Chronic Achilles Tendinopathy in Runners: Relationship between Pain and Tendon Vascularity and Efficacy and Safety of the Radial Extracorporeal Shock Wave Therapy

Antonio Ammendolia

Department of Medical and Surgical Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy.

DOI: 10.4236/crcm.2015.46044                

Abstract

Few studies report the possible correlation pain-paratendon microvascularity during the painful phase of the chronic Achilles tendinopathy and the efficacy of the radial shock wave therapy re-spect to other therapies. The aim of the present longitudinal, controlled study is to demonstrate the variation of the tendon micro vascularization in athletes affected by Achilles tendinopathy and the efficacy and safety of the radial extracorporeal shock wave therapy. Twelve elite runners with Achilles tendinopathy were compared with 12 healthy amateurs, both treated by radial extracorporeal shock wave therapy in 3 sessions (1/every 3 days). VAS scale was used for pain evaluation at one and six months after treatment and a Color and Power Doppler echography was performed to observe the paratendon microvascularity before the beginning of the treatment and at one and six months after. One month after the beginning of the treatment, it was observed a decrease of the hypervascularity in all 12 subjects with tendinopathy and no variation in the control group participants. Clinically, 80% of patients referred pain relief and they were able to return to sports activity. The decrease of the paratendon microvascularity confirms the correlation between the disappearance of the pain and the normalization of the vascularity in the athletes. Moreover, radial extracorporeal shock wave therapy consented a quickly pain relief and returned to the sport. These results confirmed the efficacy and safety of this physical therapy that it could be considered a good therapeutic choice in the treatment of the chronic Achilles tendinopathy.

Keywords

Tendinopathy, Radial Shock Wave, Microvascularity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Rees, J.D., Wilson, A.M. and Wolman, R.L. (2006) Current Concepts in the Management of Tendon Disorders. Rheumatology, 45, 508-521. http://dx.doi.org/10.1093/rheumatology/kel046
[2]	Maffulli, N., Wong, J. and Almekinders, L.C. (2003) Types and Epidemiology of Tendinopathy. Clinics in Sports Medicine, 22, 675-692. http://dx.doi.org/10.1016/S0278-5919(03)00004-8
[3]	Baxter, D.E. and Zingas, C. (1995) The Foot in Running. Journal of the American Academy of Orthopaedic Surgeons, 3, 136-145.
[4]	James, S.L., Bates, B.T. and Osternig, L.R. (1978) Injures to Runners. American Journal of Sports Medicine, 6, 40-50. http://dx.doi.org/10.1177/036354657800600202
[5]	Jones, D.C. and James, S.L. (1987) Overuse Injures of the Lower Extremity: Shin Splints, Iliotibial Band Friction Syndrome and Exertional Compartment Syndromes. Clinics in Sports Medicine, 6, 273-290.
[6]	Kolodziej, P., Glisson, R.R. and Nunley, J.A. (1999) Risk of Avulsion of the Achilles Tendon after Partial Excision for Treatment of Insertional Tendonitis and Haglund’s Deformity. Foot Ankle International, 20, 433-437. http://dx.doi.org/10.1177/107110079902000707
[7]	Myerson, M. and McGarvey, W. (1999) Disorders of the Achilles Insertion and Achilles Tendonitis. Instructional Course Lectures, 48, 211-218.
[8]	Nigg, B.M. (2001) The Role of Impact Forces and Foot Pronation: A New Paradigm. Clinical Journal of Sport Medicine, 11, 2-9. http://dx.doi.org/10.1097/00042752-200101000-00002
[9]	Öhberg, L., Lorentzon, R. and Alfredson, H. (2001) Neovascularization in Achilles Tendons with Painful Tendinosis but Not in Normal Tendons: An Ultrasonographic Investigation. Knee Surgery, Sports Traumatology, Arthroscopy, 9, 233-238. http://dx.doi.org/10.1007/s001670000189
[10]	Reiter, M., Ulreich, N., Dirisamer, A., Tscholakoff, D. and Bucek, R.A. (2004) Colour and Power Doppler Sonography in Symptomatic Achilles Tendon Disease. International Journal of Sports Medicine, 25, 301-305. http://dx.doi.org/10.1055/s-2004-815828
[11]	Alfredson, H. (2005) The Chronic Painful Achilles and Patellar Tendon: Research on Basic Biology and Treatment. Scandinavian Journal of Medicine and Science in Sports, 15, 252-259. http://dx.doi.org/10.1111/j.1600-0838.2005.00466.x
[12]	Richards, P.J., Win, T. and Jones, P.W. (2005) The Distribution of Microvascular Response in Achilles Tendinopathy Assessed by Colour and Power Doppler. Skeletal Radiology, 34, 336-342. http://dx.doi.org/10.1007/s00256-004-0834-2
[13]	Knobloch, K., Kraemer, R., Lichtenberg, A., Jagodzinski, M., Gossling, T., Richter, M., Zeichen, J., Hufner, T. and Krettek, C. (2006) Achilles Tendon and Paratendon Microcirculation in Midportion and Insertional Tendinopathy in Athletes. American Journal of Sports Medicine, 34, 92-97. http://dx.doi.org/10.1177/0363546505278705
[14]	Alfredson, H. and Lorentzon, R. (2000) Chronic Achilles Tendinosis: Recommendations for Treatment and Prevention. Sports Medicine, 29, 135-146. http://dx.doi.org/10.2165/00007256-200029020-00005
[15]	Öhberg, L. and Alfredson, H. (2003) Sclerosing Therapy in Chronic Achilles Tendon Insertional Pain-Results of a Pilot Study. Knee Surgery, Sports Traumatology, Arthroscopy, 11, 339-343. http://dx.doi.org/10.1007/s00167-003-0402-7
[16]	Koenig, M.J., Torp-Pedersen, S., Ovistgaard, E., Terslev, L. and Bliddal, H. (2004) Preliminary Results of Colour Doppler-Guided Intratendinous Glucocorticoid Injection for Achilles Tendonitis in Five Patients. Scandinavian Journal of Medicine and Science in Sports, 14, 100-106. http://dx.doi.org/10.1046/j.1600-0838.2003.00364.x
[17]	Brown, R., Orchard, J., Kinchington, M., Hooper, A. and Nalder, G. (2006) Aprotinin in the Management of Achilles Tendinopathy: A Randomised Controlled Trial. British Journal of Sports Medicine, 40, 275-279. http://dx.doi.org/10.1136/bjsm.2005.021931
[18]	Saltzman, C.L. and Tearse, D.S. (1998) Achilles Tendon Injures. Journal of the American Academy of Orthopaedic Surgeons, 6, 316-325.
[19]	Sorosky, B., Press, J., Plastaras, C. and Rittenburg, J. (2004) The Practical Management of Achilles Tendinopathy. Clinical Journal of Sport Medicine, 14, 40-44. http://dx.doi.org/10.1097/00042752-200401000-00007
[20]	Rompe, J.D., Kirkpatrick, J.D., Kullmer, K., Schwitalle, M. and Krischek, O. (1998) Dose-Related Effects of Shock Waves on Rabbit Tendon Achilles. A Sonographic and Histological Study. The Journal of Bone and Joint Surgery, 80, 546-552. http://dx.doi.org/10.1302/0301-620X.80B3.8434
[21]	Perlick, L., Schiffmann, R., Kraft, C.N., Wallny, T. and Diedrich, O. (2002) Extracorporeal Shock Wave Treatment of the Achilles Tendonitis: Experimental and Preliminary Clinical Results. Zeitschrift für Orthopädie, 140, 275-280. http://dx.doi.org/10.1055/s-2002-32475
[22]	Chen, Y.J., Wang, C.J., Yang, K.D., Kuo, Y.R., Huang, H.C., Huang, Y.T., Sun, Y.C. and Wang, F.S. (2004) Extracorporeal Shock Waves Promote Healing of Collagenase-Induced Achilles Tendonitis and Increase TGF-Beta 1 and IGF-I Expression. Journal of Orthopaedic Research, 22, 854-861. http://dx.doi.org/10.1016/j.orthres.2003.10.013
[23]	Furia, J.P. (2006) High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Insertional Achilles Tendinopathy. American Journal of Sports Medicine, 34, 733-740. http://dx.doi.org/10.1177/0363546505281810
[24]	Silvestri, E., Biggi, E., Molfetta, L., Avanzino, C., La Paglia, E. and Garlaschi, G. (2003) Power Doppler Analysis of Tendon Vascularization. International Journal of Tissue Reactions, 25, 149-158.
[25]	Lopez, R.G. and Jung, H.G. (2015) Achilles Tendinosis: Treatment Options. Clinics in Orthopedic Surgery, 7, 1-7. http://dx.doi.org/10.4055/cios.2015.7.1.1
[26]	Ochiai, N., Ohtori, S., Sasho, T., Nakagawa, K., Takahashi, K., Takahashi, N., Murata, R., Takhashi, K., Moriya, H., Wada, Y. and Saisu, T. (2007) Extracorporeal Shock Wave Therapy Improves Motor Dysfunction and Pain Originating from Knee Osteoarthritis in Rats. Osteoarthritis and Cartilage, 15, 1093-1096. http://dx.doi.org/10.1016/j.joca.2007.03.011
[27]	Foldager, C.B., Kearney, C. and Spector, M. (2012) Clinical Application of Extra Corporeal Shock Wave Therapy in Orthopedics: Focused versus Unfocused Shockwaves. Ultrasound in Medicine & Biology, 38, 1673-1680. http://dx.doi.org/10.1016/j.ultrasmedbio.2012.06.004
[28]	Chang, K.V., Chen, S.Y., Chen, W.S., Tu, Y.K. and Chien, K.L. (2012) Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: A Systematic Review and Network Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 93, 1259-1268. http://dx.doi.org/10.1016/j.apmr.2012.02.023
[29]	Furia, J.P., Rompe, J.D., Cacchio, A., Del Buono, A. and Maffulli, N. (2013) A Single Application of Low-Energy Radial Extracorporeal Shock Wave Therapy Is Effective for the Management of Chronic Patellar Tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 346-350. http://dx.doi.org/10.1007/s00167-012-2057-8
[30]	Avancini-Dobrovic, V., Frlan-Vrgoc, L., Stamenkovic, D., Pavlovic, I. and Vrbanic, T.S. (2011) Radial Extracorporeal Shock Wave Therapy in the Treatment of Shoulder Calcific Tendinitis. Collegium Antropologicum, 35, 221-225.