treatment for tendinopathy, shockwave

Hear how Physio Dave helped a keen runner with persistent Achilles Tendinopathy

I recently caught up with one of our keen running clients, Patrick, who came to the clinic complaining of chronic Achilles Tendinopathy. Read on to find out how Physio, Dave Burnett, helped Patrick recover so that he could return to distance running again.

Hi Patrick- tell us a bit about yourself and what sport and exercise you do?

As a retired rugby player and triathlete my body has taken a bit of a battering over the years. Nowadays I cycle as my main sport but still enjoy running and swimming.

How and when did you develop your running Injury?

Achilles tendinopathyIt was probably a combination of not warming up properly, pushing too hard and the uneven surface that must have aggravated my Achilles tendon problem. When you are only a short distance out the tendency is to keep going to the end which probably just aggravated the situation even further.

What did your physiotherapy involve and how did you find it useful?

Dave at Physio on the River was great! Things were made easier as I was being treated by him for a shoulder injury at the time and he saw me hobble in and immediately diagnosed the issue – which was a Chronic Achilles Tendinopathy. So, after a couple of sessions of manual therapy treatment and stretching exercises for the calf, hamstrings and glutes (buttocks) we started the Shockwave treatment.

Describe your experience of shockwave therapy?

Shockwave for the achilles tendonI had 4 sessions of Shockwave which involved getting hammered by metal pads 100 times a second! It hurts the first time, although I think this was psychological and then after that it became quite therapeutic!

Whilst you mustn’t run immediately after the treatment, you can stretch and it’s important to do loaded strengthening exercises.

Every week I felt some progress. Once we had finished the Shockwave sessions we were able to progress to more explosive “plyometric” exercises. Apart from a blip when I may have done too much too soon, I was able to gradually build up the time and distance I was running and eventually the pace.

I am making great progress now. The important thing is to listen to your body and take your time. When you get injured after 50, it’s about managing the condition. The shoulder injury also helped as it forced me to go swimming and I was able to do more rigorous plyometrics in the pool. The positive benefits of swimming are extensive!

How are you getting on now and have you achieved your goals?

I’m in a good place now and am hopeful of continuing Park Run regularly and getting to that all important 22-minute milestone. My ultimate aim is to get back to half marathons.

What’s your brief understanding of how to manage your Achilles tendon problem in the long-term?

Should it return I should first  reduce the load, gradually re-load, add plyometric exercises and load even more -with marginal increments and take my time! Thanks very much Dave!

Thanks, Patrick, for sharing your story and illustrating so nicely how we treat and help people manage chronic tendon problems like yours.

Next steps….

If this has struck a chord with you and you’re suffering with a tendon problem, to make an appointment with Dave just:

Book online

Call 020 8876 5690

Email us here

Or pop in for a chat!

Read how new shockwave therapy can help those stubborn tendon problems and more!

Here at Physio on the River, we are always working to ensure we deliver the most up to date evidence based therapies to our clients.

We are very pleased to now offer Shockwave therapy . This is a very effective therapy for many chronic painful musculoskeletal problems, examples of which are: Plantar Fasciitis of the foot, Achilles Tendonopathy, Tennis Elbow and Calcific Tendonitis of the shoulder.

sourced from Complete Pain Care

This type of treatment is now recommended by the majority of Consultant Orthopaedic surgeons when muscular, connective tissue (the web of connecting tissue between structures) and tendon problems become chronic (i.e. lasting longer than 3 months).

What is shockwave therapy?

There are many different types of machines that use varying physical mechanisms to produce shockwaves. The machine manipulates these shockwaves to deliver the appropriate dosage to bodily tissues to achieve a therapeutic response.

The most recent mode of doing this is electromagnetic pulse shockwaves. Here at Physio on the River, we are excited that we can offer this type of shockwave therapy. It uses rapid electromagnetic pulses to create precise, low amplitude shockwaves directly to tissues. The major benefit of this is that it is far less painful than many other forms of shockwave production and delivery, for example compressed air.

Can it do any harm?

As well as having a large body of academic evidence for the positive outcomes of this type of therapy (e.g. Legat 2014; Loska 2017; Moya et al 2015), it has the added benefit of having very few risk factors or contra-indications.

The National Institute of Clinical Effectiveness (NICE) guidelines have been produced for the use of shockwave therapy for many common musculoskeletal conditions including: plantar fasciitis, tennis elbow, Achilles tendinopathy and trochanteric (hip) pain syndrome. As you may have read in the press NICE are a hard nut to crack and endorsement from this organisation carries weight.

At initial assessment, if shockwave is for some reason not the best clinical option for you, the physiotherapist will discuss alternative options either at Physio on the River or referring you to a different healthcare provider, as appropriate.

What does the treatment involve?

The package of care for shockwave therapy will involve an initial Physiotherapy assessment followed by a package of as many treatments as required. The number of treatments required on average vary between 4 and 10, depending on area to be treated and the reaction to treatment.

The machine has  a small hand-held device through which the shockwaves are given. The treatment is quite noisy and can sometimes feel uncomfortable but is only given in short bursts of time. We only treat to a person’s tolerance!

How much does it cost?

Sessions of Shockwave are typically charged at £150 -£200 per session throughout the clinics in London that provide it. We are offering outstanding value – a block of 4 Shockwave treatments (typically 4-10 sessions are required) for only £300 – meaning a potential saving of up to £500!

Some health insurance companies, including Bupa, are now offering cover for this treatment so if you hold a policy it is worth checking with your company first.

If you would like to book an appointment:

Call the clinic on 0203 916 0286

Book online by clicking here.

Contact us by email here.

Or pop into the clinic in person – we’d love to have a chat!

 

 

Are you a keen golfer but suffer with elbow pain? Read how Physiotherapy can help you resolve the problem!

Do you want to improve your golf swing and get rid of that niggling elbow pain for good?

Dave Burnett is one of our Physiotherapists and he is a Titleist accredited Golf Rehab Physiotherapist. He is also a very keen golfer and he loves helping golfers recover from injury. Dave shares his knowledge of what the research tells us about elbow injuries in golfers and best practice for getting it better.

Elbow injuries account for up to 15% of chronic golf injuries in professionals and up to a massive 30% in amateurs! Why is this you might ask? Read on to find out why…

 

Why amateur players get more elbow pain than professionals

elbow pain in golfers

golfer demonstrating good follow through

It is thought that restrictions in flexibility and range of movement around your hips, trunk and shoulders mean that the club head speed in amateurs is generated more by the wrists and elbows. This extra stress on the elbows can cause elbow pain.

Professionals, on the other hand, tend to be looser in their hips, trunk and shoulders so are able to generate forces from the ground up that are shared between all the joints of their body and the stresses are not concentrated in one area.

It is therefore important to consider your swing technique and your flexibility and strength through your whole body. This is something that our Sports Rehab Physiotherapists are trained to assess and treat. We are movement specialists and analysing technique and correcting weaknesses is all part of our role.

6 common factors of elbow pain in Golfers

  • Surprisingly Tennis Elbow (pain over the outer point of the elbow) is more prevalent in golfers than Golfer’s Elbow (where pain is felt on the inner point of the elbow)!
  • It is also surprising to note that it can be left or right sided for a right handed player!
  • Commonly the pain starts within 1-2 days after hitting a lot of practice balls or playing on hard ground or mats.
  • It can also be caused by a sudden increase in playing or practice frequency
  • Returning to intense practice after a few weeks off can also provoke its onset
  • It can also be related to a change in swing or grip

So what exactly is Tennis and Golfer’s Elbow?

elbow pain in golfers

sourced from Complete Pain Care

In years gone by we thought that these conditions were a ‘tendinitis’ – in other words an inflammation of the tendon which links the muscle to the bone. This may still be the case at early onset but once the condition has become chronic we now understand that it is really a ‘tendinopathy’. This means that the tendon is struggling to cope with the forces put through it because its structure has become weakened.

Tennis elbow affects the extensor tendons that extend your wrist, hand and fingers and the tendons of these muscles combine to form one tendon that attaches to the outside of your elbow.

Golfer’s elbow affects the flexor tendons that flex your wrist, hand and fingers and the tendons of these muscles combine into one tendon that attaches to the inside of your elbow.

The good news is that although these problems can be rather persistent there are lots of things we can do to help and it is usually possible to get rid of it completely if you follow our physio’s advice!

How can Physiotherapy treatment help?

In the early stages:

  • In the early stages when it’s very painful we often use taping or a brace/clasp round the elbow to offload the painful tendon.
  • We no longer use PRICE – Protection, Rest, Ice, Compression and Elevation to help the early healing process, but now we use POLICE – Protection, Optimal Loading, Ice, Compression and Elevation.

 As pain settles:

  • Exercises are the primary treatment for golfer’s and tennis elbow. We show you how to gradually load the tendon to strengthen it. This starts with isometric exercises (working the muscle without moving the joint), through to isotonic exercises (where we work the muscle through joint movement) and finally to speed work.
  • Sometimes we find the elbow joint is stiff and needs loosening up with gentle manipulation
  • We often treat the soft tissues with massage techniques

 Vital aspects for preventing a recurrence of the problem:

  • Assessing and working on restrictions in flexibility through the ankles, knees, hips, trunk, spine and shoulders
  • Assessing and working on strength through the same chain and especially addressing weakness of your core muscles
  • Considering the grip width of the club which can affect the forces used as your gripping muscles attach at the elbow pain point
  • Considering the stiffness of the shaft of the club – this can affect the forces transferred through the elbow. The stiffer the club the more force taken and the more flexible the club shaft the more forgiving on your elbow joint.
  • Giving advice on warming up routine in order to make sure that loading of the elbow is gradually applied before a game and the muscles and tendons are fully prepared.

elbow pain in golfersWithout addressing these longer term issues elbow pain very often recurs so there are no short cuts to getting it completely resolved. Clients have a tendency to tail off their rehab once the pain is more under control. But the really important part is addressing the weaknesses and restrictions through the body that set professionals apart from amateurs. So completing a full rehab programme is essential. Our Physiotherapists will tailor your programme specifically to address the imbalances they find when they have completed a thorough assessment of your body as a whole.

If you are unfortunate enough to experience elbow pain and would like to book an appointment with one of our Physiotherapy team just call 0203 916 0286, email us here or pop into the clinic for a chat.

If you have enjoyed this blog and would like to read more on golfing injuries click on the links below:

Need to improve your golf swing performance and banish back pain? Physiotherapy could be the answer!

 

Read our top tips for preventing tennis elbow

Tennis elbow is a very common complaint at this time of year. It’s more difficult to help once it becomes established and chronic. There are some useful steps that can be taken to reduce your chances of developing it. Read this infographic for our top tips.

We used to think that tennis elbow was a tendinitis – inflammation of the tendon. But we now recognise it as a tendinopathy – a degeneration of the tendon such that it struggles to cope with the loading put through it. Nowadays we treat the condition mainly with specific exercises to strengthen the tendon.

If you are unlucky enough to start experiencing the symptoms of tennis elbow which are typically:

  • pain and tenderness over the outer point of the elbow
  • aggravated by tennis strokes
  • aggravated by lifting a kettle or even a cup if very acute!
  • can be worse with typing
  • felt on gripping things

come and see one of our Sports Physiotherapists who can help you recover and give you tailored advice on prevention.

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