Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Extracorporeal Shockwave Therapy (ESWT) has gained traction as a non-invasive treatment for musculoskeletal disorders, including tendinopathies. Initially developed for kidney stone treatment, ESWT is now used in orthopedic cases for conditions such as plantar fasciitis, rotator cuff tendinopathy, elbow tendinopathy, and Achilles tendinopathy. This modality promotes tissue repair through neovascularization and the release of growth factors, offering a safer alternative to surgical procedures. This study evaluated the efficacy of ESWT in reducing pain, improving functionality, and enhancing quality of life for tendinopathy patients.
Materials and Methods
A total of 384 patients with diagnosed tendinopathies participated, with 326 receiving ESWT and 58 assigned to a control group. The study targeted four types of tendinopathies: elbow, plantar fasciitis, Achilles, and rotator cuff. The shockwave therapy was administered using the STORZ MEDICAL Master Pulse MP200 device. Treatment parameters varied by tendinopathy to ensure optimal outcomes. For elbow tendinopathy, the initial session involved a frequency of 21 Hz, a pressure of 1.8 bar and 2,000 shocks for analgesia, followed by subsequent sessions at 15 Hz, 1.6 bar, and 1,500 shocks for therapeutic purposes. Plantar fasciitis was treated with an initial frequency of 21 Hz, pressure of 1.6 bar, and 1,500 shocks, followed by subsequent sessions at 15 Hz, 1.8 bar, and 2,500 shocks. Achilles tendinopathy treatment included an initial session at 21 Hz, 1.8 bar, and 2,000 shocks, with subsequent sessions at 15 Hz, 2.0 bar, and 3,000 shocks. Rotator cuff tendinopathy involved an initial session at 21 Hz, 1.8 bar, and 2,000 shocks, followed by sessions at 15 Hz, 1.8 bar, and 1,500 shocks. Most participants underwent three to four treatment sessions, spaced at regular intervals.
Results
The findings demonstrated that ESWT significantly reduced pain, improved functionality, and enhanced quality of life across all tendinopathy types. For elbow tendinopathy, pain scores decreased from 1.99 pre-treatment to 0.10 immediately post-treatment and 0.01 at the four-week follow-up. Similar improvements were observed for plantar fasciitis, with pain scores dropping from 2.52 pre-treatment to 0.06 post-treatment and 0.00 at follow-up. Achilles tendinopathy showed reductions from 2.35 pre-treatment to 0.11 post-treatment and 0.00 at follow-up, while rotator cuff tendinopathy pain scores declined from 2.80 pre-treatment to 0.18 post-treatment and 0.01 at follow-up. Functionality and quality of life metrics followed the same trend, with significant improvements observed in all ESWT-treated groups compared to the control groups.
Discussion
ESWT demonstrated efficacy in alleviating pain, restoring functionality, and enhancing quality of life in patients with tendinopathies. The underlying mechanisms include increased vascularization, growth factor release, and modulation of pain perception.
Conclusion
Extracorporeal shockwave therapy is a safe, effective, and non-invasive option for managing chronic tendinopathies, particularly in patients unresponsive to conventional treatments. It delivers substantial improvements in pain, functionality, and quality of life with minimal risks. ESWT is a practical outpatient intervention that can significantly enhance recovery outcomes for musculoskeletal conditions.
Implications for Physical Therapy
Physical therapists can integrate ESWT into rehabilitation programs for tendinopathy patients, either as a standalone treatment or in conjunction with conventional methods. For example:
- Plantar Fasciitis: Pairing ESWT with plantar fascia stretching and strengthening protocols can expedite recovery.
- Rotator Cuff Tendinopathy: Using ESWT alongside scapular stabilization and rotator cuff exercises can restore shoulder function more effectively.
- Achilles Tendinopathy: Incorporating ESWT with eccentric loading exercises can address both pain and tendon remodeling.
Dedes V, Stergioulas A, Kipreos G, Dede AM, Mitseas A, Panoutsopoulos GI. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018;30(2):131-146. doi:10.5455/msm.2018.30.141-146