Achilles tendinopathy is a prevalent overuse injury affecting the foot and ankle, particularly among active individuals. Conservative treatment options have been widely explored, with radial sound wave therapy (RSW) and extracorporeal shockwave therapy (ESWT) emerging as safe and effective options when used independently. However, recent research has focused on the potential benefits of combining these treatments to enhance outcomes. In this blog post, we delve into a prospective study that examines the advantages of combining ESWT and RSW for Achilles tendinopathy.

The study looked at 24 patients with a mean age of 47.2±12.8 years. Each patient received three initial treatments and subsequent treatments at six and/or 12-week intervals. The researchers aimed to evaluate the efficacy of the combined therapy and compared the results with previous studies in the field.

Before treatment, the Visual Analog Scale (VAS) score, which measures pain intensity, was recorded at 6.3±1.3, and the Roles and Maudsley (RM) score, which assesses functional impairment, was noted at 3.5±0.5. Remarkably, these scores were significantly reduced to 1.2±1.6 (P=0.00001) and 1.6±0.9 (P=0.00001) at the 17±4.5 month follow-up. Interestingly, patients with paratendinosis, a specific type of Achilles tendinopathy, experienced even better outcomes than those with insertional Achilles pathology.

The findings of this study reveal a marked improvement in outcome measures for patients treated with the combination of ESWT and RSW. These results are notably superior to previous studies conducted on isolated ESWT or RSW treatments. In addition, the significant reduction in pain intensity and functional impairment underscores the potential effectiveness of the dual treatment approach for Achilles tendinopathy.

The rationale behind combining ESWT and RSW lies in their complementary mechanisms of action. ESWT involves the application of shockwaves to the affected area, promoting tissue regeneration, neovascularization, and pain reduction. On the other hand, RSW utilizes radial sound waves to stimulate healing responses, increase blood flow, and improve collagen structure. By combining these modalities, the treatment targets the condition from multiple angles, enhancing the chances of successful recovery.

Moreover, the study’s observation that patients with paratendinosis experienced better outcomes than those with insertional Achilles pathology is noteworthy. Paratendinosis refers to inflammation of the paratenon, the sheath surrounding the Achilles tendon, while insertional Achilles pathology involves degenerative changes at the tendon insertion site. The improved response in paratendinosis patients suggests that the combined therapy may be particularly effective in addressing inflammatory components of Achilles tendinopathy.

Combining the Best of Both Worlds
To summarize, the results of this prospective study highlight the significant benefits of combining ESWT and RSW for the treatment of Achilles tendinopathy. The dual treatment approach substantially improved pain levels and functional impairment compared to previous studies focusing on individual therapies. Furthermore, by utilizing the complementary mechanisms of ESWT and RSW, this combined approach holds promise in enhancing patient outcomes. While these findings are encouraging, it is important to remember that further research and larger-scale studies are necessary to validate these results and establish optimal treatment protocols for different subtypes of Achilles tendinopathy. Nonetheless, this study provides a solid foundation for healthcare professionals and individuals seeking effective treatment options for this common overuse injury.