Common naprapathic treatments, such as eccentric training, massage, and stretching, will be compared with shockwave therapy. Chronic Achilles tendon issues, or Achilles tendinosis, are a common problem involving pain and swelling in the mid-portion of the Achilles tendon for at least 6 months. There are a variety of treatment methods, but it remains unclear which are most effective. Several previous studies show good results from both shockwave therapy and eccentric training. However, most of these studies have been evaluated only through clinical examination and rating scales. To evaluate which treatment methods are effective, an objective evaluation method is needed.
For over a decade, an MRI method (magnetic resonance imaging) has been developed using so-called UTE sequences (ultrashort echo time sequences), which are more sensitive to pathological changes in tendons. From these images, values specific to tissue composition can also be calculated, providing more precise quantification.
The study is a prospective, randomized trial. Subjects with chronic Achilles tendinosis, defined as load-related pain and tenderness upon palpation 2–7 cm proximal to the distal insertion of the Achilles tendon for at least 6 months, are being recruited via the Scandinavian College of Naprapathic Manual Medicine. The goal is to include 40 subjects with chronic Achilles issues, with 20 people in each group. Half of the subjects are randomized to shockwave therapy and half to naprapathic treatment. The naprapathic treatment is performed by 2 students at the college's clinic and spans a treatment period of 3 months. The shockwave therapy is performed by 2 experienced licensed naprapaths (Agilo Clinic) and consists of 1 treatment per week, usually 4 sessions, though this may vary from 3 to 5 sessions depending on symptoms. MRI scans are performed at the Radiology Clinic at Karolinska University Hospital in Huddinge on 3 occasions: before starting treatment, 3 months after starting treatment, and 12 months after starting treatment. In connection with the MRI sessions, subjects complete a pain assessment questionnaire (VISA-A). Subjects must also complete the VISA-A at 1 and 2 months after starting treatment.
The purpose of the study is therefore to evaluate the treatment of chronic Achilles issues by comparing naprapathic treatment and shockwave therapy using radiological changes and clinical pain assessment scales.
Helène Schulte, Licensed Physician, PhD, Director of Studies, NVR member
Helene Hultholm, Licensed Naprapath, Director of Studies
Eva Skillgate, Licensed Naprapath, Associate Professor, NVR member
