A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy
August 2nd, 2024
Achilles tendinopathy is a common musculoskeletal condition for which loading programs are currently the standard of care. However, the treatment protocols vary. We therefore propose a protocol for Achilles tendinopathy treatment using extracorporeal shockwave therapy.
Oral Extracorporeal Shockwave Therapy, or ESWT, is considered effective in at least tendinopathy treatment. There are various reports on the technique of radio ESWT without any consensus on the parameters. Here, we present a detailed treatment protocol for treating at least tendinopathy with using ESWT.
Recent developments in this field, focus on high-quality clinical research, and more accurate information, in order to define the optimal therapeutic options for each type of tendinopathy. Combining ESWT with other therapists, especially eccentric exercise, may finally enhance its effectiveness in improving patient outcomes and pain relief. To begin, place the patient in a comfortable prone position with the target area exposed.
After the physical examination, locate the area that requires treatment, and mark these points using a felt tip pen. Use the conductor, R15 for tendinopathy, and D20 for tendinopathy, and the trigger point of the deep muscle. After drying the skin thoroughly, apply an adequate amount of gel to the target area as a coupling agent.
To set up the device, press the power on or off button, or touch the liquid crystal display or LCD. Inspect parameter options on the display, and press the buttons directly on the LCD to make a selection. Adjust the parameters using the up and down buttons.
Press the pause or stop buttons located on the operator interface to stop the output. To edit the treatment screen and parameters, press the edit button, and wait for the edit treatment screen to display. Increase and decrease the parameters on the edit treatment screen, by pressing the up and down buttons as needed during the treatment process, based on the patient's tolerance and response.
Select the intensity to be used, which is 1.6 bar in this study. Starting at a lower intensity of the therapy, gradually increase the intensity as high as the patient can tolerate. Set the frequency of the treatment to about 10 hertz here.
Establish the desired number of shocks to be applied, which is 2000 in this study, and set the number of shocks per treatment within 800 to 3000. Begin the treatment by pressing the start button on the user interface, and activate the handpiece by pressing the trigger button on the handpiece. During the treatment, maintain the contact between the conductor and the skin tissue, and move the handle by drawing a small circle.
To pause the therapy at any time, press the pause button on the user interface, or the trigger button on the handpiece. To stop the therapy, press the stop button on the user interface. After the treatment, remove any residual coupling gel from the treated area.
Plan three sessions spaced one week apart. Outcomes of the treatment protocol applied to patients across both genders, showed a significant decrease in pain. The Roles and Maudsley score, which subjectively describes a patient's pain, also significantly decreased after the treatment.
Overview
This article presents a detailed treatment protocol for Achilles tendinopathy using extracorporeal shockwave therapy (ESWT). The protocol aims to enhance patient outcomes and pain relief through effective treatment methods.
Key Study Components
Area of Science
- Musculoskeletal conditions
- Tendinopathy treatment
- Extracorporeal shockwave therapy
Background
- Achilles tendinopathy is a prevalent musculoskeletal issue.
- Current treatment protocols vary significantly.
- ESWT has shown effectiveness in treating tendinopathy.
- Combining ESWT with eccentric exercise may improve results.
Purpose of Study
- To propose a standardized protocol for treating Achilles tendinopathy.
- To provide clarity on the use of ESWT in clinical practice.
- To enhance the understanding of optimal therapeutic options.
Methods Used
- Patient positioning in a comfortable prone position.
- Application of ESWT to the target area.
- Review of existing literature on ESWT parameters.
- Integration of ESWT with other therapeutic approaches.
Main Results
- Detailed protocol for ESWT application is provided.
- Evidence supports the effectiveness of ESWT for tendinopathy.
- Combining therapies may enhance treatment outcomes.
- Further research is needed to establish consensus on parameters.
Conclusions
- ESWT is a viable treatment option for Achilles tendinopathy.
- Standardized protocols can improve treatment consistency.
- Future studies should focus on optimizing treatment parameters.
Frequently Asked Questions
Executive Industry Relevance
Standardizing extracorporeal shockwave therapy (ESWT) protocols for Achilles tendinopathy addresses a critical gap in reproducibility and quantitative assessment within musculoskeletal therapeutic development. Consistent parameterization and outcome measurement enable more reliable hypothesis testing and facilitate cross-study comparisons, supporting predictive confidence in early-stage intervention strategies. This protocol-driven approach enhances translational continuity and informs risk-adjusted advancement decisions in musculoskeletal R&D portfolios.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables systematic interrogation of therapeutic hypotheses for tendon repair mechanisms.
- Supports biological de-risking by clarifying ESWT's mechanistic impact on tissue recovery.
- Facilitates functional target validation through standardized pain and function metrics.
- Improves predictive confidence for advancing non-pharmacological interventions.
Screening & Assay Development
- Establishes reproducible treatment parameters for downstream comparative studies.
- Enables quantitative assessment of pain reduction and functional improvement.
- Supports assay standardization for evaluating adjunctive therapies or combination regimens.
- Prepares validated clinical endpoints for future compound or device screening.
Translational & Preclinical Research
- Aligns protocol outputs with clinically relevant pain and function biomarkers.
- Provides continuity from mechanistic studies to patient-centered outcome measures.
- Informs risk-adjusted go/no-go decisions for device-based interventions.
- Supports predictive de-risking in translational musculoskeletal research.
Pipeline & Workflow Integration
This ESWT protocol fits within the continuum from early discovery through translational and preclinical validation for musculoskeletal therapeutics.
- Discovery Biology: Supports hypothesis testing on tendon repair and pain modulation mechanisms.
- Screening: Provides standardized, reproducible treatment parameters for comparative studies.
- Analytics: Enables quantitative measurement of pain and function as dependent variables.
- Translational Research: Bridges mechanistic findings with patient-relevant clinical outcomes.
- Enterprise Reuse: Offers a reusable protocol framework for future musculoskeletal device or combination therapy studies.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in tendon repair research.
- Operational Value: Enhances standardization, reproducibility, and scalability of ESWT protocols.
- Strategic Value: Improves go/no-go decision quality and capital efficiency in musculoskeletal portfolios.
- Portfolio Impact: Enables risk-adjusted prioritization and advancement of device-based interventions.
Implementation Considerations
- Requires expertise in musculoskeletal assessment and ESWT device operation.
- Needs access to calibrated shockwave instrumentation and quantitative pain/function analytics.
- Demands cross-team standardization of treatment parameters and outcome measures.
- May require adaptation for different tendinopathy subtypes or patient populations.
- Protocol reproducibility depends on consistent parameter selection and patient response monitoring.
