What is the comparison between Extracorporeal Shock Wave Therapy (ESWT) and Platelet-rich Plasma (PRP) therapy?

From the Guidelines

Extracorporeal Shock Wave Therapy (ESWT) is generally recommended as a first-line treatment for musculoskeletal conditions due to its non-invasive nature, lower cost, and fewer complications, whereas Platelet-Rich Plasma (PRP) therapy may be considered for chronic conditions that haven't responded to ESWT or for patients with more severe tendon degeneration. When comparing ESWT and PRP therapy, it's essential to consider the specific condition, its severity, patient preferences, and cost considerations. ESWT uses acoustic waves to stimulate healing by increasing blood flow, reducing inflammation, and promoting tissue regeneration, typically requiring 3-5 weekly sessions of 2000-3000 pulses per session 1. On the other hand, PRP involves injecting concentrated platelets from the patient's own blood to release growth factors that accelerate healing, typically requiring 1-3 injections spaced 4-6 weeks apart, followed by a gradual return to activity over 2-6 weeks. Some key points to consider when choosing between ESWT and PRP therapy include:

• ESWT has fewer complications and recovery time but may be less effective for advanced cases
• PRP offers potentially stronger regenerative effects but is more invasive, expensive, and requires blood drawing
• The results of studies evaluating the use of PRP in the treatment of knee OA had mixed results, with some studies reporting no benefit, whereas others reported small benefits from PRP 1
• ESWT appears to be safe and effective, but further research is needed to clarify the mechanisms of action and optimal treatment strategies 1
• Patient preferences regarding invasiveness, cost considerations, and any contraindications such as blood disorders for PRP or pacemakers for ESWT should also be taken into account.

From the Research

Comparison of ESWT and PRP Therapy

• ESWT and PRP therapy are both effective in treating chronic plantar fasciitis, with PRP injection showing more effective results at a longer duration 2, 3
• A study comparing ESWT and PRP injection in patients with chronic plantar fasciitis found that both treatments improved pain and reduced plantar fascia thickness, but PRP injection was more effective at 90 days 2
• Another study found that PRP injections reduced pain more than ESWT in patients with chronic plantar fasciitis, with significant differences in VAS scores at 2,4,8,12,16, and 24 weeks after intervention 3
• ESWT has been shown to be effective in treating osteoarthritis, with significant improvement in pain reduction and functional improvement compared to placebo, corticosteroid, hyaluronic acid, medication, and ultrasound 4
• A study comparing PRP injection and ESWT in treating symptomatic non-traumatic femoral head necrosis found that PRP injection was superior to ESWT in pain relief and functional improvement 5
• The use of PRP in chronic tendinopathies has been studied, with some evidence suggesting its efficacy in promoting angiogenesis, tissue remodeling, and wound healing, but more randomized controlled studies are needed to determine its effectiveness 6

Efficacy of ESWT and PRP Therapy

• ESWT has been shown to be effective in reducing pain and improving functional improvement in patients with osteoarthritis 4
• PRP injection has been shown to be effective in reducing pain and improving functional improvement in patients with chronic plantar fasciitis and symptomatic non-traumatic femoral head necrosis 2, 3, 5
• Both ESWT and PRP therapy have been shown to be safe and well-tolerated, with no serious adverse reactions reported 2, 3, 4, 5

Comparison of Outcomes

• A study comparing ESWT and PRP injection in patients with chronic plantar fasciitis found that PRP injection was more effective at 90 days, with significant differences in VAS scores and plantar fascia thickness 2
• Another study found that PRP injections reduced pain more than ESWT in patients with chronic plantar fasciitis, with significant differences in VAS scores at 2,4,8,12,16, and 24 weeks after intervention 3
• A study comparing PRP injection and ESWT in treating symptomatic non-traumatic femoral head necrosis found that PRP injection was superior to ESWT in pain relief and functional improvement, with significant differences in VAS scores, WOMAC, and HHS at 3,6, and 12 months 5