IMMEDIATE AND MEDIUM-TERM EFFECTS OF RADIAL EXTRACORPOREAL SHOCKWAVE THERAPY ON INSERTIONAL ACHILLES TENDINOPATHY

Abstract

Background Insertional Achilles tendinopathy (IAT) is a painful condition that affects the back of the heel where the Achilles tendon attaches to the calcaneus. It affects middle-aged, sedentary individuals as well as younger, more active individuals. People with IAT often experience worsening pain with prolonged inactivity or aggravation with physical activity. Exercise is the primary non-surgical treatment for Achilles tendinopathy. However, a significant percentage of people may not respond to exercise alone. For this reason, adjunct therapies are often added to exercise programs. Extracorporeal shockwave therapy (ESWT) has emerged as a potential adjunct or alternative treatment for Achilles tendinopathy, particularly radial ESWT (rESWT). rESWT is becoming utilised in clinical practice as an adjunct treatment for IAT to achieve immediate pain improvement and improved pain and function over 12-weeks or longer. However, there is not enough information comparing these applications of rESWT to a sham. Furthermore, a potential mechanism for immediate pain improvement is conditioned pain modulation, which could be measured by assessing change in local and diffuse mechanical sensitivity (pressure pain thresholds) before and after rESWT application. The research included in this thesis assessed the efficacy and mechanisms of rESWT at immediate, short and medium term timepoints in a series of randomised controlled trials. Prior to these trials we needed to know whether we can reliably assess pressure pain thresholds among people with IAT. Lastly, this thesis included a systematic review assessing whether measures such as pressure pain thresholds (and other proxy measures of peripheral and central sensitisation) change after physical therapy interventions and whether these changes occur in parallel to pain.