Shockwave Therapy for Pain
Heel pain, the most common sports injury we treat, can affect the bottom or the back of the heel. If the pain happens at the bottom of your heel bone, it is known as plantar fasciitis. Pain at the back of your heel bone is known as Achilles tendonitis.
Heel pain is a progressive problem, and it has many causes. Heel pain is generally the result of faulty biomechanics that place too much stress on the heel bone and the soft tissues that attach to it.
Anatomy: The soft tissue that connects your heel bone to the ball of your foot is called the plantar fascia, which forms the arch of your foot. It is like a rubber-band. At rest, the muscle contracts. When a person with plantar fasciitis stands, the plantar fascia is overstretched and becomes inflammed, causing heel pain at its insertion on the heel bone. As we age, we also loose elasticity in our muscles, so over-stretching is more common.
Anatomy: The Achilles tendon is the strongest tendon in the body. An overstretching of the Achilles tendon leads to pain and swelling at the insertion of the tendon on the back of the heel bone.
There are two different philosophical approaches when treating heel pain. There is a traditional pathway that uses anti-inflammatory medications and modalities to treat heel pain. There is another holistic pathway that uses shockwave to eliminate pain and repair the damaged tissue.
The traditional pathway involves using anti-inflammatory medications, cortisone injections, and physical therapy to reduce inflammation and pain. Patients who chose this pathway can expect 1-3 cortisone injections within a month and twice weekly physical therapy for 4-8 weeks. They must restrict their activity level in order to allow the pain and inflammation to subside. Patients with Achilles tendon pain cannot receive cortisone injections because they weaken the attachment of the tendon onto the heel bone, and can cause the Achilles tendon rupture. In addition to physical therapy and oral medication, their heels need to be lifted to reduce the pull on the tendon.
The holistic pathway works faster than the traditional pathway, and it is designed for Athletes because patients resume activities much more rapidly. Hollistic treatment involves using the shockwave therapy. Unlike the traditional treatments, shockwave uses “good” inflammation to increase the body’s ability to heal itself, and actually can help repair damaged tissue without surgery. Shockwave therapy provides pain relief because it numbs the injured area as it is being administered. It also stimulates the production of endorphins which promote healing. Because shockwave is non-invasive, there are no side effects associated with the treatment. Half the people who undergo a single Shockwave therapy achieve 90-100% pain relief. The other half of the patients require multiple therapies to complete their treatment. Shockwave patients cannot use any anti-inflammatory treatment including cortisone injections and oral medications such as Aleve or Advil, as they diminish the effectiveness of the shockwave therapy.
Regardless of which pathway a patient chooses to treat their heel pain, custom orthotics are required to support and stabilize the arch during walking, and correct the underlying biomechanical imbalance that caused the heel pain. Achilles tendonitis patients have heel lifts incorporated into their orthotics to lessen the pull of the tendon at its insertion into the heel bone.