Anyone who has had an Achilles tendon injury knows how painful it is.
And the treatment - a twice-daily exercise programme which lasts for 3 months – seems to be just as much as a nuisance, with many sufferers failing to complete it. But new research has convinced a once sceptical physiotherapist that less exercise combined with laser treatment is an exciting, and more effective, alternative.
“It was only really by accident that I got into the laser research, and I’m sort of converted with regards to musculoskeletal problems anyway,” says Dr Steve Tumilty from the University of Otago. “Saying that I would never use it as a standalone treatment, and I don’t think any physio worth his salt would ever use the laser as a standalone treatment.”
Steve, who is the Associate Dean of Postgraduate Studies at the School of Physiotherapy has found a statistically significant improvement of anywhere between 10 and 15 point difference in the scores on a 100 point scale, when using the laser in addition to exercise.
Currently, the gold standard treatment for Achilles tendon strains, or tendinopathy, is eccentric exercises.
Eccentric exercises work by shortening the muscle, then putting a load on it, and then lengthening the muscle through the load. So for example, standing up on tippy toes while lifting weight, then lowering the foot on the injured side back down again. There is some pain associated with the exercise but this is to be expected.
“The cells respond to the mechanical load you put on them, and they produce proteins and enzymes to help rebuild the tendon and improve its tensile strength,” says Steve.
The current recommended treatment requires people to do these eccentric exercises twice a day, seven days a week, for 12 weeks.
“When I first read that all those years ago, I thought I’m never going to get Kiwis to do that. And that’s basically what my research has shown over the past few years, when you look at compliance with the exercise regime very few will put up with that,” says Steve. “It’s quite awkward to be able to get to a gym just for ten or 15 minutes just to do these exercises.”
Steve has been trialling the use of a near infrared laser, before participants do these exercises. The laser is used to irradiate the tendon on three sides, the back, inside and outside of the tendon. The probe is run 10cm down the side of the tendon for a minute on each side. The laser is not strong enough to burn, it just creates some gentle heating.
"It's very mild heat, no pain, nothing," says Angela Spontelli Gisselman as she experiences the laser treatment. "Just a little bit of heat."
According to Steve, the laser enhances the exercises because the mitochondria in the cells absorb energy from the laser, prompting greater metabolism from cells. This leads to greater collagen production for the fibres of the tendon. It also gives a general boost to the immune system.
The laser in Steve’s clinic is applied for two sessions a week for four weeks, but the eccentric exercises would continue for at least another eight weeks.
In Steve’s recent trial he had four groups: two groups that compared the laser against placebo laser with eccentric exercise twice a week, and two groups that compared the laser against placebo laser with exercises conducted twice a day, seven days a week, for 12 weeks.
In terms of compliance to the exercise regime, Steve found that those who exercised twice a week had 100% compliance, but for those who did it twice a day, seven days a week compliance was only 55% or 65% of the required sessions depending on the group.
For those groups that received the laser, Steve found anywhere between 10 and 15 point improvement in the scores on a 100 point scale compared to the group that got the placebo.
“The group that had the combination of twice a week exercises plus laser the average score of that group, we’re talking about 20 people in each group, was 98.95. So almost a perfect score,” says Steve.
Also, the number of people in that group that did get a perfect score was much higher than the other group.
“As far as this trial is concerned, two major things came out of it, twice a week is just as good if not a little bit better than twice a day. And if you wanted to add laser to it, you can enhance the process even more,” says Steve.
However, finding a physiotherapist who uses laser treatment for people with tendinopathy might be difficult. Lasers are unfashionable in the profession, and the benefits, such as two weeks quicker recovery time, may not be justified given that a machine costs US$30,000.
However, Steve wonders why the professional sports teams aren’t using laser treatment. “Because those guys need to get the guy back on the field in a week,” he says.