What is the efficacy of Extracorporeal Shock Wave Therapy (ESWT) for treating tendonitis?

From the Guidelines

Extracorporeal Shock Wave Therapy (ESWT) is a safe and effective treatment option for chronic tendinopathies, providing significant pain relief and promoting healing. The efficacy of ESWT for treating tendonitis has been supported by various studies, including a review of common overuse tendon problems published in the American Family Physician in 2005 1. This review highlights the importance of accurate diagnosis and treatment of tendinopathies, which are often mislabeled as "tendonitis." The natural history of overuse tendinopathies involves gradually increasing load-related localized pain, and examination should include inspection, range-of-motion testing, palpation, and examination maneuvers that simulate tendon loading and reproduce pain.

Some key points to consider when using ESWT for tendonitis include:

• ESWT is a non-invasive procedure that uses acoustic pressure waves to stimulate healing and relieve pain
• A typical treatment regimen consists of 3-5 sessions spaced about one week apart, with each session lasting 5-15 minutes
• Patients can usually resume normal activities immediately after treatment, though they should avoid strenuous exercise for 48 hours
• ESWT is particularly effective for conditions like plantar fasciitis, Achilles tendonitis, tennis elbow, and rotator cuff tendonitis
• While generally safe, ESWT is not recommended during pregnancy or for patients with blood clotting disorders, bone tumors, or those taking anticoagulants

According to the study published in the American Family Physician in 2005 1, most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.

It's worth noting that the evidence rating for ESWT is B, indicating inconsistent or limited-quality, patient-oriented evidence 1. However, based on the available evidence and the potential benefits of ESWT, it is recommended as a treatment option for chronic tendinopathies that have not responded to conservative treatments.

From the Research

Efficacy of Extracorporeal Shock Wave Therapy (ESWT) for Treating Tendonitis

• The efficacy of ESWT for treating tendonitis has been studied in various research papers, with most showing positive results 2, 3, 4, 5, 6.
• A study published in 1999 found that ESWT was effective for chronic calcifying tendinitis of the shoulder, with relief of pain ranging from 5% in the control group up to 58% after two high-energy sessions 2.
• Another study published in 2018 found that shockwave therapy significantly reduced pain and improved functionality and quality of life in patients with tendinopathies, with results showing an increase of at least two points on a five-point Likert scale both post-treatment and at a 4-week follow-up 3.
• A 2011 study compared the outcome of a single high-dosage ESWT and two sessions of low-dosage ESWT for calcifying tendinitis of the shoulder, and found that a single high-level ESWT may be as effective as two applications of a lower-dosed ESWT 4.
• A systematic review published in 2022 found consistent evidence that ESWT is effective in the management of midportion Achilles tendinopathy, reducing pain and improving function 5.
• A review published in 2002 found that ESWT can be an effective therapy for patients who have had repeated nonsurgical treatment failures, with consistent positive results in favor of ESWT over placebo ESWT in individuals who have failed conservative therapy 6.

Key Findings

• ESWT has been shown to be effective in reducing pain and improving function in patients with tendonitis 2, 3, 4, 5.
• The optimal treatment protocol for ESWT is still unclear, with debate over high- versus low-energy ESWT, shockwave dosage, and number of sessions required for a therapeutic effect 6.
• Combination of ESWT with eccentric exercises and stretching may be more effective than ESWT alone in treating midportion Achilles tendinopathy 5.