Shockwave Therapy Associated With Eccentric Strengthening for Achilles Insertional Tendinopathy: A Prospective Study.

Background. The usual initial treatment for insertional Achilles tendinopathy is nonsurgical. Yet there is no standard conservative treatment for Achilles insertional tendinopathy. Shockwave therapy (SWT) has become a reliable option for the management of this illness over the past years. The aim of this study is to report the effectiveness of low-energy SWT associated with an eccentric strengthening protocol in 19 consecutive patients. Methods. This is a prospective study with 19 patients aged between 26 and 72 years diagnosed with insertional Achilles tendinopathy. The protocol consisted of SWT associated with eccentric exercises for 12 weeks. All patients were evaluated on the first day and after 24 weeks (final follow-up) with the Victorian Institute of Sports Assessment-Achilles (VISA-A) score, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, and by algometry. At the last follow-up, patients were also assessed for adherence to the protocol, complications and final outcome (in their perception as success or fail). Results and Conclusion. Fifteen (79%) patients were fully adherent to the Alfredson protocol, and 13 (68%) patients considered the treatment protocol successful. At the last evaluation, patients demanded higher pressure on calcaneus to trigger pain (algometry 1), reported less pain when the algometer was applied with 3 kg (algometry 2), had less global pain (VAS), and had higher AOFAS and VISA-A scores. This study evidences that eccentric loading associated with SWT can dramatically improve patients' symptoms. We can conclude that eccentric loading associated with SWT is an effective treatment for Achilles insertional tendinopathy. Levels of Evidence: Therapeutic, Level III: Prospective cohort.

Tratamento por ondas de choque extracorpórea na síndrome do estresse tibial: uma revisão da literatura / Treatment of medial tibial stress syndrome with extracorporeal shockwave treatment: a literature review

A síndrome do estresse tibial medial é uma lesão comum devido a sobrecarga mecânica, principalmente em atletas, devido a inflamação local e estresse ósseo. A terapia de ondas de choque (TOC) vem sendo utilizada como tratamento para esta patologia por seus efeitos analgésicos e anti-inflamatórios. Objetivo: Avaliar a eficácia da TOC no tratamento analgésico da síndrome do estresse tibial medial e medidas de funcionalidade. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos. Resultados: 3 artigos preencheram os critérios de inclusão, incluindo 166 pacientes. Os trabalhos trouxeram uma ampla variedade de intervenções, tipos de aparelhos, frequência e energia utilizada, além de diferenças nas quantidades de sessões e tipos de ondas de choque utilizado no tratamento. Conclusão: Ainda não há evidências consistentes quanto ao uso da TOC no tratamento conservador da síndrome do estresse tibial medial, com estudos pequenos, de qualidade metodológica baixa. Os estudos inclusos no trabalho não relataram efeitos colaterais significativos

Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes due to local inflammation and bone stress. Shockwave therapy (ESWT) has been used as a treatment for this pathology due to its analgesic and anti-inflammatory effects. Objective: To evaluate the effectiveness of ESWT in the analgesic treatment of medial tibial stress syndrome and measures of functionality. Methods: A review of the literature was conducted, with clinical studies in humans included. Results: 3 articles fulfilled the inclusion criteria, including 166 patients. The trials involved a wide variety of interventions, types of devices, frequency and energy used, as well as differences in the number of sessions and types of shock waves used in treatment. Conclusion: There is still no consistent evidence regarding the use of ESWT in the conservative treatment of medial tibial stress syndrome, with small studies of low methodological quality. Studies included in this review did not report significant side effects

Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol.

BACKGROUND: There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illness; however, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. HYPOTHESIS: Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. DESIGN: Double blind, placebo-controlled, parallel groups, randomised clinical trial. MATERIALS AND METHODS: 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24 weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the χ2 test and the analysis of variance for statistical analyses. DISCUSSION: This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. ETHICS AND DISSEMINATION: The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). TRIAL REGISTRATION NUMBER: 8094833648737701 (NCT02757664); Pre-results.