THE ROLE OF SHOCKWAVE IN LOWER LEG RUNNING INJURIES CONTINUED...
Changes can include: 15
Hypercellular activity with increase nucleus size of tenocytes
Areas of apoptosis
Formation of chondroid (pseudo cartilage)
Increased Type III collagen presence
Disorganized collagen bundles
Ground substance accumulation (Aggrecans)
Tendinosis recognized at an early stage can have athletes return to prior levels of activity in a 6–10 week time frame; however, when chronic and not addressed in the early stages, the window can increase to 3–6 months. 16 Treatment for this condition can be difficult as it requires exercise programs that last for several months. Additionally, exercise based approaches require progressive tendon loading which often requires individuals to tolerate moderate levels of discomfort while exercising to restore function. This can be complicated further by patients developing kinesiophobia (fear of motion) due to ongoing pain at the tendon. 17 It is generally accepted that applying repeated high load, long duration (low intensity) stress on the tissue is required as part of a successful plan of care.
Tendon loading is one form of the phenomenon known as mechanotransduction.
“Mechanotransduction” is a biological pathway to which many cell types (including Stem Cells) sense and process the mechanical information from the extracellular environment. These biomechanical forces are converted in biochemical responses, thus influencing some fundamental cell functions such as migration, proliferation, differentiation, and apoptosis. 18 Mechanotransduction is also a mechanism attributed to ESWT. These devices create this phenomena passively by imparting high energy sound waves into tissue that causes various degrees of cell deformation. This can be useful when patients cannot tolerate higher levels of tendon loading exercises.
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