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The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction
  1. Vasileios Korakakis1,2,3,
  2. Rodney Whiteley1,
  3. Alexander Tzavara2,
  4. Nikolaos Malliaropoulos4,5,6
  1. 1 Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
  3. 3 Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
  4. 4 Sports and Exercise Medicine Clinic, Thessaloniki, Thessaloniki, Greece
  5. 5 Rheumatology Department, Sports Clinic, Barts Health NHS Trust, London, UK
  6. 6 European Sports Care, London, UK
  1. Correspondence to Mr Vasileios Korakakis, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, PO Box 29222, Qatar; Vasileios.Korakakis{at}


Objective To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).

Design Systematic review.

Eligibility criteria Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.

Results Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.

Conclusion Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

  • Tendinopathy
  • Shockwave
  • Shin Splints
  • Review
  • Intervention effectiveness

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  • Contributors All authors contributed to this work and the authorship of this manuscript. VK planned, coordinated the idea, conducted the search, analysed results, wrote and reviewed the manuscript. RW coordinated the idea, analysed the results, provided writing content and reviewed. AT conducted the search, wrote and reviewed the manuscript. NM provided writing and review support.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.