Achilles tendonitis is an inflammation of the Achilles tendon resulting in heel and leg pain that can be debilitating. It occurs mostly from excessive physical activities such as running and jumping. Resting the ankle is the most likely treatment a doctor will prescribe. However, sometimes a treatment known as "therapeutic ultrasound" is used as well. In 2001 the journal "Physical Therapy" assessed reports on ultrasound's effectiveness but found little supporting evidence. Despite this, therapeutic ultrasound is commonly used by chiropractors to treat tendonitis.
Physiology and Pathology
The function of a tendon is to provide movement of a joint. The Achilles tendon moves the ankle joint, and is the largest tendon in the body. The Achilles tendon also produces more force than any other tendon; up to eight times a person's weight. Since it mediates so much force, and since it is used often, the Achilles tendon is prone to injury. According to a 2002 article in "American Family Physician," tendonitis is associated with excessive mechanical stress of the tendon, resulting in inflammation as the body attempts to repair or replace damaged cells or connective tissue. Thus, inflammation actually is a healing mechanism, and the associated increase in blood flow and lymphatic drainage are all part of this process.
How Ultrasound Works
Unlike diagnostic ultrasound which is used for imaging, the goal of therapeutic ultrasound is to stimulate tissue beneath the skin. The 2006 book "Emerging Therapeutic Ultrasound" describes the process as sound waves being emitted at a frequency too high to hear. The authors of this book claim that the waves travel up to five inches into the body and directly affect molecules and cells. They claim the intensity of this vibrating energy can be adjusted to the needs of the patient, and that usually, a lower intensity for a longer time is desirable. Finally, they claim that energy promotes warming of damaged tissues which, in turn promotes blood flow and lymphatic drainage.
Who Can Benefit
Any patient with Achilles tendonitis can use therapeutic ultrasound although its benefits are controversial. According to the authors of "Emerging Therapeutic Ultrasound," effectiveness depends on many factors, including the severity of the condition, age, and general health of the patient. There are contraindications which should be kept in mind. These include pregnancy, metal implants such as bone plates, edema, skin integrity, and cognitive or communicative issues.
Treatment Method
Treatment is best performed by a health care professional who can easily guide the device's head, or transmitter around the leg while the patient relaxes. A conductive gel is applied to the skin to create an interface for the sound energy to pass into the body. The transmitter head is then glided over the contours of the Achilles tendon and the calf muscles. Treatments last about 20 minutes. Treatment can be repeated daily or every other day for one or two weeks. After one or two weeks, the health care professional will determine if the device should be reset for more power. At this point, therapy will continue for up to six more weeks or until symptoms improve.
Misconceptions
Many people seeking therapeutic ultrasound treatment assume it will cure Achilles tendonitis. However, there is little scientific evidence to support this. Resting the joint is the widely accepted method to promote healing.
References
- "American Family Physician"; Common Conditions of the Achilles Tendon; M. Mazzone and T. McCue; May 2002
- "Archives of Physical Medicine and Rehabilitation"; Contraindications for superficial heat and therapeutic ultrasound; M. Batavia, June, 2004
- "Physical Therapy"; A Review of Therapeutic Ultrasound: Effectiveness Studies; V. Robertson; July, 2001
- "Emerging Therapeutic Ultrasound"; J. Wu and L. Nyborg; 2006
- Univ. of Maryland Medical Center: Tendinitis
