Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries
Summary
This comprehensive review evaluates the clinical use of ESWT for musculoskeletal conditions in athletes, finding it generally safe and effective for various conditions while noting that optimal protocols are not yet standardized for most indications.
Key Findings
"ESWT has been shown to be relatively safe. The main adverse effects occur at the site of application and include pain (primarily during application), skin irritation (transient reddening, bruising, swelling), or nerve irritation (transient paresthesias)."
"ESWT is a safe treatment option for peripheral musculoskeletal conditions in athletes. Treatment with ESWT requires no, to minimal, time away from sport."
"ESWT can be combined with other treatment modalities and should be used as a supplement to, rather than a substitute for, physical therapy, with the goal of achieving longer-term benefits."
Treatment Categories
Rotator Cuff Tendinopathy
moderate effectivenessMixed evidence on effectiveness. May be more effective for calcific tendinopathy with translucent calcifications.
Specific Findings
ESWT was 0.78 points better on VAS pain scale compared to placebo at 3 months
Cochrane review of 32 randomized and quasi-randomized controlled trials
Patient Type
Mixed
Shockwave Type
Not specified
Outcomes
Limitations
Did not meet minimal clinically important difference of 1.5 points
Lateral Elbow Epicondylopathy
moderate effectivenessFDA-approved indication with mixed evidence but generally positive results.
Specific Findings
Statistically significant improvement in short-term pain (1, 3, and 6 months) and grip strength (3 months)
Not specified
Patient Type
Non-athletic population (extrapolated to athletes)
Shockwave Type
Not specified
Outcomes
Limitations
No difference in function (1 to 3 months)
Greater Trochanteric Pain Syndrome
high effectivenessBoth radial and focused ESWT appear effective.
Specific Findings
76% of athletes returned to sport within 1 week to 3 months
Study by Furia et al.
Patient Type
Athletes
Shockwave Type
radial
Protocol
Outcomes
Proximal Hamstring Tendinopathy
high effectivenessStrong evidence for effectiveness in athletes.
Specific Findings
80% of athletes treated with ESWT returned to preinjury level of sports participation by 3 months vs 0% in conservative treatment
Randomized controlled trial by Cacchio et al.
Patient Type
Professional athletes
Shockwave Type
radial
Protocol
Outcomes
Patellar Tendinopathy
high effectivenessEffective nonoperative treatment with evidence of in-season benefits.
Specific Findings
ESWT may be a superior alternative to other nonoperative treatments and equal to tomy surgery
Meta-analysis of 7 studies
Patient Type
Athletes (including in-season volleyball, basketball, handball)
Shockwave Type
Not specified
Outcomes
Limitations
Various protocols used
Achilles Tendinopathy
high effectivenessEffective especially when combined with eccentric exercises.
Specific Findings
Eccentric exercises with ESWT resulted in the largest improvement in pain and function
Network meta-analysis
Patient Type
Mixed (athletes and non-athletes)
Shockwave Type
Both radial and focused studied
Outcomes
Plantar Fasciopathy
high effectivenessFDA-approved indication with strong evidence of effectiveness.
Specific Findings
Higher intensity ESWT (EFD >0.2 mJ·mm²) more effective than corticosteroid injections
Meta-analysis of nine randomized controlled trials
Patient Type
Not specified
Shockwave Type
Higher intensity
Protocol
Outcomes
Limitations
Similar recurrence rate among all groups at 1 year
Other Tendinopathies
moderate effectivenessPromising results for distal biceps and tibialis posterior tendinopathy.
Specific Findings
Promising results for distal biceps and tibialis posterior tendinopathy
Not specified
Patient Type
Recreational athletes and laborers
Shockwave Type
Not specified
Outcomes
Study Limitations
- No single optimal ESWT protocol has been identified.
- ESWT appears to have the most efficacy in the short term.
- Many studies did not report the athletic activity of the population at baseline, so the results of these studies are extrapolated to an athletic population.
