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The “Shocking” Truth About Shock Wave Therapy for Tendons & Fascia

If you have ever had a tendon injury as a runner, you can relate that this type of injury can take weeks and even months to get better! For endurance athletes, the most common tendon injuries are in the lower body and can include high hamstring tendons, patellar tendons, Achilles’ tendons, foot tendons (peroneal tendons, posterior tibialis or anterior tibialis tendons) and even plantar fascia (because it behaves like a tendon!). These injuries do usually improve over time if treated with a combination of activity changes to reduce acute overload of the tendon (or fascia), strengthening exercises like eccentrics, building tendon load tolerance back up, and pain modulation techniques like massage or dry needling . However, as evidence-based physical therapists who work with a LOT of athletes with these types of injuries; we at Precision Performance are always looking for an extra ‘edge’ in treating these issues.

So, enter the possibility of using certain modality treatments, like shock wave therapy, for tendon injuries. The choice to use shock wave therapy is likely one that will be made with input from an orthopedic doctor or a physical therapist, both of whom could deliver the actual shock wave treatments. Furthermore, shockwave therapy may be reserved for individuals who are not getting better with the above treatments mentioned (i.e., “traditional physical therapy”). The possible benefits of using shock wave therapy are that it is safe, non-invasive, and could provide a method of reducing pain and improving function for tendinopathies that might not be responding to other treatments. In some cases, it has even been shown to reduce pain immediately after treatment or within one to two days, even for long standing, issues like tendinopathies (Dedes, 2018; Ikoma, 2018)

What is shock wave therapy and how does it work?

Shock wave therapy was first used for medical treatment in the 1980s as a non-invasive form of lithotripsy (i.e., to break up kidney stones or gallbladder stones). Since then, it has been used for musculoskeletal injuries to stimulate bone building cells (osteoblasts) to improve fracture healing and also has been used widely in many types of tendon injuries (e.g., Achilles’ tendinopathy, “Tennis elbow,” Plantar fasciitis/fasciopathy, rotator cuff tendinopathies, etc.). If used to treat tendons, it is thought that the way it helps with healing is to stimulate release of growth factors at the tendon-bone interface, stimulate cartilage remodeling cells (fibroblasts etc.) and to help with growth of new blood vessels in the area (i.e., neovascularization) though the research to date is not conclusive regarding these proposed mechanisms (Dedes, 2018).

There are different types of shockwave therapy in use for these injuries and some of thes