The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

Korakakis, Vasileios; Whiteley, Rodney; Tzavara, A.; Malliaropoulos, Nikos

doi:10.1136/bjsports-2016-097347

Cited by 138 publications

(114 citation statements)

References 72 publications

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“…At 3 months, 80% of the R‐SWT group returned to preinjury level of sport, compared to 0% in the conservative group . A recent review article analyzed this study and concluded moderate level of evidence for use of R‐SWT for PHT …”

mentioning

confidence: 89%

The Role of Extracorporeal Shockwave Therapy in Return to Competition for Endurance Runners: Two Case Reports

Reilly

Tenforde

2019

PM&R

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mentioning

confidence: 89%

The Role of Extracorporeal Shockwave Therapy in Return to Competition for Endurance Runners: Two Case Reports

Reilly

Tenforde

2019

PM&R

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“…The mean SWT shocks per treatment session was 2426.92 ± 965.36 (1000-4000) with a mean EFD of 0.22 ± 0.14 (0.03-0.42) mJ/mm 2 . The mean number of treatment sessions was 3.04 ± 1.67 (1)(2)(3)(4)(5)(6)(7)(8) sessions with a mean of 24.79 ± 43.56 days between sessions. Only two studies used anesthesia before the application of SWT and four studies employed sonographic guidance to localize the area of application (Table 3).…”

Section: Plantar Fasciitis and Heel Spursmentioning

confidence: 99%

“…However, despite the differences in their physical characteristics, method of energy generation and shockwave propagation, focused and radial shockwave types share common clinical indications [2]. SWT is often indicated as a secondary conservative treatment choice for recalcitrant musculoskeletal conditions, unresponsive to standard care [1,3]. These indications include plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, calcific and non-calcific shoulder tendinopathy and lateral epicondylitis.…”

Section: Introductionmentioning

confidence: 99%

“…Good evidence based on systematic reviews exists to support the use of SWT for calcific tendinopathy of the shoulder [4], Achilles tendinopathy [5,6], knee osteoarthritis [7], early stage osteonecrosis of the femoral head [8] and plantar fasciitis [9]. However, research evidence for the effectiveness of SWT in lateral epicondylitis is variable [1] and is lacking for patellar tendinopathy [3,6].…”

Section: Introductionmentioning

confidence: 99%

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The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

Al-Abbad

Allen

Morris

et al. 2020

BMC Musculoskelet Disord

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Background: Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT. Methods: A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects. Results: Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes. Conclusions: SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.

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“…Although not consistently, some studies demonstrate efficacy of ESWT in managing tendinopathy. Low level evidence supports ESWT in lower limb tendinopathy for improving pain, function and patient perceived improvement (4). Long term benefit has been demonstrated following ESWT application in both midportion and insertional Achilles tendinopathy (5,6).…”

Section: Protocolmentioning

confidence: 99%

Extracorporeal Shockwave Therapy of Healthy Achilles Tendons Results in a Conditioned Pain Modulation Effect: A Randomised Exploratory Cross-Over Trial

Vallance

Malliaras

2019

Muscle Ligaments and Tendons J

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Background. This study investigated whether ESWT applied to healthy Achilles tendons results in a conditioned pain modulation (CPM) effect. Methods. 3000 and 6000-shock dose radial ESWT was performed on dominant side Achilles tendon (random order over 5-9 days) among 20 healthy participants (75% male). Pressure was modulated throughout, producing >4/10 pain (10=worst imaginable). Bilateral pressure-pain thresholds (PPT) were assessed pre-post ESWT at Achilles tendon, tibialis anterior and elbow lateral epicondyle (random order). PPT change per site and PPT change scores for each site were compared between doses (repeated ANOVA), PPT reliability (intraclass correlation coefficients [ICC]), and PPT change variability (each site, coefficient of variation) were investigated. Dose order was investigated (first vs second) (t-tests, each site). Results. Test-retest reliability was good for all sites (ICC [3,2]=0.76-0.89). PPT increased significantly (p<0.05) at all sites bilaterally following 3000-shock dose, and at bilateral Achilles tendon, and left sided tibialis anterior and lateral epicondyle following 6000-shock dose (right 6000-shock tibialis anterior, lateral epicondyle p>0.05). Dose order wasn't associated with outcome (p>0.05). Conclusion. ESWT produces immediate CPM effect when applied to Achilles tendon in healthy populations. This appears more consistent at 3000-shock dose. Determining if this mechanism occurs in Achilles tendinopathy will inform appropriate modality use.

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The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

Abstract: Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

Cited by 138 publications

References 72 publications

The Role of Extracorporeal Shockwave Therapy in Return to Competition for Endurance Runners: Two Case Reports

The Role of Extracorporeal Shockwave Therapy in Return to Competition for Endurance Runners: Two Case Reports

The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

Extracorporeal Shockwave Therapy of Healthy Achilles Tendons Results in a Conditioned Pain Modulation Effect: A Randomised Exploratory Cross-Over Trial

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