EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT):
ESWT is the treatment option of choice for chronic refractory tendinopathies. Low-energy radial shock wave therapy (ESWT) is recognized for its effectiveness. It works by stimulating tissue healing and neoangiogenesis (the formation of new blood vessels) in the injured area, while also providing pain relief.
Both radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT) have proven effective in treating patellar tendinopathy 17 , especially when combined with eccentric exercises. 18
In cases of stubborn patellar tendinopathy, the combination of PRP and ESWT has proven effective (Jhan et al 2024). 19
Neuromuscular Electrostimulation (NMES)
NMES can be used to strengthen the quadriceps without placing excessive strain on the tendon during very painful phases. Combined with active exercise the muscles are worked hard but not overloading the tendon. For better exercise recovery low frequency programmes (8Hz), like Capillarisation on the Chattanooga and Compex devices, are recommended. The research has shown that combining NMES with active exercise, throughout the rehabilitation process, provides superior results than using exercise alone. 29-31
Patella teninopathy management summary
Modality
Acute pain and inflammation
Tissue healing
Stengthening and recovery
Pain from day 1 Anti-Inflammation from day 2-3
Daily first week from day 2-3
Post exercise to Quadriceps
PBMT (LFT)
Transmitter
Prom-inflammation from day 1 plus Myofascial Trigger Points
1 x ESWT/week Combine daily with PBMT from day 2-3 post ESWT
Post exercise to Quadriceps
ESWT (FSW/RSW)
Transmitter
TENS x 2-3 daily for pain Capillarisation (5Hz) on Quads with cold compression on knee
Capillarisation (5Hz) on Quads x 2 daily
Disuse atrophy x 2/day isometric hold progress to resistance combined with active exercise
16
NMES (WPro)
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