From the Guidelines
Extracorporeal Shock Wave Therapy (ESWT) should be considered a primary treatment for chronic tendinopathies, particularly plantar fasciitis, Achilles tendinopathy, lateral epicondylitis (tennis elbow), and calcific shoulder tendinopathy. The treatment typically involves 3-5 sessions spaced 1-2 weeks apart, with each session lasting about 10-15 minutes. Patients may experience immediate improvement, though full benefits often develop over 2-3 months post-treatment. ESWT works by delivering acoustic pressure waves to injured tissues, stimulating neovascularization, increasing blood flow, and activating stem cells to promote tissue regeneration and healing. This non-invasive approach offers an effective alternative for patients who haven't responded to conservative treatments like rest, physical therapy, and anti-inflammatory medications, potentially helping them avoid surgery.
Key Points to Consider
- ESWT is not recommended for the reduction of penile curvature or plaque size in Peyronie's disease, as stated in the 2015 AUA guideline 1.
- The evidence for ESWT in tendinopathies is more promising, with studies suggesting its safety and effectiveness, although further research is needed to clarify the mechanisms of action and optimal treatment strategies 1.
- Patients should expect mild discomfort during treatment and possible temporary soreness afterward, but can typically resume normal activities immediately.
- ESWT is contraindicated during pregnancy, for patients with bleeding disorders, or when infection is present at the treatment site.
Treatment Details
- Treatment sessions: 3-5 sessions spaced 1-2 weeks apart
- Session duration: about 10-15 minutes
- Mechanism of action: delivering acoustic pressure waves to injured tissues, stimulating neovascularization, increasing blood flow, and activating stem cells to promote tissue regeneration and healing.
From the Research
Conditions for Primary Treatment with ESWT
The following conditions have been identified as potential primary treatment targets for Extracorporeal Shock Wave Therapy (ESWT):
- Chronic Achilles tendinopathy: ESWT has been shown to be effective in the management of chronic Achilles tendinopathies, particularly when other conservative therapies have failed 2, 3.
- Plantar fasciitis: ESWT has been found to be effective in the treatment of plantar fasciitis, with both focused and radial shock wave therapy showing benefits 2, 4, 5.
- Calcific tendinopathy: ESWT has been successfully used to treat calcific tendinosis of the supraspinatus and plantar fasciitis when nonsurgical management has failed 2, 5.
- Lateral epicondylitis: While results have been mixed, some studies suggest that ESWT may be effective in the treatment of lateral epicondylitis, particularly when combined with other therapies 4, 5.
Key Considerations
When considering ESWT as a primary treatment, the following factors should be taken into account:
- Energy level: Higher energy levels may be more effective, but also increase the risk of complications 4, 5.
- Treatment protocol: The frequency and timing of ESWT sessions can impact effectiveness 3, 6.
- Patient selection: ESWT may be more effective in certain patient populations, such as those with chronic conditions or those who have failed other conservative therapies 2, 3, 6.