Abstract
PurposeThe general consensus that tendinopathy, at least in the chronic stage, is mainly a degenerative condition and inflammation plays a minor role has led to a shift from treatments that target inflammation towards treatment options that promote regeneration. One of these treatments is extracorporeal shockwave therapy (ESWT), a physical therapy modality that uses pressure waves to treat tendinopathy. This review was undertaken to give an overview of the literature concerning this treatment, and special attention is given to the differences between focused and radial ESWT.MethodsA narrative description of wave characteristics, generation methods and in vitro effects of ESWT is given. The literature on ESWT as a treatment for one common tendinopathy, patellar tendinopathy, was systematically reviewed.ResultsWaves that are generated for focused and radial ESWT have very different physical characteristics. It is unclear how these characteristics are related to clinical effectiveness. Studies into the biological effects of ESWT have mainly used focused shockwave therapy, showing a number of effects of shockwaves on biological tissue. The systematic review of studies into the clinical effects of ESWT for patellar tendinopathy showed conflicting evidence for its effectiveness.ConclusionPhysical characteristics of focused and radial waves differ substantially, but effect on clinical effectiveness is unclear. Whereas in vitro studies often show the effects of ESWT on tendon tissue, results of clinical studies are inconsistent. Based on the review of the literature, suggestions are given for the use of ESWT in clinical practice regarding timing and treatment parameters.Level of evidenceIV.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-012-2009-3) contains supplementary material, which is available to authorized users.
Highlights
Tendon injuries are common in the entire population, especially in relation to sports and occupation [45, 46]
This review was undertaken to give an overview of the literature concerning this treatment, and special attention is given to the differences between focused and radial extracorporeal shockwave therapy (ESWT)
Whereas in vitro studies often show the effects of ESWT on tendon tissue, results of clinical studies are inconsistent
Summary
Tendon injuries (tendinopathies) are common in the entire population, especially in relation to sports and occupation [45, 46]. It consists of a short acute inflammatory stage but after some time, it gradually becomes a degenerative condition [1]. Because both conservative and surgical management of tendinopathy is not always successful, new treatment modalities have been developed. One of these modalities is extracorporeal shockwave therapy (ESWT). In 2002, Chung and Wiley [8] published a review about ESWT for treating tendinopathies. They concluded based on the literature that there was strong evidence for the effectiveness of ESWT for chronic tendinopathy and that further research was required to settle debates concerning
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