はじめに
Cycling has become one of the most popular forms of exercise and transportation in the United States. Whether it’s for competitive sport, endurance training, or commuting, cyclists place repetitive mechanical stress on the lower limbs, particularly the knees, Achilles tendons, and hamstrings. Chronic pain and overuse injuries are common complaints, often leading to decreased performance or even forced breaks from riding. Non-invasive treatments have emerged as effective solutions, with Shockwave Therapy (Extracorporeal Shockwave Therapy, ESWT) gaining particular recognition in sports medicine. This therapy, combined with modern rehabilitation protocols, can accelerate tissue repair, reduce pain, and help cyclists maintain optimal function. Additionally, Laser Therapy (Low-Level Laser Therapy / Photobiomodulation) offers complementary benefits in pain modulation and inflammation control. This article explores how Shockwave Therapy works, its advantages for cyclists, and how it can keep you riding pain-free.
1. Understanding Common Cycling Injuries
Cyclists are prone to a spectrum of injuries that are often mechanical and repetitive in nature. Understanding these injuries is the first step toward effective treatment and prevention.
1.1 Knee Pain in Cyclists
Knee pain is among the most prevalent musculoskeletal complaints in cyclists. Common conditions include patellofemoral pain syndrome (PFPS), patellar tendinopathy, and overuse-related cartilage stress. PFPS is characterized by irritation of the cartilage beneath the patella due to misalignment or muscular imbalance. Repetitive pedal strokes, often exceeding hundreds per ride, place chronic load on the knee joint, particularly during uphill climbs or sprints. Patients typically report aching around or behind the kneecap, stiffness during and after rides, and reduced pedaling efficiency. Without intervention, chronic knee pain can progress to tendon degeneration, reduced muscle strength, and even early cartilage deterioration. Shockwave Therapy targets these conditions by stimulating tendon healing, breaking down micro-calcifications, and increasing blood flow to promote tissue repair.
1.2 Achilles Tendon Injuries
Although more commonly associated with runners, Achilles tendinopathy is also a frequent problem in cyclists. This condition involves degeneration or inflammation of the Achilles tendon, which connects the gastrocnemius and soleus muscles to the calcaneus (heel bone). The repetitive plantarflexion motion during pedaling, especially under heavy resistance, can contribute to tendon microtrauma. Patients often report localized pain near the heel, stiffness, and reduced range of motion. If left untreated, chronic Achilles tendon injuries may lead to tendon thickening, collagen disorganization, and increased risk of rupture. Shockwave Therapy stimulates tenocyte activity and enhances collagen production, supporting both pain relief and structural healing. Laser therapy can further assist by reducing inflammation at the cellular level and accelerating metabolic processes in the tendon tissue.
1.3 Hamstring Tendinopathy and Muscle Strains
Cyclists are also vulnerable to hamstring tendinopathy and muscle strains, particularly during high-intensity intervals, sprinting, or climbing. Tendinopathy often occurs at the musculotendinous junction, where the tendon meets the muscle belly, leading to localized soreness, stiffness, and weakness. Microtrauma from repetitive contractions can accumulate over time, resulting in chronic discomfort. Rehabilitation of these injuries requires a combination of mechanical stimulation, controlled loading, and tissue regeneration strategies. Shockwave Therapy promotes angiogenesis—formation of new blood vessels—enhances fibroblast activity, and improves collagen alignment, while laser therapy can reduce pain perception and support metabolic recovery in the affected tissue.
2. What is Shockwave Therapy?
衝撃波治療, or Extracorporeal Shockwave Therapy (ESWT), is a non-invasive treatment widely used in orthopedics and sports medicine for musculoskeletal disorders. It involves delivering high-energy acoustic waves to affected tissues, stimulating biological processes that promote healing, reduce pain, and improve function. This therapy is particularly effective for tendinopathies, chronic pain, and soft tissue injuries. Unlike invasive interventions, ESWT can be applied in an outpatient setting, allowing patients to resume activity shortly after treatment.
2.1 Mechanism of Action
Shockwave Therapy works through the mechanical delivery of acoustic waves that generate controlled microtrauma in the target tissue. This microtrauma triggers several physiological responses:
- Neovascularization: The formation of new blood vessels improves nutrient delivery and waste removal.
- Collagen synthesis: Fibroblasts and tenocytes are stimulated to produce new collagen, enhancing tendon strength.
- Pain modulation: Shockwaves reduce levels of substance P and other pain mediators.
- Tissue remodeling: Microtrauma prompts the realignment of collagen fibers and repair of microtears.
By combining mechanical stimulation with the body’s natural repair mechanisms, ESWT accelerates recovery from chronic tendinopathies and soft tissue injuries.
2.2 Types of Shockwave Therapy
There are two primary types of ESWT:
- Focused Shockwave Therapy (F-ESWT): Delivers high-energy waves to a precise depth, suitable for deep tendons and ligaments, such as the Achilles or patellar tendons.
- Radial Shockwave Therapy (R-ESWT): Distributes energy over a broader, more superficial area, commonly used for muscle injuries, fascia pain, and broader soft tissue problems.
The choice of modality depends on injury depth, tissue type, and treatment goals. Energy levels, pulse frequency, and session duration are tailored individually by trained clinicians to maximize efficacy while minimizing discomfort.
2.3 Benefits for Cyclists
Cyclists benefit from Shockwave Therapy due to its:
- Non-invasive nature: No surgery or long recovery period.
- Tissue regeneration stimulation: Improves tendon and muscle healing through increased collagen synthesis and angiogenesis.
- Pain reduction: Decreases chronic discomfort, enabling continued training and riding.
- Prevention of chronic degeneration: Reduces risk of tendon rupture or long-term functional impairment.
When combined with structured rehabilitation and proper bike fitting, ESWT can significantly improve cycling performance and longevity.
3. Shockwave Therapy for Specific Cycling Injuries
ESWT has proven efficacy for multiple cycling-related injuries, particularly tendinopathies and overuse injuries in the lower limbs.
3.1 Knee Pain and Patellofemoral Tendinopathies
Patellar tendinopathy and PFPS are common among cyclists due to repetitive knee flexion and extension. Shockwave Therapy alleviates pain by promoting microvascular circulation and stimulating collagen remodeling at tendon insertion points. Treatment typically involves multiple weekly sessions, with measurable improvement in pain scores and functional mobility often observed within 4–6 weeks. ESWT also assists in reducing adhesions and micro-calcifications that contribute to chronic irritation. Combining this therapy with strengthening exercises targeting the quadriceps and hip stabilizers ensures long-term recovery and performance maintenance.
3.2 Achilles Tendon Injuries
Achilles tendinopathy in cyclists manifests as heel pain and stiffness, particularly after intense rides. Focused ESWT targets the tendon insertion to stimulate collagen synthesis and improve tendon elasticity. Patients often report pain reduction within a few weeks, although full functional recovery may require several sessions. Rehabilitation protocols, including eccentric calf strengthening and stretching, are recommended in conjunction with ESWT to optimize tendon remodeling and prevent recurrence. Laser therapy can complement this by enhancing mitochondrial activity and reducing inflammatory markers in the tendon tissue, accelerating overall recovery.
3.3 Hamstring and Other Tendinopathies
Chronic hamstring tendinopathy or proximal muscle strains require careful management. ESWT promotes localized microtrauma, inducing angiogenesis and fibroblast proliferation at the musculotendinous junction. This accelerates healing, reduces stiffness, and improves flexibility. For cyclists, combining ESWT with dynamic stretching, progressive resistance exercises, and proper cadence training helps prevent reinjury. Laser therapy can also be integrated to decrease pain and inflammation, particularly in superficial muscular tissues.
4. What to Expect During a Shockwave Therapy Session
Understanding the procedure reduces anxiety and helps cyclists comply with treatment plans.
4.1 Preparation and Consultation
Before starting ESWT, a detailed evaluation is performed by a certified clinician. This includes:
- Assessment of the injury severity and chronicity.
- Review of previous treatments and medical history.
- Imaging (ultrasound or MRI) if necessary to identify structural changes.
- Formulating a personalized treatment plan that determines modality, energy level, and session frequency.
This ensures that treatment is safe and maximally effective.
4.2 The Procedure
During the session, the clinician uses a handheld applicator to deliver acoustic pulses to the injured tissue. Patients may feel tingling, pressure, or mild discomfort, but the procedure is generally well-tolerated. Sessions typically last 10–20 minutes, and no anesthesia is usually required. The number of pulses, energy flux density, and treatment points are tailored according to injury type and tissue depth. Proper application ensures maximum stimulation for healing while minimizing discomfort.
4.3 Recovery and Aftercare
Post-treatment, minor soreness or redness at the application site is normal. Light cycling can often resume within 24–48 hours, while high-intensity training should be deferred until pain decreases. Rehabilitation exercises focusing on strength, flexibility, and movement patterns are recommended to support tissue remodeling and prevent re-injury. ESWT is most effective when integrated with an individualized exercise program and optimized bike fit.
5. Tips to Prevent Cycling Injuries
While ESWT accelerates healing, preventive strategies are essential for long-term performance and health.
5.1 Proper Bike Fit and Posture
Adjusting saddle height, handlebar position, and pedal alignment reduces repetitive stress on knees, hips, and Achilles tendons. Correct posture improves pedaling efficiency and minimizes asymmetric loading, reducing the risk of tendinopathy.
5.2 Warm-Up and Stretching
Dynamic stretches before riding, such as leg swings and hip mobility drills, prepare muscles and tendons for repetitive load. Post-ride static stretching reduces muscle tightness and supports recovery, while foam rolling can enhance circulation and tissue elasticity.
5.3 Training and Load Management
Gradually increasing training volume and intensity prevents overuse injuries. Integrating rest days, cross-training, and low-intensity rides allows tendons and muscles to adapt safely to increasing loads. Structured training prevents sudden overloading, which is a primary factor in chronic tendon injuries.
FAQ
Q1: Is Shockwave Therapy painful?
Patients usually experience mild pressure or tingling sensations. Clinicians adjust energy levels for comfort while ensuring effective tissue stimulation.
Q2: How many sessions are typically needed?
Most chronic tendon injuries respond well to 3–6 sessions, spaced 5–7 days apart, depending on severity.
Q3: Can Shockwave Therapy replace surgery?
ESWT can prevent or delay surgery in many chronic cases, but complete tendon ruptures may still require surgical intervention.
Q4: How soon can I ride after treatment?
Light cycling is typically safe within 24–48 hours, with intense training deferred until clinician approval.
Q5: Can Shockwave Therapy be combined with Laser Therapy?
Yes. Laser therapy complements ESWT by reducing inflammation and enhancing cellular metabolism, particularly in superficial tissues.
結論
Shockwave Therapy is an effective, non-invasive solution for cyclists dealing with chronic knee, Achilles, or hamstring pain. By promoting collagen synthesis, angiogenesis, and tissue remodeling, ESWT accelerates recovery while allowing riders to maintain performance. When combined with rehabilitation exercises, proper bike fit, and preventive strategies, it can significantly improve function and prevent long-term injury. For cyclists seeking non-surgical options to stay on the saddle, ESWT, potentially augmented by Laser Therapy, represents a reliable and evidence-based approach to maintaining mobility and enjoying cycling pain-free.
参考文献
“Effectiveness and Safety of Shockwave Therapy in Tendinopathies.” PubMed,
https://pubmed.ncbi.nlm.nih.gov/30061805/
“Efficacy of Extracorporeal Shock Wave Therapy for Lower-Limb Tendinopathy: Meta-analysis.” PubMed,
https://pubmed.ncbi.nlm.nih.gov/29557811/
“Effectiveness of Shockwave Therapy vs Radial Shockwave Therapy.” PubMed,
https://pubmed.ncbi.nlm.nih.gov/33506031/
“Systematic Review of ESWT Effects on Pain.” BMC Sports Sci Med Rehabil,
https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-024-00884-8
“Extracorporeal Shockwave Therapy.” Wikipedia,
https://en.wikipedia.org/wiki/Extracorporeal_shockwave_therapy
“Low-Level Laser Therapy.” Wikipedia,
https://en.wikipedia.org/wiki/Low-level_laser_therapy
Gokhan K, et al. Efficacies of Extracorporeal Shockwave Therapy and Low-Level Laser Therapy in Tendinopathies. ScienceDirect,
https://www.sciencedirect.com/science/article/abs/pii/S1268773123000103
“Photobiomodulation as Medicine: LLLT.” PMC,