Therapy Help a Tendon?
Researchers are still investigating exactly how ESWT produces its effects.
Potential mechanisms include changes in:
- Local blood flow
- Cellular activity
- Growth-factor signaling
- Pain processing
- Tissue remodeling
- The local inflammatory response
Shockwave Therapy Isn’t a Replacement for Exercise
This is one of the most important things to understand about treating chronic tendon pain.
Shockwave therapy should generally be viewed as an adjunct to rehabilitation, not a replacement for progressive exercise.
Tendons adapt to load.
That means your treatment should ultimately help your tendon tolerate the activities that matter to you.
Depending on your condition, rehabilitation may include:
- Isometric exercises
- Heavy slow resistance training
- Eccentric strengthening
- Progressive tendon loading
- Balance training
- Plyometrics
- Running progression
- Sport-specific training
Shockwave can be incorporated into this process to help manage symptoms while you progressively rebuild capacity.
Is Shockwave Therapy Right for You?
Shockwave therapy may be worth considering if you have persistent tendon pain that hasn’t responded adequately to your current treatment plan.
However, shockwave isn’t the magic fix.
It is important to be assessed by your medical provider to determine if shockwave therapy is appropriate as an adjunct to your treatment.
At Release Physical Therapy, we use clinical evaluation and individualized treatment planning to determine whether focal shockwave, radial pressure wave therapy, or another intervention is appropriate.
Schedule an appointment today to get rid of your nagging tendon pain and see if shockwave (focal or radial) can help you achieve your goals.
