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Extracorporeal shock wave therapy immediately affects Achilles tendon structure and widespread pressure pain thresholds in healthy people

a repeated-measures observational study

Leong, Hio Tenga; Docking, Seanb; Girdwood, Michaelb; Bonello, Christianb; Cook, Jillb; Rio, Ebonieb

American Journal of Physical Medicine & Rehabilitation: April 22, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001203
Research Article: PDF Only

Objectives Extracorporeal shockwave therapy (ESWT) is a common clinical treatment for tendinopathy, yet negative effects on tendon structure have been shown in animal studies. This study aimed to investigate the effect of ESWT in healthy participants (i.e. no Achilles tendon pain or pathology).

Design This study examined the effect of three helpbouts of weekly ESWT over 3-weeks in 13 healthy participants. Outcomes measures assessed were; (1) Achilles tendon structure, quantified using ultrasound tissue characterisation (before and 3-hours post ESWT), (2) pressure pain thresholds, over the Achilles tendon and common extensor tendon origin (before, immediately after and 3-hours post ESWT) and (3) hop pain (before and immediately post ESWT).

Results There was a significant reduction in echo-type-I (p<0.05) and increase in echo-type-II (p<0.05) at 3-hours after the first ESWT session that recovered to baseline levels before week 2. There were no significant changes in UTC echopattern observed in subsequent sessions. There were increased pressure pain thresholds (PPTs) immediately following ESWT at the common extensor tendon origin but no significant change at the Achilles tendon. PPTs returned to baseline at 3-hours after ESWT. There were no significant changes in PPT in subsequent sessions.

Conclusions ESWT resulted in transient changes to tendon structure and widespread hyperalgesia.

a Chinese University of Hong Kong. Pond Cres, Ma Liu Shui, Hong Kong

b La Trobe Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia


Conflicts of Interest: None

Funding or financial benefits: None

Corresponding author: Dr. Ebonie Rio, 03 9479 3785, La Trobe Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia.

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