Investigation of the Effectiveness of Shockwave Therapy, Photobiomodulation, and Physical Therapy in the Management of Non-insertional Achilles Tendinopathy- MHSRS 2024
Rossi r, gabler g, persinger j, karikari n, mckee s, schroeder j, grogan s, hager n, metzger e, isaacson b, wagner l, pasquina p
Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium
Non-insertional Achilles Tendinopathy (AT) is a common overuse injury in active and sedentary adults. In the military, overuse injuries of the lower extremity (e.g., AT) are the most common category of disability and are most prevalent in the Army. Research studying the sub-population of AT amongst active duty (AD) personnel is scant and warrants analysis given its high prevalence. Current laser-induced photobiomodulation (PBMT) studies demonstrate increased cell proliferation and metabolism, which may aid the tendon repair and remodeling process. Extracorporeal shockwave therapy (SWT) is a process that delivers energy to the muscles or tendons for pain relief and to enhance tissue repair. by stimulating an inflammatory response and healing cascade.Studies support ESWT as an effective treatment for AT when combined with eccentric strengthening (ECC). The addition of PBMT may enhance these effects by increasing cellular function and optimizing the cascade. Thus, the combination of modalities should be investigated. The primary aim of our trial is to evaluate the effects of four randomized treatment groups in the management of AT: Physical Therapy (PT), PT with SWT, PT with PBMT, and PT combined with SWT and PBMT.
Participants receive self-guided ECC PT. The PT/SWT arm receives weekly SWT for three weeks. The PT/PBMT arm receives twice weekly PBMT for three weeks. The PT/SWT/PBMT arm receives both interventions. Baseline, three-month, and six-month intervals assess ultrasound measures (cross-sectional area, width/degree of thickening within the tendon at the site of maximal circumference/maximal pain, neovascularity, and elastography), quantitative function in heel raises to fatigue, ankle strength, and ROM are assessed at baseline, three months, and six months. The following surveys are collected: Victorian Institute of Sports Assessment–Achilles, Patient-Reported Outcomes Measurement Information System, The University of Wisconsin Running Injury and Recovery Index, Defense and Veteran’s Pain Rating Scale, and Lower Extremity Functional Scale.
PBMT and SWT are effective tendinopathy treatments. Combining both modalities may elicit synergistic structural changes and modulate AT pain. This study can potentially promote positive change in the management of AT, which adversely affects the military population, by promoting novel treatment options for our warfighters.