Shockwaves in the treatment of tendonitis

Tendonitis: What Is It And Why Does It Take So Long?

A tendonitis is by definition a inflammation of the tendon† She is part of the family of tendinopathies, namely all tendon disorders: tears, ruptures or even enthesopathies. “In everyday language we often call all tendinopathies tendinitis: it is language abuse,” explains the physiotherapist.
In practice, tendonitis is generally the first stage of tendinopathy. When not treated effectively and the tendon is left in an inflammatory process, risk is that it deteriorates, degenerates and gives rise to a real tendon injury
However, this tendonitis often tends to last for a long time because it puts the person suffering from it in a vicious circle complicated to break: “the patient is in pain, so he rests to calm the pain. But significantly resting the tendon with a reduction in stress, even without injury, will reduce its biomechanical properties. The patient therefore suffers more and goes longer back to rest, hoping it will pass, hence greater deconditioning. It’s a real spiral,” explains the physiotherapist.
The solution is therefore not to immobilize the tendon, but to optimal activity

Monhamed Chaouche, physiotherapist: The patient suffering from tendonitis should therefore exercise a minimum of activity so as not to damage or injure the tendon and sufficient not to cause it to weaken.

At the same time, a effective support is important to avoid the risks of complicationss and more severe tendon lesions.

Shockwave device: what does the treatment consist of?

The term shock wave appeared in medicine in the 80s, as part of the treatment of kidney stones, using lithotripsy. This mode of action, which makes it possible split calculations to eliminate them, was gradually extended to sports medicine to treat calcifications, and then in rheumatology in front of treat tendinopathies.
A shock wave treatment consists of sending acoustic waves with a very high intensity through the skin with the help of a powerful device, in order to create strong pressure directly at the injured area. “These waves, by creating micro-lesions will transfer energy in the tissue, improve tissue regeneration; to accelerate the physiological healing process“, describes the physiotherapist. They therefore make it possible on the one hand to reduce pain by reducing inflammation and on the other hand to help restore the mobility of the tendon.

A shock wave treatment takes on average between 7 and 10 minutes. The patient is received by the physiotherapist, who applies a gel to the area to be treated and installs him in a comfortable position so that he can easily access the area to be treated with a device that looks like a gun. Depending on the outcome of his assessment, the practitioner selects the desired fitting parameters. “There are two parameters to take into account: intensityie the amount of energy released per square millimeter, and the frequency which corresponds to the number of beats per second” indicates the physiotherapist. It generally starts with 4 beats per second or 4 Hz and then gradually increases according to the patient’s tolerance. Average and according to the intensity chosen to treat the lesion , device sends between one thousand and two thousand strokes per session in the painful area.

Focal or radial shock waves?

There are two types of shock waves: shock waves focal lengths and shock waves radial

Focal shock waves are high-energy acoustic waves aimed at a fixed point at a certain depth.

Mohamed Chaouche: At the same time, the radial shock waves are finer, more powerful and deeper, making it possible to target a more precise point, limiting the exposure of the surrounding tissues.

Radial shock waves, on the other hand, are mechanical – and no longer acoustic – waves of low to medium energy, which are transmitted to the skin by direct shocks and diffuse radially (in a cone) into the tissue. “They force you to tap harder on the skin in intensity, but you lose quality and precision,” adds the specialist.

Shockwave therapy: does it hurt?

Despite its terrifying name, shock wave therapy is not violent treatment “we don’t change the tissues at all, on the contrary, the goal is to repair them!” urges the physiotherapist.
Depending on the tendon lesions and the clinical assessment, the practitioner defines a range of effective intensities for the treatment. “The goal is then to from minimum intensityand D’increase according to patient tolerance“, explains Mohamed Chaouche. The idea is therefore to provide the patient with the highest intensity that is tolerable. However, if the shock waves are not painful, they are still relatively unpleasant.

What efficiency?

Shock waves have three effects on tendinopathies, to relieve pain and repair the tendon:

Short term effects

When the fibers are stimulated by the waves, block nociceptive impulses transported through the small diameter slow fibers, which would have the effect of inhibiting the painful afferents in the medulla and thus of reduce the feeling of pain : we speak of “port control”.

Medium-term effects

The shock waves would be a endorphin release throughout the body, as well as pain-reducing substances. They would also allow to increase the proliferation of cytokines through the vessel walls, which play important roles in the immune response, inflammation and healing

The long-term effects

The shock waves help to regenerate damaged fibers and calcifications disintegrate to facilitate their resorption and the regeneration of damaged tissue : the scar tissues are reorganized, the tendon body is remodeled and the tendon entheses are regularized.

The shock waves help to increase local blood circulation and promote neovascularization of the treated area, and thus tissue repair.

However, the effects vary depending on the nature of the lesions, their anteriority, their location and the person treated.

How many sessions to get results?

Focal shockwave therapy requires an average of one session per week for six weeks to be effective. “The results can be done immediately, but we have to wait 6 weeks after the first 6 sessions to have the final resultsthe physiotherapist says.

Knee, shoulder, foot, wrist, quervain…: are they effective for all tendonitis?

so practical all tendon pathologies respond favorably to treatment by shock waves, the best indications are the calcifying tendinopathies – by breaking up the limestone deposits – and myoaponeurotic muscle damagethem heel spurs

“In addition, some locations lend themselves better to it than others and it is then up to the practitioner to assess the relevance of the shock wave treatment,” explains the specialist.
So when the shoulderelbow, Achilles heeland the knee are easily accessible and generally respond well to treatment, the adductors or subscapularis are good more difficult to access, which makes therapy more difficult.

Are there any contraindications to shock waves?

Contraindications for shockwave treatment are:

– bleeding disorders,
– The pregnancy,
– Areas near an infection, cancer or prosthesis,
– Wearing a pbait maker

Are Shockwaves reimbursed?

Shock waves are not reimbursed by health insurance. They are out of nomenclature, meaning prices are set at the practitioner’s discretion. They cost on average between 60 and 100 euros per session.
“However, certain supplemental health insurance plans are beginning to cover all or part of the sessions,” Mohamed Chaouche points out.

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