Extracorporeal Shock Wave Research Articles

Extracorporeal shockwave therapy rescued mouse critical limb ischemia via upregulating GPR120 against inflammation and promoting angiogenesis for restoring the blood flow in ischemic zone-experimental study.

This study tested the hypothesis that extracorporeal shockwave therapy (ECSWT) effectively rescues critical limb ischemia (CLI) in mice through the upregulation of GPR120, which protects against inflammation and angiogenesis to restore blood flow in the ischemic area. Compared with the control, ECSWT-induced GPR120-mediated anti-inflammatory effects significantly suppressed the expression of inflammatory signaling biomarkers (TAK1/MAPK family/NF-κB/IL-1β/IL-6/TNF-α/MCP-1) in HUVECs, and these effects were abolished by silencing GPR120 or by the GPR120 antagonist AH7614 (all P < 0.001). C57BL/6 mice (n =40) were equally categorized into Groups 1 (sham-operated control), 2 (CLI), 3 (CLI+ECSWT), and 4 (CLI+ECSWT+AH7614). By Days 7, 14, and 28 just prior to harvesting the quadriceps muscle, the laser Doppler results showed that the ratio of ischemia to normal blood flow (INBF) in the CLI area was highest in Group 1, lowest in Group 2, and significantly greater in Group 3 than in Group 4 (all P < 0.0001). Endothelial cell markers (CD31/vWF) and GPR120+cells exhibited identical patterns of INBF among the groups, whereas angiogenesis biomarkers (CXCR4/SDF-1/VEGF/VEGFR2) were significantly and progressively upregulated from Groups 1 to 4 (all P < 0.0001). The protein levels of inflammation (MMP-9, IL-6, and TNF-α) and oxidative stress (NOX-1 and NOX-2) and the cellular levels of inflammation (CD68+)/DNA damage (γ-H2AX+) displayed opposite patterns, whereas the small vessel density in the CLI area displayed an identical pattern of INBF among the groups (all P < 0.0001). ECSWT rescued CLI by increasing GPR120-mediated suppression of inflammation and enhancing angiogenesis via activation of VEGFR2.

The effects of extracorporeal shock wave therapy in children with cerebral palsy: a systematic review.

Spastic Cerebral Palsy (CP) is a major cause of movement disorders in pediatric rehabilitation. Current treatments are often invasive and may lead to substantial discomfort. Extracorporeal shockwave therapy (ESWT) presents a potential alternative, offering a less invasive approach with a reduced side effect profile. However, the impact of ESWT on children with CP remains unclear. This systematic review aims to summarize the current evidence on ESWT's impact in children with spastic CP across various domains of the International Classification of Functioning, Disability, and Health for Children and Youth. To answer the main question, a systematic literature study is used. The studies, collected from four databases, were screened and data on outcome measures and methodological quality were extracted. Effect sizes were calculated to facilitate study comparison. In total, twelve randomized controlled trials met inclusion criteria, with PEDro scores ranging from three to eight. The combined study population included 421 children. Positive effects were observed on resistance to passive movements, passive range of motion, and gross motor skills, with effect sizes ranging from moderate (0.65) to very large (7.69). ESWT demonstrated positive effects across multiple domains in children with spastic CP.

Pain, Function, and Elastosonographic Assessment After Shockwave Therapy in Non-Calcific Supraspinatus Tendinopathy: A Retrospective Observational Study

Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30–75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p &lt; 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p &lt; 0.05), and SWEv increased (5.7 ± 1.8 m/s, p &lt; 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p &lt; 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = −0.6 and r = −0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes.

Artificial Intelligence in the Prediction of Stone-Free Status in Urinary Stone Disease Treated with Extracorporeal Shockwave Lithotripsy: A Systematic Review

Background Urolithiasis is one of the most common urological diseases worldwide. One of the most common therapy, extracorporeal shock wave lithotripsy (ESWL), has a high failure rate. The failure rate can be significantly reduced by identifying the candidates most likely to benefit from ESWL, for example, by using machine learning (ML) algorithms. Decision tree analysis (DTA), artificial neural networks (ANN), and random forests (RF) represent a few of the machine learning approaches employed to forecast the stone-free outcome following ESWL. Methods 219 studies were searched through six electronic databases (CENTRAL, MEDLINE, EMBASE, EBSCO, Proquest, SCOPUS). We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and adhered to the Standards for Reporting Diagnostic Accuracy Studies (STARD). To evaluate the potential bias in all the studies, we utilized the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results 41,484 patients from 11 studies were included. The ML models highlight varying levels of diagnostic precision, with sensitivity spanning from 35-96%, and specificity ranging from 63-98.4%, and area under the curve falling between 0.49-0.96. It is shown in this study that the accuracy of RF and DTA in predicting stone-free status is superior than ANN. Conclusion ML is a comparable predictive method to statistical analysis in predicting stone-free status. Random forest method and DTA are superior MLs compared to ANN. Stone size, density, and 3D texture analysis are the most important variables to be considered in the ML models and should be included in the models to ensure accuracy of stone-free status prediction.

Extracorporeal Shock Waves Therapy for the Treatment of Acute and Chronic Wounds-A Prospective, Monocentric Clinical Trial to Examine the Effect of Shock Waves on Wound Healing.

The aim of our prospective blinded clinical study was to examine a possible improvement and acceleration of epithelialization by treatment with low-energy extracorporeal shock waves on skin graft donor and recipient sites in patients with chronic wounds. In addition, several secondary parameters were investigated to evaluate the compatibility of the therapeutic method, its influence on infection occurrence and bacterial colonization. A total of 35 patients were included in the study. Of these, 25 participants were assigned to the verum-placebo group and 10 to the sham treatment group. The study of the sham control group was done to exclude a possible "remote effect" of the placebo area. Depending on the group, the wound areas were treated with low-frequency shock waves, placebo, or sham. The examinations were performed immediately on Day 0 after surgical treatment and on Days 5, 7, 9, and 12 after surgery. To record long-term results, an additional evaluation of the wound situation was performed on Day 90. Epithelialization was statistically significantly accelerated by shock wave application at both skin graft recipient sites and donor sites (0.86 vs. 0.92, p < 0.05). Furthermore, the risk of wound infection was significantly reduced by using extracorporeal shock waves. Serious side effects were not reported. A repeated application of ESWT followed by standardized wound care was shown to significantly accelerate the time to re-epithelialization at the skin graft donor and recipient site compared with re-epithelialization time in patients of the sham/placebo group.

Extracorporeal shockwave therapy for the treatment of deep dermal burns of the hand: a preliminary study

Extracorporeal shockwave therapy for the treatment of deep dermal burns of the hand: a preliminary study

Negative Prognostic Factors and Clinical Improvement Prediction Modeling for ESWT in Calcific Shoulder Tendinitis Using Artificial Intelligence Techniques.

The efficacy of extracorporeal shockwave therapy (ESWT) for treating shoulder calcific tendinitis can be influenced by various prognostic factors. This study aimed to identify prognostic factors associated with the failure of ESWT for symptom relief and to evaluate the predictive capability of the eXtreme Gradient Boosting (XGBoost) algorithm of artificial intelligence techniques in this context. This retrospective study enrolled patients with persistent shoulder pain attributed to calcific tendinitis who underwent ESWT after failed conservative treatment between January 1998 and December 2022. Age, sex, duration of symptoms, calcification classification and size, pre-ESWT visual analog scale (VAS), and pre-ESWT Constant-Murley score (CMS) served as potential input attributes. The post-ESWT VAS score and CMS score were the output attributes. The XGBoost model was utilized to predict treatment outcomes based on these factors. The dataset was balanced using the synthetic minority oversampling technique (SMOTE), and the model's performance was assessed using 10-fold cross-validation. Spearman's rank correlation coefficient analysis was adopted to explore the relationships between significant continuous input attributes and post-ESWT VAS and CMS scores. A total of 296 patients with calcific tendinitis were enrolled and completed the one-year follow-up. The findings revealed that a prolonged symptom duration (>10 months), severe pain (pre-ESWT VAS > 5), and higher pre-ESWT CMS (>55) were significant prognostic factors for the failure of ESWT for symptom relief. Using these factors as inputs, the XGBoost model demonstrated high accuracy, precision, recall, F1 score. By reducing the input attributes to age, calcification size, pre-ESWT CMS, and symptom duration, the model maintained a high prediction rate, suggesting that these factors are sufficient for effective prediction. The present study identified significant prognostic factors for associated with the failure of ESWT in the treatment of shoulder calcific tendinitis. By utilizing artificial intelligence techniques, particularly the XGBoost algorithm, we demonstrated an effective ability to predict the VAS and the CMS outcomes following ESWT. By employing the trained XGBoost model, clinicians can offer accurate predictions regarding the outcome of ESWT in this clinical scenario, aiding in treatment decision-making and optimizing patient care.

Comparing the long-term effect of extracorporeal shockwave therapy and therapeutic ultrasound in treating trigger finger: A prospective cohort study.

To investigate the long-term effects of Extracorporeal shockwave therapy (ESWT) and ultrasound (US) in treating the trigger finger. Trigger finger, also known as stenosing tenosynovitis, is a common type of tenosynovitis affecting the flexor sheath of any finger. Extracorporeal shockwave therapy and therapeutic US are conservative treatments that use waves of varied frequency to target damaged regions and improve function. This cohort study was carried out in Saudi Arabia, using samples obtain from the files of patients with trigger fingers who visited the orthopedic department at Al-Rass General Hospital between May and June 2023. Of the 38 people with trigger fingers who were initially included, 24 satisfied the requirements for inclusion (11 underwent US, and 13 received ESWT). Assessments were conducted in September 2023, two months later. A goniometer was used to measure the range of motion (ROM), an electrical dynamometer was used to test grip strength, a numerical pain rating scale was used to quantify discomfort, and QuickDASH was used to measure general functional capacity. Extracorporeal shockwave therapy and US significantly affected all outcomes, including pain severity, ROM, hand strength, and general functional capability (p<0.005). In the immediate period, the US outperformed ESWT in enhancing general functional capability. Over time, ESWT was more essential for reducing pain (p=0.001). This study provides preliminary evidence that ESWT and US have similar effects in treating trigger fingers.

The Effects of Focused Extracorporeal Shockwave Therapy versus Deep Friction Massage in Supraspinatus Tendinopathy: A Randomized Controlled Trial

The Effects of Focused Extracorporeal Shockwave Therapy versus Deep Friction Massage in Supraspinatus Tendinopathy: A Randomized Controlled Trial

Effects of transcranial magnetic stimulation combined with extracorporeal shockwave therapy for poststroke spasticity: study protocol for a randomised controlled trial

IntroductionSpasticity is a common complication of stroke, which is related to poor motor recovery and limitations in the performance of activities. Both transcranial magnetic stimulation (TMS) and extracorporeal shockwave therapy...

Stone-free Rate of Ultrasound-assisted and Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Radiopaque Renal Stones

Background: Extracorporeal shock wave lithotripsy (ESWL) has been a widely accepted method for treating urinary stones since the early 1980s. ESWL is the preferred non-invasive treatment for renal stones that are smaller than 1.5 cm. Ultrasound and fluoroscopy are used during ESWL operations to visualize the fragmentation. Objective: To determine the Stone-free rate of ultrasound-assisted and fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones. Methodology: A prospective cohort study was conducted at the Sindh Institute of Urology and Transplantation from 25th February to 25th August 2022, including 75 participants per group with renal stones &lt;1.5 cm, radio-opaque kidney stones, and consented patients. Both groups were treated using identical lithotripters with ultrasound and fluoroscopy for stone localization. Post-lithotripsy, X-ray or ultrasound assessed stone clearance. Frequency and percentages were calculated for variables like age, gender, and stone-free rates. Mean values and deviations were computed. The Chi-Square test analysed categorical variables. Paired sample statistical analysis evaluated differences in stone size and clearance, with p-values &lt;0.05 deemed statistically significant. Results: Within group A, 53 patients (70.7%) exhibited no stones, whereas in group B, 45 patients (60%) were devoid of stones. These findings suggest that group A surpassed group B in terms of achieving stone-free statuses. Conclusion: Our research findings indicate that ultrasound-assisted extracorporeal shockwave lithotripsy achieved a stone-free rate of 70.7%, surpassing the stone-free rate of 60% achieved by fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones.

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

Long-Term Efficacy of Combined Focused and Radial Extracorporeal Shockwave Therapy for Gluteus Medius Tendon Pathology: A Pilot Study.

Background: Gluteus medius tendinopathy is amongst the most prevalent lower limb tendinopathies and is now recognized as the primary cause of insidious lateral hip pain. Typically affecting middle-aged women, this condition causes disability and reduced quality of life as it negatively impacts most daily life activities. Several studies demonstrate that extracorporeal shockwave therapy is effective in reducing pain and promoting functional recovery in several musculoskeletal disorders including tendinopathies. However, most published data are limited to evaluating focal or radial shockwaves as single interventions. Contrariwise, there is little evidence reporting the use of combined ESWT treatment and outcomes for managing tendon pathologies, and no data are reported on combined ESWT for gluteus medius tendinopathy. Objectives: The aim of this study was to evaluate the clinical outcomes of combined ESWT in gluteus medius tendinopathy. Methods: Medical charts of 11 consecutive patients with gluteal tendinopathy confirmed by ultrasound who underwent a combined ESWT protocol were reviewed. Changes in pain severity and lower limb function were evaluated using the numerical rating scale, the Victorian Institute of Sports Assessment for Gluteal tendinopathy questionnaire, and the Roles and Maudsley score. Clinical outcome measurements were collected at baseline (T0), 2 months after combined ESWT (T1), and at long-term follow-up (T2), at least 10 months post-treatment (mean 26 months). Results: The mean age of the sample was 62.55 ± 3.17 years. A marked prevalence of females was recorded (nine subjects, 81.8%). A significant improvement was observed in all outcome criteria both at short- and long-term follow-up after combined ESWT compared to baseline (p < 0.05). Treatment success rates were 90.9% and 81.8% at T1 and T2, respectively. Conclusions: Combined ESWT is effective and safe for patients with gluteal tendinopathy, with good long-term results in terms of pain relief and improved functional impairment.

Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial.

To investigate the efficacy of adding radial extracorporeal shockwave therapy or sham to exercise for people with insertional Achilles tendinopathy. A two-armed, parallel-group, explanatory, single-centre, randomised controlled trial within a superiority framework. Private clinic. People diagnosed with insertional Achilles tendinopathy who were over 18 years old with a symptom duration of greater than 3 months. A total of 76 people were randomly assigned (one-to-one ratio) to receive three sessions of radial extracorporeal shockwave therapy or sham to the affected side (or most affected side if bilateral). All participants received identical education and exercise. The primary outcome was the Victorian Institute of Sports Assessment - Achilles questionnaire. Measures were recorded at baseline, 6 weeks and 12 weeks. At 12 weeks, the questionnaire data were available for 37 people (96%) in the radial extracorporeal shockwave therapy group and 36 people (95%) in the sham group. For the primary outcome, we found no evidence for between-group differences at 6 (3, 95% confidence interval -4.6-10.5) or 12 weeks (4.6, 95% confidence interval -2.5-11.6). There was also no evidence for a between-group difference for any secondary outcome measures at either 6 or 12 weeks (p > .05). No serious adverse events were reported. The addition of radial extracorporeal shockwave therapy to exercise and education did not lead to improvements in pain, function or other outcomes compared to sham at 6 or 12 weeks among people with insertional Achilles tendinopathy.ANZCTR Reg No: ACTRN12620000035921.

The Use and Benefits of Focused Shockwaves for the Diagnosis of Myofascial Pain Syndrome by Examining Myofascial Trigger Points in Low Back Pain.

Background/Objectives: Low back pain (LBP) is a widespread public health issue, with myofascial pain syndrome (MPS) being a common cause, affecting 67-100% of patients. However, there are significant challenges in the diagnostic process due to the subjective and unreliable nature of manual palpation. Focused Extracorporeal Shockwave Therapy (F-ESWT), traditionally used for MPS treatment, offers a reproducible and non-invasive mechanical stimulus, making it a potential diagnostic tool. This study evaluated F-ESWT's diagnostic efficiency in chronic LBP patients by focusing on "recognition" and "referral" of pain. Methods: twenty-eight participants were screened for myofascial trigger points (MTrPs) in the lumbar, gluteal, and thigh regions. Identified MTrPs were stimulated using F-ESWT, and patient feedback was recorded. Results: data showed high diagnostic accuracy for muscles such as the quadratus lumborum, gluteus medius, and gluteus minimus muscles, achieving "referral" rates of 96%, 95%, and 92% and "recognition" rates of 84%, 86%, and 85%, respectively. Other structures like adductors, iliopsoas, erector spinae, and biceps femoris muscle showed consistent but lower diagnostic rates. Conclusions: the study's findings indicate that F-ESWT effectively reproduces pain patterns, offering a precise, reproducible, and non-invasive diagnostic approach for MPS in chronic LBP. However, they also highlight the necessity for detailed diagnostic criteria in managing myofascial pain.

A comparative analysis of platelet-rich plasma alone versus combined with extracorporeal shockwave therapy in athletes with patellar tendinopathy and knee pain: a randomized controlled trial

BackgroundPatellar tendinopathy, also known as jumper’s knee, can significantly impact the quality of daily life for patients due to the associated pain. A randomized controlled trial was investigated the clinical, sonographic, and serum cytokine markers in patellar tendinopathy of athletes following platelet-rich plasma (PRP) or PRP with extracorporeal shockwave therapy (ESWT) treatments. Our aims to investigate and compare therapeutic effects of PRP versus a combination of PRP with ESWT for treating patellar tendinopathy.MethodsA total of 33 athletes with patellar tendinopathy were randomized into two groups. PRP + Sham (PS) group received intraarticular injection of autologous PRP (5 mL) once and sham ESWT. PRP + ESWT (PE) group received intraarticular injection of autologous PRP once and after 1 week ESWT (0.2 mJ/mm2 energy flux density, 1350 impulses, 4 Hz) once. All patients were followed up for 1 year.ResultsAutologous PRP injection and its combination with ESWT are both effective treatments for chronic patellar tendinopathy in athletes. PRP combined with ESWT resulted in faster reduction of knee pain than PRP alone at the 1-month follow-up. Serum IL-33 showed no significant difference at the 12-month follow-up. Levels of interleukin (IL)-6, IL-15, and IL-17 increased at the 12-month follow-up, potentially due to the additional training. However, the athletes did not report any discomfort or injuries, and no abnormalities were detected by ultrasonography after study. We demonstrated improvements in pain and functional scores, as well as knee injury protection in athletes, following 12 months of PRP and PRP with ESWT treatments.ConclusionsThe study analyzed the therapeutic effect of PRP injection alone and combining PRP injection with ESWT for chronic patellar tendinopathy. Our results showed that combined treatment can facilitate the pain relief early than PRP alone and is a safety treatment modality. No adverse effect was noted in our study.Trial registration Research registry and the registration number is researchregistry9518. Registered 14 September 2023. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650263e4f549fd00282a338c/. The level of evidence is level II.

Comparative Analysis of Extracorporeal Shockwave Therapy, Bisphosphonate, and Wharton Jelly-Derived Mesenchymal Stem Cells in Preserving Bone and Cartilage Integrity and Modulating IL31, IL33, and BMP2 in the Cartilage of Ovariectomized Rat Model.

Background: Osteoporosis (OP) is a chronic inflammatory bone disease characterized by reduced bone structure and strength, leading to increased fracture risk. Effective therapies targeting both bone and cartilage are limited. This study compared the therapeutic effects of extracorporeal shockwave therapy (ESWT), bisphosphonate (Aclasta), and human Wharton jelly-derived mesenchymal stem cells (WJMSCs) in a rat model of OP. Methods: Female rats were assigned to four groups: Sham (no surgery or treatment), OP (bilateral ovariectomy, OVX), ESWT (OVX + ESWT on both tibias at 0.25 mJ/mm2, 1500 impulses per tibia), Aclasta (OVX + zoledronic acid 0.1 mg/kg via tail vein injection), and WJMSC (OVX + 2 × 10⁶ WJMSCs). Pathological changes, bone microarchitecture (by micro-CT), serum cytokines (by ELISA), and tissue-specific molecular markers (by immunohistochemistry) were evaluated. Results: All treatments improved bone density, preserved cartilage, and modulated cytokines (IL31, IL33, VEGF, and BMP2), with Aclasta showing the greatest improvements in bone parameters and cartilage preservation. ESWT and WJMSC also demonstrated significant effects, with ESWT highlighting non-invasive chondroprotective potential. Conclusions: Aclasta provided the best overall therapeutic response, particularly in bone regeneration. However, ESWT and WJMSC also showed comparable chondroprotective effects. ESWT emerges as a promising non-invasive alternative for OP management when pharmacological or cell-based therapies are not feasible.

Highlights of Medial Tibial Stress Syndrome in Military Recruits: A Narrative Review.

Medial tibial stress syndrome (MTSS), commonly known as shin splints, is characterized by pain and inflammation in the shin caused by repetitive stress. While often associated with sports and physical activity, MTSS can significantly impact daily life, particularly in military recruits, making it a pertinent concern for this population. This narrative review synthesizes findings from a comprehensive search of databases to explore the prevalence, risk factors, and management of MTSS among military recruits. The search identified 35 studies discussing these aspects. MTSS is highly prevalent among military recruits, with an incidence ranging from 35% to 56%. Key risk factors include female sex, higher BMI, low aerobic fitness, smoking, and specific anatomical characteristics. Various treatments, including extracorporeal shockwave therapy (ESWT), compression therapy, pneumatic leg braces, and shock-absorbing insoles, have been shown to effectively accelerate recovery. Early identification of at-risk individuals could significantly reduce MTSS incidence and related healthcare costs. Emerging artificial intelligence tools also hold promise for delivering precise risk assessments. In conclusion, MTSS is a common issue among military personnel, driven by the physical demands of their training and specific risk factors. Further research into predictors of MTSS across diverse military populations is essential to improve outcomes.

Sex Differences and Extracorporeal Shockwave Therapy Outcomes in Runners with Achilles or Hamstring Tendinopathy.

Background/Objectives: Achilles and hamstring tendinopathies are common injuries in runners, and extracorporeal shockwave therapy (ESWT) may be an effective treatment. Runners are at risk for lower extremity tendinopathies and the Male and Female Athlete Triad (Triad). The purpose of this study is to evaluate the association of sex, exposure to hormonal contraceptives, menopause, and Triad-related risk factors with ESWT outcomes in the treatment of Achilles and hamstring tendinopathy. Methods: This is a retrospective cohort study of runners with either Achilles or hamstring tendinopathy who received radial or combined radial and focused ESWT. Tendon function was measured using Victorian Institute of Sport Assessment (VISA) questionnaires completed before and following treatment. Treatment success was defined by a change in VISA score that met the minimal clinically important difference (MCID). Results: There were 88 runners (54.5% female, 45.5% male) with Achilles (52.3%) or hamstring (47.7%) tendinopathy. No measurable difference was found in the proportion of females and males overall that achieved the MCID (57.1% and 72.5%, p = 0.17). Similar rates of females and males met MCID for Achilles (77.8% and 75.0%, p = 0.83) and hamstring tendinopathy (46.7% and 66.7%, p = 0.24). However, females with Achilles or hamstring tendinopathy who used oral contraceptive pills (OCPs) were less likely to meet the MCID compared to females not on OCPs (p = 0.031); this finding was present in a subgroup analysis of runners with only Achilles tendinopathy (p = 0.025). No associations were found between achieving the MCID and Triad risk factors, including body mass index, energy availability, weight-related behaviors, bone health, or menstrual function (all p > 0.05). Conclusions: Female and male runners reported similar success rates for ESWT, and Triad risk factors were not found to impact outcomes. However, females who used oral contraceptive pills were less likely to achieve the MCID from ESWT.

Three Weeks of Extracorporeal Therapy and Telerehabilitation for Supraspinatus Calcific Tendinosis: A Case Report

This case report presents the treatment of a patient with shoulder calcification and reduced Range of Motion (ROM) using a combination of Extracorporeal Shockwave Therapy (ESWT) and telerehabilitation. The patient received three sessions of ESWT, once per week, followed by daily guided shoulder exercises delivered via telerehabilitation for three weeks. Pre- and post-treatment assessments included goniometry for ROM, the Shoulder Pain and Disability Index (SPADI) score for shoulder function and X-ray imaging. The results demonstrated significant improvements in pain, function and ROM suggesting the potential benefits of this combined approach in reducing patient burden and promoting sustainability in physiotherapy.