Lower limb physiotherapist Benoy Mathew on managing running injuries with shockwave therapy

Benoy Mathew PT, MSc, MCSP, PG Cert (MSK US) is a specialist lower limb physiotherapist and a MSK Sonographer. He works for the NHS at Guys and St. Thomas Hospital London as an Advanced Practice Physiotherapist and in private practice. He has a special interest in chronic hip & groin pathologies and the management of running injuries. He is passionate about the application of research in clinical practice and is the co-author of ‘Hip and Knee Pain Disorders’. Benoy is also a Venn Healthcare tutor, and regularly runs courses to educate practitioners on shockwave therapy theory and practice.

In this interview, which was recently published in Frontline Magazine, Benoy talks about his use of shockwave in the treatment of lower limb pathologies and running injuries.

What running injuries do you see the most in your clinic?

The majority are overuse injuries such as chronic tendinopathy and bone stress injuries. The most common tendon disorders I treat in runners are Achilles, gluteal and proximal hamstrings. I also treat conditions such as medial tibial stress syndrome and osteitis pubis using focused shockwave.

What is unique about injuries in runners compared to other patient groups?

Around 80% of running-related injuries are overuse injuries, which means it is usually due to imbalance of tissue capacity and training load. The majority of injuries involve the knee, leg, foot and ankle. Novice runners are more likely to develop knee pain during running, whereas experienced runners tend to develop chronic tendinopathies such as Achilles or proximal hamstrings.

When did you start incorporating shockwave therapy into your management of running injuries?

I have used shockwave in running injuries since 2015. I was finding that certain injured runners did not respond to traditional load management / strength training protocols and were still struggling with pain. This was affecting their return to running and training, which was very frustrating. I have found shockwave to be a useful evidence-based adjunct for pain reduction and to facilitate early loading and progression of exercises such as plyometrics.

What are the clinical benefits of using shockwave therapy in runners?

I use both the Storz Medical radial and focused shockwave therapy, which bring different therapeutic benefits. Radial shockwave is useful while dealing with superficial structures like Achilles tendon and plantar fascia but is not effective for deeper structures and bone pathologies. While dealing with conditions such as shin splints and bone stress injuries, focused shockwave is the modality of choice to facilitate bone remodeling and pain relief. I find the addition of shockwave to the rehab of running injuries can enhance early return to running, in this population.

How have your running patients responded to shockwave treatment?

I find runners with Achilles and patellar tendinopathy respond well to both radial and focused shockwaves. Certain conditions like proximal hamstrings tend to need more sessions (around 5-6) from my experience. The full recovery can take 12-16 weeks and it is important that runners don’t see this treatment as a quick fix. Runners should also have a concurrent rehab programme, along with their shockwave treatment sessions.

How has shockwave changed your practice?

Most runners are keen to return to running at the earliest opportunity. Multiple trials have shown that the addition of shockwave therapy to a tendon loading program in chronic lower limb tendinopathy results in a clinically important improvement, rather than just exercise therapy on its own. It is important to note that shockwave is not an isolated treatment and is always provided with education on load management, appropriate rehab and strength and conditioning to improve tissue capacity. Shockwave is simple and quick to administer and it is very safe.

For information on Storz Medical systems click here.

For clinics near you which provide shockwave therapy visit our shockwave therapy clinic finder on https://www.vennhealthcare.com/contact/#clinics

Details of Benoy’s Book – https://www.handspringpublishing.com/product/hip-and-knee-pain-disorders/