Investigation of the Effectiveness of Shockwave Therapy, Photobiomodulation, and Physical Therapy in the Management of Non-insertional Achilles Tendinopathy- Big Sky Sports Medicine Conference
R rossi, j schroeder, s grogan, n hager, e metzger, g gabler, j persinger, n karikari, s mckee, b isaacson, l wagner, p pasquina
Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference
Non-insertional Achilles Tendinopathy (AT) is a common overuse injury in athletes and United States military Service Members. Photobiomodulation therapy (PBMT) delivers non-ionizing light to produce beneficial outcomes. Extracorporeal shockwave therapy (SWT) delivers mechanical energy to the tendon and has been shown to be effective for AT. The addition of PBMT to SWT is hypothesized to enhance these effects by increasing cellular function and healing. Our primary aim was to evaluate PBMT, SWT, and Physical Therapy (PT) on non-insertional AT.
Forty-five participants were randomized to: PT only, PBMT+PT, PBMT+SWT+PT, or SWT+PT. SWT treatment: 1x/week/3 weeks at 15hz for 3000 pulses. PBMT treatment: 2x/week/3 weeks at 10 J/cm2, 25W. Study duration was 6 months. Outcomes: activity logs, pain/functional surveys, ultrasound tendon thickness measurements, and Range of Motion (ROM).
At 3-months, all groups improved in Defense and Veterans Pain Rating Scale, Lower Extremity Functional Scale, University of Wisconsin Running Injury and Recovery Index (PBMT+SWT+PT: + 7.1 units; p = 0.1), Patient-Reported Outcomes Measurement Information System (6-week function scores: SWT+PT > PBMT+PT; p < .1), & Victorian Institute of Sport Assessment-Achilles. PBMT+SWT+PT group had a Long Axis Maximal Circumference decrease of 3.1 mm (p = 0.1). Treatment with SWT increased Knee Flexed Passive Dorsiflexion by 5.37° (p = .01). No significant intergroup differences in the above outcomes at 12-weeks (p > 0.1).
These results justify further investigation in the optimal dose/treatment frequency of SWT+PBMT. Our findings can inform clinical treatment options for AT to optimize recovery and return to activity.