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

From the Guidelines

Extracorporeal Shock Wave Therapy (ESWT) is a safe, noninvasive, and effective treatment option for chronic tendinopathies, providing significant pain relief. The efficacy of ESWT for treating tendonopathy has been supported by various studies, including a review published in the American Family Physician in 2005 1, which suggests that ESWT appears to be a safe and effective means of pain relief for a number of chronic tendinopathies. Some key points to consider when using ESWT for tendinopathy include:

• ESWT is particularly effective for common tendinopathies like plantar fasciitis, Achilles tendinopathy, tennis elbow, and rotator cuff tendinopathy.
• A typical treatment regimen consists of 3-5 sessions spaced one week apart, with each session lasting about 10-15 minutes.
• Patients may experience mild discomfort during treatment and temporary soreness afterward, but this usually subsides within 24-48 hours.
• The therapy works best when combined with a structured rehabilitation program including appropriate stretching and strengthening exercises.
• Results are not immediate but typically develop over 2-3 months as the tendon healing progresses.
• ESWT is generally contraindicated during pregnancy, for patients on blood thinners, or for those with certain medical conditions like malignancy in the treatment area. It's essential to weigh the benefits and potential drawbacks of ESWT, considering factors like cost and the availability of other treatment options, as noted in the study 1. Overall, ESWT can be a valuable treatment option for patients with chronic tendinopathies who have not responded to conservative treatments, providing significant pain relief and promoting tendon healing.

From the Research

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

• The effectiveness of ESWT in treating tendonopathy has been evaluated in several studies, with varying results 2, 3, 4, 5, 6.
• A study published in 2018 found that shockwave therapy significantly reduced pain and improved functionality and quality of life in patients with tendinopathy, with improvements seen in elbow tendinopathy, Achilles tendinopathy, plantar fasciitis, and rotator cuff tendinopathy 2.
• A systematic review published in 2022 found consistent evidence that ESWT is effective in the management of midportion Achilles tendinopathy, with reductions in pain and improvements in function 3.
• Another systematic review published in 2018 found moderate-level evidence that ESWT is effective in treating Achilles tendinopathy, patellar tendinopathy, and proximal hamstring tendinopathy, with low-level evidence for its effectiveness in treating greater trochanteric pain syndrome and medial tibial stress syndrome 4.
• A systematic review and meta-analysis published in 2023 found that ESWT has a negligible effect on pain and function for patellar tendinopathy and Achilles tendinopathy, but has a large effect on pain and function for plantar fasciitis 5.
• A systematic review published in 2014 found evidence for the benefit of F-ESWT and RPT in a number of soft tissue musculoskeletal conditions, including plantar fasciitis and calcific tendinitis, with evidence that both treatment modalities are safe 6.

Conditions Treated with ESWT

• ESWT has been used to treat a variety of tendonopathies, including:
  • Achilles tendinopathy 2, 3, 4, 5
  • Patellar tendinopathy 2, 4, 5
  • Plantar fasciitis 2, 4, 5, 6
  • Rotator cuff tendinopathy 2
  • Proximal hamstring tendinopathy 4
  • Greater trochanteric pain syndrome 4
  • Medial tibial stress syndrome 4

Comparison of ESWT to Other Treatments

• ESWT has been compared to other treatments, including:
  • Eccentric exercises 3, 4, 5
  • Conservative treatment 3, 4, 5
  • Corticosteroid injection 4
  • Low laser therapy 5
  • Placebo 2, 5