Lots of studies point to a longer lifespan for people who exercise regularly. And research shows the more activity you get, the greater the potential boost in longevity.
And with more than 80 million adults in the U.S. age 65 and older anticipated by mid century, the number of older, active adults is on the rise.
But with age, also comes the increased risk of pain and overuse injuries. Some of the more common conditions include heel pain — often caused by plantar fasciitis — achilles tendinopathy and tennis elbow, which strikes many adults, even those who don't play the sport.
Some of the most common treatments for these overuse injuries include rest and over-the-counter medicines such as ibuprofen and acetaminophen. Many people who seek medical attention are also prescribed exercises and stretches as part of physical therapy. But when those treatments don't resolve the problem, and the pain persists, there's an alternative therapy that helps many people find relief, known as shockwave therapy.
A stabbing pain that came on suddenly
Jonathan Segal, a retired physician from Menlo Park, Calif., is always on the go. He's in his early 70s and maintains a super active lifestyle. "I go hiking two or three times a week," Segal says. He also loves to play pickleball, ride his bike, and he volunteers at a nature preserve where he is always on his feet. Last year, Segal began experiencing pain in his heel. The condition came on quickly and unexpectedly with no specific trigger or event to explain the onset.
"When I first got up from being in bed or sitting in a chair, my first steps were painful," Segal says. The sensation felt like a stabbing pain, which he recognized as a telltale symptom of plantar fasciitis, a top cause of heel pain. It's caused by irritation and damage to a thick band of connective tissue on the bottom of the foot, known as the plantar fascia, which helps with shock absorption during weight-bearing activities like walking, running and jumping.
A few years ago Segal had extracorporeal shockwave therapy, or ESWT, on his achilles tendon, and it worked well, so he asked around to find a doctor who offered the treatment for plantar fasciitis.
The treatment is delivered in a doctor's office or clinic. A medical provider uses a wand-like device to apply pressure to the area of pain. The device generates shockwaves through sound waves that deliver pulses of high-intensity pressure. The treatment is approved by the FDA for the treatment of plantar fasciitis and tennis elbow. Shockwave therapy is also effective for Achilles tendinopathy and there are mixed results for its use in tendonitis in the shoulder and hamstring injuries.
Segal went for three sessions of shockwave therapy, administered by Dr. Raymond Chou of Stanford University School of Medicine, who specializes in non-surgical orthopedic care and rehabilitation. "It takes a correct diagnosis," Chou says, to make sure shockwave therapy is an appropriate treatment for patients who have not responded to the more conservative approaches, including rest, stretching and night splints.
'Uncomfortable, but manageable.'
Chou held the wand-like device to Segal's heel for about five to ten minutes. "It's delivered once a week for three weeks," Chou says. And he sees very good results for many patients including Segal.
"It feels like somebody's tapping with a rubber hammer onto your tissues," Segal says, describing the sensation as uncomfortable, but manageable. The device can be adjusted to increase or decrease the intensity, based on what a patient can tolerate.
Shockwave therapy works by boosting blood flow to the injured area and stimulating the body to repair damaged tissue.
Researchers are still nailing down the exact mechanisms that make the therapy effective, including the potential growth of new blood vessels in the damaged areas, interrupting pain signals by overwhelming nerve endings that have grown into the injured tendons or fascia, and destroying nerve fibers in the affected area, which can also lead to long-term pain relief.
It's been six months since Segal completed his treatment and he says he's feeling much better.
"Within a week or two of the first treatment, it had started to improve," Segal says. And soon after the third treatment the symptoms "disappeared completely," he says.
You can remain active after treatment
Not everyone experiences complete relief, though research shows most patients who get shockwave therapy experience significant reductions in pain with lasting effects and a low recurrence rate.
There are two types of shockwave therapy, including radial shockwave therapy which disperses the pressure waves over a wider, shallower area, and focused shockwave therapy that targets the pressure at a precise point. Providers evaluate which option is best for each patient.
The treatment was first approved by the FDA in the early 2000s for a few conditions. Now there's ongoing research into a range of musculoskeletal conditions that may be effectively treated with the therapy. "It's not a new treatment modality, but certainly with time, the technology has improved," says Dr. Joshua Romero, a sports medicine specialist at the Mayo Clinic, who has written about the history of the treatment.
He says shockwave therapy appeals to people who want to remain physically active, because there's minimal activity restriction after the procedure, unlike with surgery or injections. "It allows them to maintain their sport or active lifestyle while still getting treatment," Romero says.
One downside is that the treatment is not typically covered by most insurance plans. Out of pocket costs range from about $100 dollars per session, up to several hundred. "I had to pay the entire cost myself," Segal says, and "it was definitely worth it."
But given the track record and the evidence behind the therapy, especially in cases when it can help someone avoid surgery or other invasive procedures, Segal thinks it should be covered by insurance.
Segal is back to hiking and biking and all the activities he looks forward to each day. "Health is probably the single greatest determinant of the quality of life later in life," Segal says, pointing to the importance of physical, social and emotional health. " The more you have that's positive in all those realms, the better quality of life you have," he says, and being able to maintain the activities you enjoy is a key component.
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