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Improvement of active calf muscle extensibility

Improvement of active calf muscle extensibility by means of radial shock waves in chronic achillodynia.

Summary
The aim of this study was to investigate the possibility of improving active calf muscle extensibility by means of radial shock waves (RSWT) in patients with chronic achillodynia. To this end, radial shock waves were applied to the shortened calf muscles in 102 patients, and active dorsal extension of the affected ankle joint was measured before and after completion of therapy and 3 to 6 months later. The results of the study showed a lasting improvement in active dorsal extension by 9 degrees after 4.4 therapy sessions with 4000 to 6000 shock waves per session.

Materials and methods:

• 102 orthopedic practice patients (63 males, 39 females)
• Average age 45.3 years
• Unilateral chronic achillodynia (> 6 months) and a history of failed conservative therapy
• Inclusion criteria: a soft tissue induced reduction in the active dorsal extension of the ankle joint to less than 20° when examined at 90° knee flexion
• 4 to 6 radial RSWT sessions at weekly intervals with MP100
• Each session 4000 to 6000 radial shock waves
• D-Actor^® 20mm head
• Shock waves were primarily applied to the proximal gastrocnemius muscles where most palpable indurations were found
• 2,5 bars and 15 Hz
• Active dorsal extension of the ankle joints was measured by means of a gravity goniometer before and afte r completion of RSWT and 3 to 6 months later (1 examiner)
• Statistical significance level was set at p<0.05

Results:

• Average active dorsal extension measured prior to shock wave therapy was 16.7° (12°-19°)
• Significant improvement in the active dorsal extension to 25.8° (21°-32°) was achieved after an average of 4.4 shock wave therapy sessions
• Follow-up examinations conducted after an average of 4.6 months (3-6 months) showed that the active dorsal extension had increased to 26.2°
• None of the patients required early termination of the therapy

Discussion:
RSWT of chronically shortened calf muscles results in an over 9° increase in the active dorsal extension of the ankle joint. The effects achieved last at least for several months. Consequently, this therapy approach is far superior to conventional stretching therapy, both in terms of the degree of improvement and in terms of the duration of its effectiveness.

Compared to the otherwise recommended daily stretching exercises, which need to be performed over a period of several weeks, shock wave therapy requires relatively little time as 4 to 5 therapy sessions of 7 minutes duration each are sufficient to achieve the desired results. Except for the pain perceived during treatment, shock wave therapy had only minimal side effects and is thus indicated for almost all patients.

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