The prospective, simple randomized study assesses the effect of focused extracorporeal shock wave therapy (f-ESWT) on pain intensity and calcification size compared to the application of ultrasound physical therapy in treating patients with calcar calcanei. A total of 124 patients diagnosed with calcar calcanei were consecutively included in the study. The patients were divided into two groups: the experimental group ( n = 62 ), which included the patients treated with f-ECWT, and the control group ( n = 62 ), consisting of patients treated with the standard ultrasound therapy method. The experimental group’s patients received ten therapy applications spaced seven days apart. The patients in the control group had ten ultrasound treatments on ten consecutive days over two weeks. All patients in both groups were tested using the Visual Analog Scale (VAS) to measure pain intensity before the beginning and at the end of treatment. The size of the calcification was assessed in all patients. The study hypothesizes that f-ESWT reduces the pain and the size of the calcification. Pain intensity reduction was registered in all patients. The calcification size in patients in the experimental group was reduced from the initial range of 2 mm–15 mm, to a content of 0.0 mm–6.2 mm. The calcification size in the control group ranged from 1.2 to 7.5 mm, without any change. None of the patients experienced any adverse reactions to the therapy. Patients treated with standard ultrasound therapy did not have a statistically significant reduction in the calcification size. In contrast, the patients in the experimental group treated with f-ESWT showed a substantial decrease in the calcification size.

Tendons are the soft tissue that connects muscles to bones. They are made of collagen and elastin, they are strong and solid, and have no possibility of contraction. Their strength helps us to move. Recovery of tendon injuries is long-lasting and can take more than six months. If a tendon is shed during a time injury, calcification occurs at the site of the injury and the disease is called calcifying tendinopathy. The very existence of calcifications is an indication for treatment with a mechanical shock wave (Shock wave). Mechanical shock waves can act in focus or radially. The difference between focused and radial waves is primarily in their physical basis. Focused shock waves differ from radial shock waves in terms of therapeutic depth of penetration into the tissue. The basic biological effect of a mechanical shock wave is stimulating. The energy of the mechanical shock wave acts at the cellular level by stimulating the reduction of inflammation and pain in the tissue. Using mechanical shock wave in the treatment of calcified tendinopathies, a safe method for breaking calcifications was obtained. Shock wave can be applied to using: different frequency, different number of strokes, as well as different strength of strokes in their studies. The choice of parameters for the application depends on whether it is calcified or non-calcified tendinopathy. Indications for the use are: painful shoulder, heel spur, plantar fasciitis, tennis elbow, Achilles tendon tendinopathy, jumping knee, patellar tendinitis, myalgia, myogelosis and muscular tendon overstrain syndrome. Contraindications for the use are: the existence of prostheses, knees and hips, as well as various orthopedic material, pacemaker, as well as the presence of chronic diseases such as multiple sclerosis, amyotrophic lateral sclerosis or tumors. The application of a mechanical shock wave is new, non-invasive method, easy to apply, always reduces pain and practically without side effects. This method has a special role in the treatment of chronic inflammation of diseased tendons, with or without calcification. The only dilemma in the application of a mechanical shock wave can be in the number of applications as well as the time break between the applications of two consecutive mechanical shock waves therapy.

Introduction: Shock wave therapy represents a new method in the treatment of lateral epicondylitis-tennis elbow, which achieves good results. Aim: The aim of this paper was to test and analyze the effect of five-week and ten-week shock wave therapy on the reduction of pain intensity in men with lateral epicondylitis, who played tennis recreationally. Materials and methods: The study included 21 male patients, aged 22-65 years (x̄ ± sd, 41.7 ± 10.5 years), with the diagnosis of chronic lateral epicondylitis, without calcifications, which had been established with a clinical and ultrasound examination. The subjects were divided into two groups, according to age: the younger group (≤ 40 years) and the older group (> 40 years). Once in seven days, all the patients were treated with shock wave therapy, which was applied with a focused probe (frequency of 10 Hz; 1,600 shocks; pressure at 1.6 bars). The patients had a total of ten therapies. The intensity of pain was determined with the visual analog scale (VAS) for pain. The assessment of pain intensity with the visual analog scale (VAS) was performed before the start of therapy, as well as after five and after ten applications of shock wave therapy, i.e. after five and ten weeks of therapy application. Results: In men with chronic lateral epicondylitis, a statistically significant decrease in pain intensity occurred on the VAS scale (p < 0.001), during the observation period of then weeks. A statistically significant decrease of pain intensity on the VAS scale during the observation period occurred both in patients aged under 40 years (p < 0.001) and in those aged over 40 years (p = 0.001). There was no significant difference in pain intensity between the younger and older men, neither at the beginning of therapy, nor after five and ten shock wave therapy sessions. Conclusion: To conclude, our results indicate that the application of ten shock wave treatments in men with chronic lateral epicondylitis significantly reduces pain.