Disclosures: Mani Singh, MD: No financial relationships or conflicts of interest

Background and/or Objectives: The purpose of this study is to analyze and describe treatment protocols utilized in extracorporeal shockwave therapy (ESWT) for tendinopathies, plantar fasciitis, and joint or osseous disorders. Our objective is to describe commonly employed treatment protocols by researchers and clinicians.

Design: Systematic Review in PubMed, MEDLINE, and Cochrane Database up to October 2021. Keywords included extracorporeal shockwave therapy, ESWT, tendinopathy, osteoarthritis (OA). Additional articles were identified by cross-reference.

Setting: Literature Review

Participants: not applicable

Interventions: not applicable

Main Outcome Measures: Data collected included ESWT targets, shockwave device, type of shockwave (focused, radial, or combination), frequency, impulses, energy, treatment sessions and intervals.

Results: 138 studies were included in our analysis (1991 to 2021). Some common indications for ESWT included (number of studies): plantar fasciitis (33), lateral epicondylitis (19), Achilles tendinopathy (17), calcific rotator cuff tendinopathy (17) and rotator cuff tendinopathy (6), patellar tendinopathy (10), knee osteoarthritis (10), osteonecrosis of the femoral head (9), greater trochanteric pain syndrome (5), medial tibial stress syndrome (3), hamstring tendinopathy (2). Low to medium energy levels (up to 0.28 mJ/mm2) were predominantly employed. While there is significant heterogeneity in protocols between researchers and across pathologies, trends can be seen in the treatment of tendinopathies and plantar fasciitis (radial/focused/combination, 4-10Hz, 2000-3000 pulses, 3-4 weekly sessions), knee OA (radial, 6-8Hz, 1000-2000 pulses, 3-4 weekly sessions), and bone disorders (significant variation but favoring focused, 1000-6000 pulses, medium-high energy, 1-5 sessions).

Conclusions: There remains significant heterogeneity in ESWT treatment protocols, including type of shockwave therapy, frequency, impulses, energy delivery, number of sessions, and session intervals. While many studies illustrate the benefits of ESWT, there is limited evidence describing the optimal treatment protocols, number of treatment sessions, or whether focused or radial ESWT is superior to the other. Future studies should aim to fill in these gaps.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/heterogeneity-in-extracorporeal-shockwave-treatment-protocols-a-literature-review/