Extracorporeal Shockwave Therapy for the Treatment of Tendinopathies: Current Evidence on Effectiveness, Mechanisms, Limitations, and Future Directions

Tendinopathy is a chronic degenerative tendon disorder which is characterised by pain, swelling and impaired physical function and performance, presenting in both athletes and the general population. Extracorporeal shockwave therapy (ESWT) is an increasingly common treatment for tendinopathy, which can initiate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and provides a brief overview of its history and development. The central purpose of the review is to synthesise research findings investigating the effectiveness of ESWT for seven common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, gluteal, hamstring and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT is effective and can be recommended in treatment for the seven tendinopathies. However, the evidence is stronger for certain tendinopathies compared to others and uncertainties remain regarding the optimal ESWT treatment parameters. The consensus from recent literature is that although ESWT can be effective in isolation it should be combined with other treatments in tendinopathy, which needs to be addressed in future research.