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Systematic review
Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review
  1. Hye Chang Rhim1,2,
  2. Jaehyung Shin2,
  3. Jane Kang3,
  4. Paige Dyrek1,
  5. Zack Crockett1,
  6. Pearl Galido4,
  7. Carrie Wade5,
  8. Karsten Hollander6,
  9. Joanne Borg-Stein1,
  10. Steven Sampson7,
  11. Adam S Tenforde1
  1. 1 Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
  2. 2 Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Riverside University Health System, Moreno Valley, California, USA
  4. 4 Western University of Health Sciences, Pomona, California, USA
  5. 5 Countway Library, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
  7. 7 Orthohealing Center, Los Angeles, California, USA
  1. Correspondence to Dr Adam S Tenforde, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA; atenforde{at}mgh.harvard.edu

Abstract

Objective To determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.

Design Systematic review.

Data sources We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched four databases: PubMed (NLM), Embase (Elsevier), CINAHL Complete (EBSCO) and Web of Science (Clarivate).

Eligibility criteria for selecting studies Included studies were randomised controlled trials, cohort and case–control studies, cases series and reports that evaluated outcomes following ESWT for athletes, physically active individuals and occupational groups requiring regular physical activity such as military cadets.

Results 56 studies with 1874 athletes or physically active individuals were included. Using the Oxford level of evidence rating, included studies were 18 level I (32.1%), 3 level II (5.4%), 10 level III (17.9%), 13 level IV (23.2%) and 12 level V (21.4%). Based on the level I studies, ESWT may be effective alone in plantar fasciitis, lateral epicondylitis and proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated ESWT with minimal side effects.

Conclusion ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports-related injuries and without major adverse events. Further high-level research is needed to better define the role and clinical outcomes of ESWT.

  • Athletic Injuries

Data availability statement

No data are available. Not applicable.

https://doi.org/10.1136/bjsports-2023-107567

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    Data availability statement

    No data are available. Not applicable.

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    Footnotes

    • SS and AST are joint senior authors.

    • Twitter @HCRhimMD, @k_hollander_, @doctor1040

    • Contributors HCR, SS and AST conceived and designed the study. HCR, JS, JK, PD, ZC and PG had full access to all data in the study and take responsibility for the integrity of the data. CW did the literature search. HCR, JK, PD, ZC, PG and JS interpreted the data and wrote the first draft of the manuscript. All authors contributed to critical revision of the report for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SS is a medical consultant for Globus Medical and Bioventus. AST serves as senior editor for PM&R Journal. AST gives professional talks, such as grand rounds and medical conference plenary lectures, and receives honoraria from conference organizers. AST has participated in research funded by the Arnold P. Gold Foundation (physician and patient care disparities), the Football Player Health Study at Harvard (health in American-Style Football players), the American Medical Society for Sports Medicine (bone density research), the Uniform Health Service and Enovis (Achilles tendinopathy). AST receives funding from the NFLPA and Department of Defense for studies evaluating shockwave for management of orthopedic injuries. AST is a paid consultant for State Farm Insurance and Strava. KH is editor for the German Journal of Sports Medicine and associate editor for the BMJ Open Sports and Exercise Medicine. KH receives funding from the German Federal Institute of Sports Science and the German Ministry for Economic Affairs and Energy for research in the field of running biomechanics and injury prevention.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.