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Writer's pictureDr. Nate Funk

Journal Review: Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries

Have you ever wondered how athletes bounce back from injuries so quickly, keeping their game strong even during the season?


In my quest to unveil the secrets behind this remarkable feat, I delved into a comprehensive study published in Current Sports Medicine Reports in June 2021. Authored by experts in the field, including Dr. Allison N. Schroeder, MD, and Dr. Adam S. Tenforde, MD, this research shines a spotlight on the intriguing world of Extracorporeal Shockwave Therapy (ESWT) and its role in sports medicine. Join me as I dissect this article, exploring how ESWT is revolutionizing the management of sports-related injuries, and uncovering the strategies that help athletes get back on their feet faster than ever.


 

What is Extracorporeal Shockwave Therapy?


During ESWT, a device applicator is placed over the skin near the injured tissue. Brief high-energy acoustic shockwaves are then transmitted through the applicator into the treatment area. These shockwaves provide a mechanical force that may stimulate healing.


There are two main types of ESWT:

  • Focused shockwave: Uses higher energy targeted at a specific point. Effective for deeper tissues.

  • Radial shockwave: Uses lower energy over a wider area. Effective for superficial tissues.


ESWT is thought to work through several mechanisms:

  • Breaking up calcifications or scar tissue

  • Increasing blood flow and cell metabolism

  • Stimulating new blood vessel growth

  • Triggering anti-inflammatory and pain-relieving effects

 

Research on ESWT for musculoskeletal conditions has grown rapidly in recent years. Studies show it is a safe, non-invasive treatment option that allows minimal time away from sports.

 

Although protocols vary, research overall supports the use of ESWT for these common sports injuries:


Rotator Cuff Tendinopathy

  • May improve pain and function from calcific tendinopathy

  • Less evidence for non-calcific tendinopathy

  • Consider when translucent calcifications are present


Lateral Elbow Tendinopathy

  • Improves pain in short term in most studies

  • Be cautious with energy levels due to pain over the elbow


Hip/Gluteal Tendinopathy

  • Effective for greater trochanteric pain syndrome

  • Focused ESWT may reach deeper tissues


Hamstring Tendinopathy

  • Up to 80% return to sport after 3 months in one study

  • 4 sessions often used


Patellar Tendinopathy

  • Shows benefits over other non-operative treatments

  • Can treat in-season athletes for short-term relief


Achilles Tendinopathy

  • Addresses pain to promote return to activity

  • Combines well with eccentric exercises


Plantar Fasciopathy

  • FDA approved for plantar fasciitis

  • Shows benefits over other common treatments


Other Tendinopathies

  • Growing evidence for distal biceps, posterior tibialis, etc

  • Radial ESWT effective for superficial tendons


 

ESWT presents an effective non-surgical option to help athletes recover from chronic overuse injuries to tendons and other soft tissues. This innovative modality should be considered sooner in treatment rather than as a last resort prior to surgery.

 

The Future of ESWT


While studies clearly demonstrate ESWT can reduce pain and improve function for many musculoskeletal conditions, more research is still needed to find optimal protocols and long-term outcomes.


As ESWT becomes more mainstream, researchers continue working to determine the ideal number of treatments, energy levels, and post-procedure protocols to maximize results. Evidence-based guidelines will provide sports medicine specialists the information they need to fully utilize these shockwave devices.


While protocols continue to be optimized, current evidence supports integrating focused or radial ESWT into a comprehensive rehabilitation program for athletic injuries. Under proper guidance, ESWT can often get athletes back to sport quickly and safely.



Reference:

Schroeder, Allison N. MD1; Tenforde, Adam S. MD2; Jelsing, Elena J. MD3. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Current Sports Medicine Reports 20(6):p 298-305, June 2021. | DOI: 10.1249/JSR.0000000000000851

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