Hi guys! This video is about shockwave and whether or not it's useful for Achilles tendinopathy. So,
what I'm going to look at is how shockwave therapy actually works. Then we're going to look at what
the research has shown; does it help for Achilles tendinopathy? And lastly, how I would sometimes
slot it in with my rehab programme for my Achilles patients. So, my name is Maryke. I'm one of the
physios from treatmyachilles.com, where you can get online physiotherapy assessment as well as
treatment for your injuries. So, have a look at … The link to our website is in the Description of
this video if you want more information about that. Good! So, what is shockwave therapy?
Basically, the machine has a gun where there's a cylinder and there's a piece of metal that
moves really quickly inside. Now, it's not that piece of metal that makes contact with your skin;
that metal actually just makes contact with another piece of metal at the front of the
gun that doesn't move, and because it crashes into it, it makes a loud noise; so, it creates a sound
wave. That sound wave is then transferred to your tissue, and that's what causes the therapeutic
effect. So, you usually have gel - ultrasound gel - that they use with the shockwave machine. Now,
it's been shown to help for pain management in a whole horde of different soft tissue injuries,
but we don't actually know why yet. They've got ideas, but they're not quite sure how it
works. What does the research show for Achilles tendinopathy? Actually, it's quite positive at
this stage. It does show that it may work. The problem is just that the research studies are of
quite low quality at this point; there aren't any strong, randomised controlled trials where they
look at shockwave versus other treatment. And you have to do that, because otherwise the Achilles
tendinopathy could have just gotten better by itself or through other measures if you don't
compare the two. There are a few trials where they have compared it to other treatments, and
shockwave has shown … was shown to be the best. It's a bit problematic as well, because they've
often used other treatments that we know don't work, like for instance, for insertional Achilles
tendinopathy, the one study used eccentric heel drops, and they compared shockwave to those. Now,
we know that for eccentric heel drops usually make insertional Achilles tendinopathy worse. So,
we … I could have told them that the shockwave would probably look better at the end of that
study compared to the eccentric heel drops without even knowing the results. So,
there's a lot of research still needed. But some of the studies that's a bit better than that one,
or better designed than that one, is showing that it may be useful. In clinical practice I
have seen good results with it, especially for my patients with insertional Achilles tendinopathy
and especially for those guys who are so sore that we just can't start the rehab, anything;
even the most low-load exercises aggravate their pain too much. For those patients, the shockwave
therapy has been really, really useful. So, it's not a standalone treatment; you can't see it as an
ultimate cure for Achilles tendinopathy, but it's definitely got a place in the rehab process. The
only downside is that it's quite expensive. So, you need between three to six sessions,
usually, to see a good result, and each session can cost quite a few pounds. It can cause a bit
of treatment soreness afterwards, but I've not had many patients complain of soreness that lasted
more than a day or so, and usually paracetamol just takes it away and helps for it. So yes,
if you've got an Achilles tendinopathy that just does not want to allow you to get going with your
rehab, shockwave may be an option for you. So, let me know if you've got any questions; you can
ask them in the comments or just email me direct. But if you need more help with your injury, you're
always welcome to consult us via video call – link is in the Description of this video. Take care!