Extracorporeal Shock Wave Therapy

eddavisdpm · Nov 29, 2010

The last two papers are interesting in that ESWT was applied to patients with heel pain but not for the primary indication of ESWT, plantar fasciosis.

There is no documented effect of ESWT on acute tendinitis nor fasciitis and the first paper confirms that.

The second paper is a bit odd in that the radiographic criterion of heel spurs was used. The spur itself is not the cause of pain although it is likely that when radiographic evidence of a spur exists, there has been long term strain of the plantar fascia at its attachment. The relative success of the treatment in this study is not to be unexpected since it is more likely that long term plantar fasciitis had been treated. Sonographic evidence of fasciosis would have been a more logical inclusion criterion in my opinion.

NewsBot · Mar 17, 2012

Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: a Systematic Review and Network Meta-analysis.
Chang KV, Chen SY, Chen WS, Tu YK, Chien KL.
Arch Phys Med Rehabil. 2012 Mar 12.

OBJECTIVES:
To compare the effectiveness of focused shock wave (FSW) therapy of different intensity levels and a new alternative, radial shock wave (RSW) for managing plantar fasciitis.

DATA SOURCES:
Electronic databases including Medline and Pubmed were searched from 1996 to September 2011.

STUDY SELECTIONS:
Randomized control trials that compared shock wave and placebo therapy were included. Two reviewers independently scrutinized eligible articles and disagreement was resolved by discussion. Literature searching identified 93 non-duplicate citations, of which 12 trials comprising 1431 participants were included.

DATA EXTRACTION:
Information such as patient characteristics, shock wave intensity and outcome measures were extracted by one reviewer and checked by another. Both reviewers assessed trials' quality by using Jadad's scale.

DATA SYNTHESIS:
FSW of different intensity ranges were treated as three subgroups, whereas studies using RSW were regarded as a separated one. The success rates of treatment and pain reduction magnitudes were used as the outcomes. The traditional meta-analysis showed that medium and high intensity FSW had reliably higher success rates and pain reduction than placebo, while the effectiveness of low intensity FSW and RSW appeared less convincing due to very large confidence intervals. After employing network meta-analysis, the probability of being the best therapy was the highest in RSW, followed by low, medium or high intensity FSW. The meta-regression indicated that the success rate of FSW wasn't related to its intensity, whereas elevated energy efflux densities tended to relieve pain more.

CONCLUSIONS:
Setting the highest and mostly tolerable energy output within medium intensity ranges is the prior option when applying FSW on plantar fasciitis. RSW is considered as an appropriate alternative due to its lower price and probably better effectiveness.
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NewsBot · Mar 22, 2012

Extracorporeal shockwave therapy in musculoskeletal disorders.
Wang CJ.
J Orthop Surg Res. 2012 Mar 20;7(1):11.

The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.
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NewsBot · Sep 19, 2012

Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial
Babak Vahdatpour, Sepideh Sajadieh, Vahid Bateni, Mehdi Karami, Hamidreza Sajjadieh
Journal of Research in Medical Sciences, Vol 17, No 9 (2012)

BACKGROUND AND AIM: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations.
MATERIALS AND METHODS: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm2) in 3 sessions at weekly intervals) or sham therapy (n = 20 in each group). Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients’ pain scores, performed at baseline and 12 weeks after completion of the therapy.
RESULTS: The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001), but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03). Both groups showed significant pain improvement over the course of the study (P < 0.001), though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049).
CONCLUSIONS: ESWT contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.
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eddavisdpm · Sep 19, 2012

This article is of high value, in my opinion, as it utilizes an objective and measurable parameter to determine the effects of ESWT on tissue.

What makes so-called "intractable"plantar fasciitis intractable? We all see many patients who have had heel pain "for years" and who claim "nothing is working." Such patients often fall into three categories:
1) Plantar fasciiits in which there remain a biomechanical/pathomechanical issue not adequately addressed.
2) Plantar fasciosis.
3) Heel pain of an etilogy other than plantar fasciitis...Baxter's neuritis, RA, tarsal tunnel syndrome, etc.

Sonography should be considered the gold standard for examination of the plantar fascia as it is relatively quick, simple and a fraction of the price of an MRI. It allows one to differentiate acute plantar fasciitis. chronic plantar fasciitis, plantar fascial tears, occasionally Baxter's neuritis if instrument resolution is adequate.

Thinning and remodeling of the plantar fascia has been a consistent finding in my approximately 10 years of ESWT use. I only perform ESWT if sonography demonstrates findings consistent with fasciosis.

NewsBot · Oct 18, 2012

Extracorporeal Shockwave Therapy for Treatment of Delayed Tendon-Bone Insertion Healing in a Rabbit Model; A Dose-Response Study
Dick Ho Kiu Chow et al
Am J Sports Med October 17, 2012

Background: Tendon–bone insertion (TBI) consists of both hard and soft tissues. TBI injury with delayed repair is not uncommon. High-dose extracorporeal shockwave (ESW) is effective for treating nonunion fracture, whereas low-dose ESW is used for tendinopathy therapy. The dosing effect of ESW on delayed TBI healing is lacking.

Hypothesis: Low-dose ESW might have a healing enhancement effect comparable to that of high-dose ESW in treating delayed TBI healing.

Study Design: Controlled laboratory study.

Methods: Partial patellectomy was adopted to create a delayed TBI healing model by shielding the healing interface between tendon and bone. Ninety-six female New Zealand White rabbits with unilateral delayed TBI healing at the knee joint were divided into 3 groups: controls, low-dose ESW (LD-ESW; 0.06 mJ/mm2, 4 Hz, 1500 impulses), and high-dose ESW (HD-ESW; 0.43 mJ/mm2, 4 Hz, 1500 impulses). The TBI shielding was removed at week 4 after partial patellectomy, followed by treatment with control or ESW at week 6. The rabbits were euthanized at week 8 and week 12 for radiological, microarchitectural, histological, and mechanical assessments of healing tissues.

Results: Radiologically, both the LD-ESW group and the HD-ESW group showed larger new bone area than the controls at week 8 and week 12. Microarchitectural measurements showed that the LD-ESW and HD-ESW groups had larger new bone volume than the controls at week 12. Histological assessments confirmed osteogenesis enhancement. Both the LD-ESW and HD-ESW groups showed significantly higher failure load at the TBI healing complex than the control group at week 12. No significant difference was detected between the 2 ESW treatment groups at week 8 or week 12.

Conclusion: Extracorporeal shockwave, a unique noninvasive physical modality, had similar effects between the low and high dose for treating delayed TBI healing.

Clinical Relevance: Low-dose ESW for TBI delayed healing might be more desirable and have better compliance in clinical applications.
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NewsBot · Nov 6, 2012

Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebocontrolled trial with ultrasonographic and subjective outcome
assessments
Babak Vahdatpour, Sepideh Sajadieh, Vahid Bateni, Mehdi Karami, Hamidreza Sajjadieh
Journal of Research in Medical Sciences; September 2012

Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT)
in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective
evaluations.

Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to
receive ESWT (4000 shock waves/session of 0.2 mJ/mm2) in 3 sessions at weekly intervals) or sham therapy (n = 20 in each group).
Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients’ pain scores, performed at
baseline and 12 weeks after completion of the therapy.

Results: The two groups were similar in baseline characteristics. Over the
study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001), but slightly
increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03). Both groups showed significant pain improvement over the course
of the study (P < 0.001), though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ±
1.8, P = 0.049).

Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.
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NewsBot · Apr 5, 2013

Effectiveness of Extracorporeal Shock Wave Therapy in Chronic Plantar Fasciitis: A Meta-analysis.
Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED.
Am J Phys Med Rehabil. 2013 Apr 2.

The objective of this study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating chronic plantar fasciitis. An online database search was conducted for studies using ESWT in managing chronic plantar fasciitis. Eleven high-quality randomized controlled trials were included in the meta-analysis and showed that ESWT was more effective in reducing morning pain (weighted mean difference, -0.77 [95% confidence interval {CI}, -1.30 to -0.25]; odds ratio, 0.65 [95% CI, 0.42-1.00]). Moderate-intensity ESWT was more effective in decreasing overall and activity pain (weighted mean difference, -6.6 [95% CI, -6.74 to -6.46], and weighted mean difference, 0.47 (95% CI, 0.30-0.74). Both moderate- and high-intensity ESWT were more effective in improving functional outcome, with odds ratios of 0.51 (95% CI, 0.30-0.84) and 0.47 (95% CI, 0.29-0.75). The adverse effects that were seen more in ESWT were pain on the calcaneal area and calcaneal erythema. This study concludes that moderate- and high-intensity ESWT were effective in the treatment of chronic plantar fasciitis.
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NewsBot · Jul 10, 2013

A complication due to shock wave therapy resembling calcaneal stress fracture.
Erduran M, Akseki D, Ulusal AE.
Foot Ankle Int. 2013 Apr;34(4):599-602.
(no abstract)

Walking1 · Jul 15, 2013

Dieter Fellner said: ↑

Extra Corporal Shock Wave Therapy: This treatment does not appear to have gained favour in the UK. I have spent the last year in the US, where the treatment often now preceeds surgical intervention.

I am interested to hear from any practitioners willing to share their experience of using ESWT in the treatment of heel pain/achilles tendon pathology.

Apologies to Podiatry Forum visitors.
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I have found ESWT to be a good adjunct to our practice. We have had good results with its use on PFI and Achilles tendonitis however it is often used as part of a treatment package that may include Orthotics and or strapping.

danielywu · Jul 19, 2013

Since medicine is a science, its equation of “Diagnosis+Treatment=Cure” must be constant. Curing is a matter of knowing pathology and providing treatment. For curing the conditions of heel fibrositis and plantar fasciitis, treatment is often the missing part of the equation. I believe foot orthotics is the next best treatment concept to complete rest which is impractical and thus ineffective. But effective orthotics requires correct design principle.
The purposes of foot orthotics are to reduce the impact force on injured and inflamed fibrous tissue of the heel and also reduce the traction force on injured and inflamed plantar fascia in walking. In order to do so, the mechanical principle designed into the orthotics has to be sound.
The impact-softening principle in cushioning in-soles has not worked well because the end point of total compression force on the injured heel during heel strike and stance phase is not changed. Then the effect of cut-out hole principle has not been consistent either because it would not be able to reduce traction force for the plantar fasciitis condition. Secondly, often the site of heel pad fibrositis may not be in the center of the heel. In addition, the diverted impact to the small surrounding rim area is neither sufficient nor comfortable.
However, I have found the weight-sharing principle with rigid total-contact foot orthotics to dramatically increase the total weight bearing surface and also its rigid arch support to help reduce traction force on the plantar fascia in walking. The validity of this mechanical principle can be confirmed by patients feeling reduction in pressure and pain of their heels immediately in standing. If it is not the case then either the orthotics could not provide the rigid total contact effect or the diagnosis was wrong, because the cause-and-effect in science should always be exact and constant. I have also found the ready-made rigid total-contact foot orthotics of GloboTec Patricia model by Bauerfeind from Germany worked extremely well except for its standard arch height would not be sufficient for pes cavus feet. Custom-made orthotics are rarely needed for my practice and cannot ensure consistence in my part of world. I always fit theses orthotics for patients myself to confirm its immediate response in standing. Such practice has ensured appropriate treatment and provided convenience for patients. Actually, my patients used only occasional medications and physiotherapy, rarely injections, never shockwave therapy and surgeries.

Walking1 · Jul 19, 2013

I am glad to read that you have such great success with you form of treatment and I intend to somewhat agree with your basic assessment of rigid Orthotics however I have been in this profession for 43 years and I can assure you that it is wise to have up your sleeve as many treatment regimes as possible. Not everyone responds to your favourite form of treatment and so I do find that some cases of chronic PFI responds well to the use of ESWT.

NewsBot · Jul 20, 2013

Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis
Su-Jin Lee, MD, Jung-Ho Kang, MD, Ja-Young Kim, MD, Jin-Hong Kim, MD, Seo-Ra Yoon, MD, and Kwang-Ik Jung, MD
Ann Rehabil Med. 2013 Jun;37(3):379-388. English.

Objective
To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis.

Methods
Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT.

Results
Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05).

Conclusion
Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT.
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NewsBot · Aug 3, 2013

Radial shock wave therapy for plantar fasciitis: a one year follow-up study.
Ilieva EM.
Folia Med (Plovdiv). 2013 Jan-Mar;55(1):42-8.

The vast majority of published papers on the efficacy of extracorporeal shockwave therapy (ESWT) have come up with rather controversial results in patients with plantar fasciitis. The AIM of the present study was to investigate the effect of radial shock wave therapy in patients with chronic proximal plantar fasciitis.
MATERIAL AND METHODS:
Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symptoms 10.14 +/- 1.11 mos). Radial shock wave therapy was administered in five sessions. Total number of shocks per session was 2500 at a pressure of 2.5 bars. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up 3, 6, and 12 months after end of treatment.
RESULTS:
Statistically significant improvement in pain and functional capacity was found after completion of treatment in comparison with baseline; the improvement was preserved throughout a one-year follow-up. VAS mean score for pain showed changes in pain while walking the first few steps in the morning from 6.28 +/- 0.4 before therapy to 2.85 +/- 0.48 after treatment and to 1.52 +/- 0.31 at 3 months, to 1.09 +/- 0.25 at 6 months, and to 0.52 +/- 0.14 at 12 months of follow up (p <0.001). Similar dynamics was observed in pain intensity during daily activities, at rest, in the evening and upon compression. The AFOAS score showed a statistically significant reduction in pain--from 11.90 +/- 2.35 at baseline to 31.90 +/- 1.48 after the end of interventions (p < 0.001), and to 39.52 +/- 0.47 at one year of follow-up (p < 0.001). The mean values of the evaluation reflecting activity limitations and support requirements increased from 3.85 +/- 0.42 to 7.85 +/- 0.46 after treatment and to 9.71 +/- 0.19 at one year of follow up (p < 0.001). Similar dynamics was seen in the maximum walking distance and walking surfaces. Gait abnormalities changed from 3.43 +/- 0.50 at baseline to 6.28 +/- 0.59 after treatment (p < 0.001).
CONCLUSION:
Based on the results of this study we could conclude that radial shock wave therapy is a safe non-invasive method of treatment. Our preliminary findings indicate that it could be an effective treatment of choice for patients with chronic plantar fasciitis that is recalcitrant to other conservative treatment modalities
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NewsBot · Aug 5, 2013

A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence
Cathy Speed
Br J Sports Med doi:10.1136/bjsports-2012-091961

Background ‘Shock wave’ therapies are now extensively used in the treatment of musculoskeletal injuries. This systematic review summarises the evidence base for the use of these modalities.

Methods A thorough search of the literature was performed to identify studies of adequate quality to assess the evidence base for shockwave therapies on pain in specific soft tissue injuries. Both focused extracorporeal shockwave therapy (F-ESWT) and radial pulse therapy (RPT) were examined.

Results 23 appropriate studies were identified. There is evidence for the benefit of F-ESWT and of RPT in a number of soft tissue musculoskeletal conditions, and evidence that both treatment modalities are safe. There is evidence that F-ESWT is effective in the treatment of plantar fasciitis, calcific tendinitis, and that RPT is effective in plantar fasciitis. Where benefit is seen in F-ESWT, it appears to be dose dependent, with greater success seen with higher dose regimes. There is low level evidence for lack of benefit of low-dose F-ESWT and RPT in non-calcific rotator cuff disease and mixed evidence in lateral epicondylitis.
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NewsBot · Sep 3, 2013

THE EFFECTIVENESS OF EXTRACORPOREAL SHOCKWAVE THERAPY FOR CHRONIC PLANTAR FASCIITIS: A SYSTEMATIC REVIEW
Wirix L., Walgraeve J., Soete H., De Schepper J.
World Congress of Podiatry; October 17-19 Rome, Italy

Background: Plantar fasciitis is the most common source of heel pain. In many cases, conservative therapy offers hardly any solution. Surgery, on the other hand, is effective in the small proportion of patients and has many side effects. Thus, there is a need for a reliable therapy which can be used after unsuccessful conservative therapy. Because there is lack of clarity, literature was examined so the caregivers will have a clear answer to the questions and needs of their patients.
Methods: Literature was being extracted from The Cochrane Library, Medline and the Web of Science. Baseline screening was being performed for relevance on title and abstract. Following keywords were used, singly or in combination: ESWT, PLANTAR FASCIITIS, SHOCKWAVE. To maximize the search, backward chaining of reference lists from retrieved papers was also undertaken. After that, a second evaluation, focusing on scientific reliability, was performed, using the validated CBO-guidelines. After screening and selecting, articles with a score equal or higher than eight (out of ten) were further analysed and described.
Results: Literature doesn’t provide clear evidence to substantiate the use of ESWT. There are many variable characteristics and the success itself seems inconsistent. As seen in table 1, only five out of nine top ranked authors report positive results.
Discussion: Published literature differs too much in characteristics of subjects, therapy and follow-up to draw clear conclusions from the data.
Conclusion: As there is clearly conflicting evidence, the need for further research, a large-scale trial which tests the internal differences in a more systematic, scientific manner arises.
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NewsBot · Nov 13, 2013

This clinical trial was just registered:

Sonoelastographic Changes After Low Energy Extracorporeal Shock Wave Therapy (ESWT) in Plantar Fasciitis

Extracoporeal shock wave therapy(ESWT) was perfomed on the plantar fascia of chornic plantar fasciitis patients. Pre-ESWT and post-ESWT pain intensity, sonography and sonoelastrography of the plantar fascia was checked. Our hypothesis is that the plantar fascia stiffness increased after ESWT as clinical symptom improves.
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NewsBot · Jan 7, 2014

Treatment of chronic plantar fasciitis with extra corporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation
Roberto Androsoni, Alfonso Apostólico Netto, Rafael Rocha Macedo, Ricardo Pozzi Fasolin, Guilherme Boni, Rodrigo Fileto Gavaldão Moreira
Revista Brasileira de Ortopedia (English Edition); Available online 3 January 2014

Objective
This paper has the purpose to analyze prospectively the treatment results in patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT).
Methods
We evaluated 30 patients (36 feet); 16 (53.3%) patients were male and 14 (47.7%) female with mean age of 48.7 y.o., varying from 33 to 78 y.o.; 16 (53.3%) present the problem on the left side, 14 (46.7%) on the right ones and 6 (20%) bilateral; the symptomatology varied from 6 to 60 months, with the average of 13.58 months. These patients were submitted to a weekly ESWT session for 4 consecutive weeks. We measured the plantar fascia thickness millimeters with ultrasound and we applied American Orthopaedic Foot and Ankle Society (AOFAS) scale for ankle and hindfoot, and Roles & Maudsley scales in pre ESWT, after one, three and six months after and decrease in the plantar fascia thickness by the ultrasound (p = 0.011) along the different moments studied.
Results
We observed improvement of the evaluated criteria (p < 0.001) and plantar fascia thickness by ultrasound (p = 0.011) at different time points studied.
Conclusion
The ESWT can be considered an important tool in the primary or adjuvant treatment of the chronic plantar fasciitis when associated with conventional therapies. This methodology is safe, non-invasive and provides precocious rehabilitation and return to regular activities considering the results of the statistical analysis. This resource provides decrease in the thickness of the plantar fascia.
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NewsBot · Mar 25, 2014

Is extracorporeal shock wave therapy clinically efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials
Meng-chen Yin, Jie Ye, Min Yao, Xue-jun Cui, Ye Xia, Qi-xing Shen, Zheng-yi Tong, Xue-qun Wu, Jun-ming Ma, Wen Mo
Archives of Physical Medicine and Rehabilitation; Available online 21 March 2014

Objective
To assess the efficacy of ESWT and provide clinicians with an evidence base for their clinical decision making.
Data Sources
PubMed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and Evidence Based Medicine Reviews.
Study Selection
All randomized or quasi-randomized controlled trials of ESWT for chronic recalcitrant plantar fasciitis were searched. Searching identified 108 potentially relevant articles, of which 7 studies with 550 participants met inclusion criteria.
Data Extraction
The number of patients, population, BMI, duration of symptoms, adverse effects, blinding method, and the details of shock wave therapy were extracted.
Data Synthesis
For Intervention success rate, ESWT of low-intensity was more effective than control treatment of low-intensity. For pain relief, the pooled data showed a significant difference between the ESWT and control groups. For function, only low-intensity ESWT was significantly superior over the control treatment.
Conclusions
The efficacy of low-intensity ESWT is worthy of recognition.The short-term pain relief and functional outcomes of this treatment are satisfactory. However, owing to the lack of a long-term follow-up, its long-term efficacy remains unknown.
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NewsBot · Jan 3, 2015

Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis
Yan W, Sun S, Li X.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014 Dec;39(12):1326-30.

OBJECTIVE:
To observe the therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis.
METHODS:
A total of 153 plantar with plantar fasciitis were randomly divided into a combined group (n=51), an extracorporeal shock wave group (n=53) and an orthopaedic group (n=49). The combined group received treatment of both extracorporeal shock wave and orthopaedic insole while the extracorporeal shock wave or the orthopaedic group only received the treatment of extracorporeal shock wave or orthopaedic insole. The therapeutic parameters such as visual analogue scale (VAS) scores, continued walking time and thickness of the plantar fascia were monitored before and aft er the treatment for 2 weeks, 1 month and 3 months, respectively.
RESULTS:
The VAS scores in the 3 groups were all reduced after the treatment compared with the corresponding scores before the therapy (P< 0.05). The VAS score in the extracorporeal shock wave group was greater than that in the orthopedic group after the treatment for 2 weeks. The VAS score in the combined group was smaller than that in the orthopedic group after the treatment for 2 weeks and 3 months (P< 0.05). The VAS scores in the orthopedic group and the combined group were smaller than those in the extracorporeal shock wave group after the treatment for 1 month or 3 months (P< 0.05). The continued walking time and thickness of the plantar fascia was improved after the treatment (P< 0.05). The cure rate and total effective rate in the combination group were obviously greater than those in the two other groups. The cure rate in the orthopedic group was greater than that in the extracorporeal shock wave group (P< 0.05).
CONCLUSION:
Extracorporeal shock wave combined with orthopaedic insole therapy is an effective method to treat plantar fasciitis. It is recommended to spread in clinic.
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NewsBot · Feb 25, 2015

The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis
Tae Gon Kim, Sea Hyun Bae, Gye Yeop Kim, Kyung Yoon Kim
Journal of Physical Therapy Science; Vol. 27 (2015) No. 2 February p. 523-526

[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis.
[Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment.
[Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy.
[Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients.
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björn · Feb 25, 2015

only read the abstract, but that conclusion sounds interesting, given the improvement was better with 30 minutes of stretching (!!) 5 days a week for 6 months (Who complies that vigorously??).

Walking1 · Feb 25, 2015

I do agree with the research in that we do at my practice combine a stretching regime as part of the shock wave treatment structure however maybe not to that intensity.

Don ESWT · Apr 3, 2015

And so, it appears that you lot still cannot come to a definite conclusion on ESWT.
I know it works for some and not for other patients. My results have been the same since 1998
92% male and 65% female or 80% success overall. FOOTWEAR,FOOTWEAR,FOOTWEAR... and compliance post treatment

The latest project I am involved with is a radial arm 3D scanner for the fabrication of Medical Grade Footwear, Orthotics and AFO's

It scans form knee to toe, not just the plantar surface of the foot. Entire scanning system including Laptop is $4,000.00 AUD. It produces PLY.Files, STL.Files. You can use our lab or the Lab of your choice. No minimum per month and no monthly fees.

Don Scott
Grafton
NSW

daisyboi · Apr 3, 2015

It's an interesting paper but it draws a conclusion that is not supported by their research. Since there was no group with a treatment intervention of only ESWT then the conclusion "extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients." cannot be supported. How do we know these changes were not due to the stretching or even just to the passage of time?

NewsBot · May 7, 2015

Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis
A Randomized, Controlled Multicenter Study
Hans Gollwitzer, MD; Amol Saxena, DPM; Lawrence A. DiDomenico, DPM; Louis Galli, DPM; Richard T. Bouché, DPM; David S. Caminear, DPM; Brian Fullem, DPM; Johannes C. Vester ; Carsten Horn, MD; Ingo J. Banke, MD; Rainer Burgkart, MD; Ludger Gerdesmeyer, MD
J Bone Joint Surg Am, 2015 May 06; 97 (9): 701 -708 .

Background: The effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis is controversial. The objective of the present study was to test whether focused extracorporeal shock wave therapy is effective in relieving chronic heel pain diagnosed as plantar fasciitis.

Methods: Two hundred and fifty subjects were enrolled in a prospective, multicenter, double-blind, randomized, and placebo-controlled U.S. Food and Drug Administration trial. Subjects were randomized to focused extracorporeal shock wave therapy (0.25 mJ/mm2) or placebo intervention, with three sessions of 2000 impulses in weekly intervals. Primary outcomes were both the percentage change of heel pain on the visual analog scale composite score (pain during first steps in the morning, pain with daily activities, and pain with a force meter) and the Roles and Maudsley score at twelve weeks after the last intervention compared with the scores at baseline.

Results: Two hundred and forty-six patients (98.4%) were available for intention-to-treat analysis at the twelve-week follow-up. With regard to the first primary end point, the visual analog scale composite score, there was a significant difference (p = 0.0027, one-sided) in the reduction of heel pain in the extracorporeal shock wave therapy group (69.2%) compared with the placebo therapy group (34.5%). Extracorporeal shock wave therapy was also significantly superior to the placebo therapy for the Roles and Maudsley score (p = 0.0006, one-sided). Temporary pain and swelling during and after treatment were the only device-related adverse events observed.

Conclusions: The results of the present study provide proof of the clinically relevant effect size of focused extracorporeal shock wave therapy without local anesthesia in the treatment of recalcitrant plantar fasciitis, with success rates between 50% and 65%.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Editorial on the above

NewsBot · May 21, 2015

Prognostic factors of extracorporeal shock wave therapy for tendinopathies.
Notarnicola A, Maccagnano G, Tafuri S, Fiore A, Margiotta C, Pesce V, Moretti B.
Musculoskelet Surg. 2015 May 16

INTRODUCTION:
Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis.
AIM:
The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases.
METHODS:
Three hundred fifty-five patients were analyzed 2 months after shock wave treatment for rotator cuff tendinitis, epicondylitis, Achilles tendinopathy, trocanteritis, jumper's knee or plantar fasciitis. We recorded the epidemiological, clinical and treatment protocol, and these data were correlated with treatment outcome.
RESULTS:
Clinical improvement was achieved in 45.9 % of these patients. We discovered that laterality different to the dominant limb (p < 0.0001) and repeated shock wave treatments (p = 0.004) are prognostic factors in an unsuccessful therapy, while being male (p = 0.015) and a high body mass index (p = 0.004) are factors for success. We found no differences in relation to age, diet, blood type, work or sport activity, presence of co-morbidities, drugs, type of tendinopathy, density of energy delivered and other physiotherapy treatment. Knowledge of these prognostic factors may lead to improved insight for physicians and physiotherapists to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly
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NewsBot · Aug 25, 2015

Dose related effects of extracorporeal shockwave therapy in patients with plantar fasciitis
Mikisha j Prajapati, Nehal Shah.
IJTRR. 2015; 4(4): 164-166doi: 10.5455/ijtrr.00000083

Introduction: Plantar fasciitis is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. Treatment of plantar fasciitis includes ultrasound, wax bath, exercise therapy and shock wave therapy.
Objective: The aim of the study was to compare the different doses of shock wave and its effects in patients with plantar fasciitis.
Method: 30 subjects with clinically diagnosed as plantar fasciitis with symptoms 3 months or more were included.Subjects with history of ankle or foot fracture, referred pain due to sciatica and other neurological disorders were excluded. Outcome measures included VAS, FFI, and PPT. Patients were divided into two groups. Group A were given shock wave therapy with dosage of 1000shocks, energy flux density 0.16 mj/mm2 and 6 Hz and Group B were given dosage of 2000shocks, energy flux density o.16mj/mm2 and 6 Hz for 2weeks total 6 sessions. Pre and post VAS, Foot function index and pain pressure threshold was taken.
Result: Results showed significant difference in VAS, FFI and PPT(p<0.001) for within group analysis but There was no significant difference in between group analysis in VAS (p=0.42) FFI (p=0.008) and PPT(p=0.34).
Conclusion: It can be concluded from the study that the treatment given to both the groups were effective in reducing pain and improving functional activity.but there was no significant difference between the groups.
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NewsBot · Sep 1, 2015

Extracorporeal shockwave therapy (ESWT) for refractory Achilles tendinopathy: a prospective audit with 2-year follow up
James Taylor et al
The Foot; Article in Press

Background
Achilles tendinopathy (AT) represents a triad of tendon pain, swelling and impaired performance. Extracorporeal shockwave therapy (ESWT) has been endorsed by the National Institute for Health and Care Excellence (NICE) for refractory AT. This audit investigates the long-term outcomes of patients treated with ESWT for refractory AT.

Methods
Forty six patients treated with ESWT for AT between October 2010 and August 2011 completed visual analogue, satisfaction scores and functional assessment questionnaires over two years. Patients were subdivided into two groups depending on whether their AT was insertional (IAT) or non-insertional (NAT).

Results
Forty six patients (mean age 58yrs) completed all treatments and full 2 year follow up. There was significant improvement in pain at rest, on activity and of function within both NAT and IAT groups over the two-year period. Satisfaction scores were significant in the NAT group but not in the IAT group.

Conclusions
ESWT appears to be of benefit in the long term improvement of pain at rest, on activity and functional outcome. However, subjective patient opinion may not match the perceived clinical outcome observed in this audit in all patients and individuals should be counselled regarding this prior to treatment.
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NewsBot · Sep 5, 2015

Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.
Gerdesmeyer L, Mittermayr R, Fuerst M, Al Muderis M, Thiele R, Saxena A, Gollwitzer H
Int J Surg. 2015 Aug 29.

Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy.
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NewsBot · Dec 8, 2015

Repetitive shockwave therapy improves muscular microcirculation
Tobias Kisch et al
Journal of Surgical Research 30 November 2015

Background
Extracorporeal shock wave therapy (ESWT) is mainly applied in tendon as well as bone problems based on stem-cell activation and healing acceleration. The effect of ESWT on muscle tissue is much less understood to date. However, from a clinical perspective, muscle injuries are of distinct interest especially in elite athletes such as soccer players.

Material and Methods
26 rats were randomized into two groups. Group A received a single application of high energetic focused ESWT (0.3mJ/mm2, 4Hz, 1000 impulses, 10J), while Group B underwent the same procedure every ten minutes for three sessions (3x 0.3mJ/mm2, 4Hz, 3x1000 impulses, totaling 30J). Blood flow at a depth of 8 mm was measured continuously and non-invasively by a combined Laser-Doppler-Imaging and photospectrometric technique (Oxygen-to-see, O2C, LEA Medizintechnik, Germany).

Results
One minute after the application of high energy ESWT blood flow in Group A increased by 16.5 % (p=0.007). Thereafter, it decreased from minute 2 after application and remained significantly unchanged to baseline value until the end of the measuring period at 50 minutes (p=0.550). Group B showed a similar significant increase in blood flow of 16.4 % (p=0.049) and a decrease afterwards, too. After the second focused ESWT blood flow was boosted to 26.6 % (p=0.004), remaining significantly elevated until the third application was initiated. Muscular blood flow was increased to 29.8 % after the third focused ESWT (p<0.001), remaining significantly increased for another ten minutes.

Conclusion
Focused ESWT enhances blood flow in the muscle of rats. Moreover, repetitive ESWT extended this beneficial effect.
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NewsBot · Jan 24, 2016

Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis
R. Scheuer et al
International Journal of Surgery; Article in Press

Highlights
•Focused ESWT needs to be applied only once in many cases.
•None of the treatment parameters assessed relevantly affected outcome.
•None of the anamnestic or sociodemographic parameters assessed affected outcome.
•Treatment success was independent of the physician applying ESWT.
•Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed.
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Introduction
Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis.

Methods
284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19–77 weeks after the first application of ESWT.

Results
76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors.

Discussion
Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions.

Conclusions
In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed.
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Louelle · Jan 28, 2016

Personal clinical observation - ESWT is very effective for plantar fibromatoma, does anyone else have experience with this?

NewsBot · Feb 13, 2016

A review of the cellular and molecular effects of extracorporeal shockwave therapy
G. A. Chamberlain, G. R. Colborne
Veterinary and Comparative Orthopaedics and Traumatology (VCOT); 2016

Extracorporeal shockwave therapy (ESWT) is a novel therapeutic modality and its use in promoting connective tissue repair and analgesic effect has been advocated in the literature. It is convenient, cost-effective, and has negligible complications; it therefore bypasses many of the problems associated with surgical interventions. This paper reviews the proposed mechanisms of action in promoting tissue repair and regeneration as well as analysing its efficacy providing an analgesic effect in clinical applications. Further research will be required to not only identify the underlying mechanisms more precisely, but will also be critical for ensuring consistency across the literature so that the most beneficial treatment protocol can be de
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NewsBot · Mar 5, 2016

Influence of two conservative treatment methods on foot health status in men with chronic calcaneal spur: A randomized controlled study
Paweł Lizis et al
Kontakt; 28 February 2016

Objective
This study compared the effectiveness of extracorporeal shockwave therapy (ESWT) with ultrasound therapy (US-control group) in preventing social limitations and the improvement of foot health status (FHS) in men with a chronic calcaneal spur (CS).

Material and methods
Forty men were randomly allocated and then received ESWT or US therapy. Two people from the US group ignored the call for study 3 months later, so they were excluded. Therefore, 38 men were analyzed. The ESWT group received 5 treatments once a week, and sessions took place at weekly intervals. Meanwhile, the US group received 10 treatments, 3 times per week. The FHS was assessed using a foot health status questionnaire (FHSQ). The scores were recorded and compared within the groups and between the groups pre treatment, immediately post treatment, and 3 months post treatment.

Results
We found a significant improvement of FHS and reduction of social limitations immediately post treatment (up to 3 months post treatment in patients with chronic CS).

Conclusion
The results of this study provide evidence that patients with CS can obtain greater significant health benefits of the foot care when treated by ESWT, rather than by US.
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NewsBot · Apr 1, 2016

COMPARISON OF RADIAL SHOCK WAVE THERAPIES WITH TWO
DIFFERENT FREQUENCY AND DENSITY ON HEEL PAIN
Selnur NARİN et al
Vol 22, No. 12;Dec 2015

Objective: The aim of this study is to compare results of two different
frequencies and density of radial shock wave therapy after 10 sessions.
Design: Randomized, controlled trial; Level of evidence, 1.
Setting: University-based orthopedic referral patients.
Patients: 41 patients who were clinically diagnosed with plantar fasciitis and
whose symptoms lasted more than 6 weeks were included in the study. Patients
were randomly divided into 2 groups, and both groups were administered 10
sessions of treatment consisting of 15 Hz frequency, 3.0 Bar density and 2000
impulses / session for the 1st group, and 10 Hz frequency, 2.0 Bar density and
2000 impulses / session for the 2nd group.
Main Outcome Measures: Visual analog scale (VAS) and a modification of the
clinical rating system of the American Orthopedic Foot and Ankle Society
(AOFAS) were used for outcome measurement. The patients were assessed before
treatment and followed up 4 weeks, and 12 weeks after end of treatment.
Results: Mean VAS scores were reduced after RSWT from 7.52 ? 2.34 (mean ?
SEM) at baseline to 0.57 ? 0.68 at 12 weeks in the 1
st group and from 6.45 ? 2.04
at baseline to 0.40 ? 0.60 at 12 weeks in the 2
nd group . Similar changes were
found for mean AOFAS scores from baseline after RSWT but were not observed
significance between groups. No serious adverse events of RSWT were observed.
Conclusion: Radial shockwave treatment is effective and safe for patients with
plantar fasciitis
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NewsBot · Jul 15, 2016

Success and Recurrence Rate after Radial Extracorporeal Shock
Wave Therapy for Plantar Fasciopathy: A Retrospective Study
Nikos Malliaropoulos, et al
BioMed Research International Volume 2016, Article ID 9415827, 8 pages

Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for
plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified
in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An
individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of
shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual
Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients
having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before
treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success
rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive
Spearman?s rho correlation ( = 0.462, < 0.001) was found between pretreatment pain duration and the total number of rESWT
sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for
plantar fasciitis.
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NewsBot · Jul 23, 2016

Historical ESWT Paradigms Are Overcome: A Narrative Review
Heinz Lohrer et al
BioMed Research International; Volume 2016, Article ID 3850461

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal
disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT.
Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size,
anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus
meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the
physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical
focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full,
regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated
without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be
managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further
elucidated
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NewsBot · Aug 27, 2016

Cadaveric experiments to evaluate pressure wave generated by radial shockwave treatment of plantar fasciitis
Srdjan Cirovic et al
Foot and Ankle Surgery; 26 August 2016

Highlights
•Pressure waves generated by a simulated radial shock wave treatment of plantar fasciitis were measured in two cadaveric feet.
•Measured pressure traces were highly repeatable with amplitude of the order of MPa and of the duration of about 400 μs.
•Negative pressure in one of the two feet was sufficiently low to potentially generate cavitation with multiple shock waves.
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Background

Shockwave treatment is increasingly used for plantar fasciitis and Achilles tendinopathy. To be effective it is believed that high pressure must be achieved in the tissues. We report on the first human cadaveric experiments to characterize pressure from radial shockwave therapy (rSWT) for plantar fasciitis.

Methods

The pressure from rSWT was measured in two cadaveric feet using a needle hydrophone. Maximal pressure and energy flux were calculated from the measurements.

Results

The pressure persisted longer than supposed, for up to 400 microseconds. The peak negative pressure was up to two Mega Pascal. The predicted energy in the tissue strongly depended on the time interval used in calculations.

Conclusions

The measured pressure may be sufficiently high to cause cavitation in the tissue, which is one of the proposed healing mechanisms associated with rSWT. The results suggest that the energy is imparted to the tissues for much longer than previously thought.
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NewsBot · Oct 13, 2016

Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury
Angela Zissler et al
Am J Sports Med October 11

Background: Muscle injuries are among the most common sports-related lesions in athletes; however, optimal treatment remains obscure. Extracorporeal shock wave therapy (ESWT) may be a promising approach in this context, because it has gained increasing importance in tissue regeneration in various medical fields.
Hypothesis: ESWT stimulates and accelerates regenerative processes of acute muscle injuries.
Study Design: Controlled laboratory study.
Methods: Adult Sprague-Dawley rats were divided into 4 experimental groups (2 ESWT+ groups and 2 ESWT– groups) as well as an uninjured control group (n ≥ 6 in each group). An acute cardiotoxin-induced injury was set into the quadriceps femoris muscle of rats in the experimental groups. A single ESWT session was administered to injured muscles of the ESWT+ groups 1 day after injury, whereas ESWT– groups received no further treatment. At 4 and 7 days after injury, 1 each of the ESWT+ and ESWT– groups was euthanized. Regenerating lesions were excised and analyzed by histomorphometry and immunohistochemistry to assess fiber size, myonuclear content, and recruitment of satellite cells.
Results: The size and myonuclear content of regenerating fibers in ESWT+ muscle was significantly increased compared with ESWT– muscle fibers at both 4 and 7 days after injury. Similarly, at both time points, ESWT+ muscles exhibited significantly higher contents of pax7-positive satellite cells, mitotically active H3P+ cells, and, of cells expressing the myogenic regulatory factors, myoD and myogenin, indicating enhanced proliferation and differentiation rates of satellite cells after ESWT. Mitotic activity at 4 days after injury was doubled in ESWT+ compared with ESWT– muscles.
Conclusion: ESWT stimulates regeneration of skeletal muscle tissue and accelerates repair processes.
Clinical Relevance: We provide evidence for accelerated regeneration of damaged skeletal muscle after ESWT. Although further studies are necessary, our findings support the view that ESWT is an effective method to improve muscle healing, with special relevance to sports injuries.
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Extracorporeal Shock Wave Therapy

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