Extracorporeal Shockwave Therapy for Tendinopathy

Shockwaves are three-dimensional pressure pulses of microsecond duration with a peak pressure of 35-120 MPa and have been applied to the treatment of soft tissue and musculoskeletal disorders for over 20 years. The concentrated shockwave energy per unit area, the energy flux density (EFD, in mJ/mm²), is currently used as a descriptive parameter of shockwave dosage. As a guideline, low energy extracorporeal SW therapy (ESWT) is EFD ≤0.12 mJ/mm², and high energy is >0.12 mJ/mm². Another commonly used grouping defines EFD <0.08 mJ/mm² as low energy, between 0.08 and 0.28 mJ/mm² as medium energy, and 0.28-0.6 mJ/mm² as high energy. ESWT is an efficacious and efficient alternative to surgery for rotator cuff calcification. Combining physical therapy, shockwaves treatment is effective and safe for chronic patellar tendinopathies. Recently, high-quality controlled trials have confirmed excellent results of ESWT in chronic Achilles tendinopathy. For proximal plantar fasciitis, the literature review unveiled some controversy in its effect, with the vast majority of papers favoring ESWT. The success rate ranged from 68 to 91% in shockwave treatment for lateral epicondylitis of the elbow. Further studies have to focus on the efficacy of different treatment modalities such as EFD, frequency, and the application pressure.