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Achilles tendinopathy - does therapeutic ultrasound work?

Achilles tendinopathy is a degenerative disorder with changes in the collagen fibre structure of the tendon. An important factor to note with chronic injuries, such as Achilles tendinopathy, is that they are not inflammatory. This means there won't be the classic inflammatory signs and symptoms of swelling, redness and heat. Patients will still report pain, reduced function and a withdrawal from sporting or occupational demands. It is therefore critical to implement the necessary treatment plan for a successful outcome.

Tendinopathies usually result from repeated micro-injuries without adequate time for healing or restoration. Over time, the physical structure changes making the tendon less able to withstand the stresses that is required.

Therapeutic ultrasound has long been a treatment modality to help with injuries such as tendinopathies, but does the research still encourage its use as a primary intervention? Therapeutic ultrasound exerts its effects which are usually attributed to both its thermal and non-thermal effects in tissues. The thermal effects cause a rise in tissue temperature locally, which increases blood flow that aids to a decrease in both swelling and muscle spasm and also increases the extensibility of collagen fibres. The non-thermal effect is cavitation, which enhances the acoustic micro streaming events. Micro streaming alters the structure, function and permeability of cell membranes by increasing the activity levels within the cell, leading to tissue repair.

The most up to date research in the treatment of Achilles tendinopathy states that both extracorporeal shockwave therapy and transverse friction massage, combined with eccentric exercises, are more advantageous than therapeutic ultrasound in improving pain severity, quality of life, and ankle function.

Dedes, V. et al. (2020). Achilles tendinopathy : Comparison between shockwave and ultrasound therapy. International Journal of Physical Education, Sports and Health. 7(4): 239-243.


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