scholarly journals Extracorporeal Shockwave Therapy for the Treatment of Tendinopathies: Current Evidence on Effectiveness, Mechanisms, Limitations, and Future Directions

2020 ◽  
Author(s):  
Ian Burton
Keyword(s):  
Tendon Healing ◽  
Patellar Tendinopathy ◽  
Current Evidence ◽  
Future Research ◽  
Future Directions ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Research Findings ◽  
And Performance

Tendinopathy is a chronic degenerative tendon disorder which is characterised by pain, swelling and impaired physical function and performance, presenting in both athletes and the general population. Extracorporeal shockwave therapy (ESWT) is an increasingly common treatment for tendinopathy, which can initiate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and provides a brief overview of its history and development. The central purpose of the review is to synthesise research findings investigating the effectiveness of ESWT for seven common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, gluteal, hamstring and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT is effective and can be recommended in treatment for the seven tendinopathies. However, the evidence is stronger for certain tendinopathies compared to others and uncertainties remain regarding the optimal ESWT treatment parameters. The consensus from recent literature is that although ESWT can be effective in isolation it should be combined with other treatments in tendinopathy, which needs to be addressed in future research.

scholarly journals Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A Narrative review

2020 ◽  
Author(s):  
Ian Burton
Keyword(s):  
Rotator Cuff ◽  
Combined Treatment ◽  
Tendon Healing ◽  
Heel Pain ◽  
Patellar Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Plantar Heel Pain ◽  
Lateral Elbow

Tendinopathy is a chronic degenerative musculoskeletal disorder that is common in both athletes and the general population. Exercise and extracorporeal shockwave therapy (ESWT) are among the most common treatments used to mediate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and exercise in isolation and briefly synthesises evidence of their effectiveness for various tendinopathies. The central purpose of the review is to synthesise research findings investigating the combination of ESWT and exercise for five common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT combined with exercise in the form of eccentric training, tissue specific stretching or heavy slow resistance training are effective for specific tendinopathies and can therefore be recommended in treatment. Whilst there are at present a limited number of studies investigating combined EWST and exercise approaches, there is evidence to suggest that the combination improves outcomes in treatment of plantar heel pain, Achilles, lateral elbow, and rotator cuff tendinopathy. However, despite overall positive outcomes in patellar tendinopathy, the combined treatment has not been shown at present to offer additional benefit over eccentric exercise alone.

scholarly journals Focused Extracorporeal Shockwave Therapy in Physical Medicine and Rehabilitation

2020 ◽  
Author(s):  
Richard Crevenna ◽  
Michael Mickel ◽  
Othmar Schuhfried ◽  
Christina Gesslbauer ◽  
Andrej Zdravkovic ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Surrounding Tissue ◽  
Patellar Tendinopathy ◽  
Physical Medicine ◽  
Physical Treatment ◽  
Extracorporeal Shockwave Therapy ◽  
Non Union ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Physical Medicine And Rehabilitation

Abstract Purpose of Review Focused extracorporeal shockwave therapy (fESWT) is a physical treatment modality developed over the last 25 years for musculoskeletal indications. It has many indications in the field of physical medicine and rehabilitation (PM&R) and is effective, time-efficient, and cost-efficient. This review focuses on basics and on clinical indications as well as on significant trends in fESWT. Recent Findings In PM&R, stimulation of healing processes in tendons, surrounding tissue, and bones via mechanotransduction seems to be a relevant biological effect. The International Society for Medical Shockwave Treatment (ISMST) describes different types of indications (such as approved standard indications—in accordance with most scientific evidence—like calcifying tendinopathy of the shoulder, plantar fasciitis lateral epicondylopathy of the elbow, greater trochanter pain syndrome, patellar tendinopathy, Achilles tendinopathy and bone non-union, common empirically tested clinical uses, exceptional or expert indications, and experimental indications). Summary fESWT is a relevant treatment option in PM&R and regenerative medicine. In recent years, historical paradigms (for example, application in cancer patients) have changed and new indications (such as nerve regeneration, myofascial trapezius syndrome, low back pain, dermatosclerosis, and lymphedema) are supported. Future translational research should focus on establishing actual exceptional indications and experimental indications for clinical routine.

The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy

2011 ◽  
Vol 45 (6) ◽  
pp. 537-538 ◽  
Author(s):  
J. Zwerver ◽  
I. van den Akker-Scheek ◽  
F. Hartgens ◽  
H. van de Worp ◽  
E. Verhagen ◽  
...  
Keyword(s):  
Patellar Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy

A Narrative Review Evaluating Extracorporeal Shockwave Therapy as a Potential Regenerative Treatment for Musculoskeletal Conditions in Military Personnel

2021 ◽  
Author(s):  
Hannah K Steere ◽  
Stephanie DeLuca ◽  
Joanne Borg-Stein ◽  
Gerard A Malanga ◽  
Adam S Tenforde
Keyword(s):  
Lower Extremity ◽  
Military Personnel ◽  
Platelet Rich Plasma ◽  
Musculoskeletal Injuries ◽  
Patellar Tendinopathy ◽  
Military Population ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
The Military

ABSTRACT Introduction Extracorporeal shockwave therapy (ESWT) has a wide variety of clinical applications ranging from urology to orthopedics. Extracorporeal shockwave therapy is of particular interest to military medicine in the treatment of diverse musculoskeletal injuries, including recalcitrant tendinopathy. Much of the evidence for ESWT is from studies in the civilian population, including athletes. A few investigations have been conducted within military personnel. Musculoskeletal conditions within military personnel may contribute to pain and physical limitations. Optimal functional outcomes could be achieved through ESWT. The purpose of this narrative review is to summarize the current evidence on the efficacy of ESWT the in management of lower extremity musculoskeletal injuries in the military. Further, we explore the relative efficacy of ESWT compared to regenerative medicine procedures, including studies with treatment using platelet-rich plasma. Materials and Methods A literature review was performed in April 2020 to identify studies evaluating the use of ESWT for lower extremity conditions commonly observed in military personnel, including plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, medial tibial stress syndrome, and knee arthritis. The literature search was completed by two researchers independently, using PubMed and Embase databases and same search terms. Disagreements were adjudicated by a senior author. Due to the paucity of relevant search results, the search term parameters were expanded to incorporate active participants. Results Two studies evaluated the use of ESWT in a military population for lower extremity injuries. This included a randomized control trial in active military with medial tibial stress syndrome and an unblinded retrospective study for the chronic plantar fasciitis condition. Both studies in the military had favorable outcomes in the use of ESWT compared to other treatment arms. The remaining studies predominantly included athletes. Although heterogeneity on the quality of the studies may prevent meta-analysis and limit the generalization of the findings, the majority of studies demonstrated an improvement in pain and return to activity using ESWT. Two studies using platelet-rich plasma as a treatment arm identified similar short-term outcomes compared to ESWT for Achilles tendinopathy and patellar tendinopathy. Conclusion Our findings suggest that ESWT is a safe and well-tolerated intervention with positive outcomes for lower extremity conditions commonly seen in the military. The few studies comparing ESWT to PRP suggest regenerative benefits similar to orthobiologics in the shorter term. More robust quality designed research may enable the evaluation of ESWT efficacy within the military population. In summary, the use of ESWT may provide pain reduction and improved function in active populations with lower extremity musculoskeletal injuries. Further research in the military is needed to evaluate shockwave efficacy in order to advance musculoskeletal care and improve outcomes.

Role of extracorporeal shockwave therapy in patients with rotator cuff tendinopathy: synthetic analysis of last two decades

2021 ◽  
pp. 1-16
Author(s):  
Arooj Fatima ◽  
Haider Darain ◽  
Syed Amir Gilani ◽  
Ashfaq Ahmad ◽  
Asif Hanif ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Grey Literature ◽  
Functional Mobility ◽  
Current Evidence ◽  
Eligibility Criteria ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Rotator Cuff Tendinopathy

Abstract Objective: The study is designed explore the current evidence on effectiveness of shockwave therapy in patients with rotator cuff tendinopathy from 2000-2019. Methodology: Data bases were searched including Cochrane, Medline, Embase and PEDro from 2000 to latest. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Cochrane risk of bias tool and included studies were critically appraised using PEDro scale. Results: In current review, 11 articles were finally included based on eligibility criteria. However data was not extractable from 2 studies due to which 9 studies were finally reviewed as shown in figure I. There were 8 Randomized trials and 1 randomized pilot study. The summary of critical appraisal of included studies through PEDro scale was done which showed that 4 studies had high quality and 5 studies fall under the category of fair. Conclusion: Extracorporeal shockwave therapy showed significant improvement in terms of reducing pain and improving functional mobility as compared to traditional rehabilitation in patients with rotator cuff tendinopathy in some studies however in others results were not found to be significant. This systematic review has established that there is no consensus between both interventions however; extracorporeal shockwave therapy is an acceptable practical alternative among patients having tendinopathy. Keywords: Extracorporeal shockwave therapy, Rotator cuff tendinopathy, Systematic review, Continuous...

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