Background: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited.Aims: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar Fasciitis. Methods: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJlmm') or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy.Results: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37%0 of the subjects in the ESWT group and 24%) in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31Y0 in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 370/0 and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period.Conclusions: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.

Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach to the treatment of a number of soft tissue complaints. Whilst benefit has been demonstrated in calcific tendinitis, evidence is lacking for benefit in the management of non-calcific rotator cuff disorders.Aims: To perform a double-blind placebo controlled trial of moderate dose ESWT in chronic lateral epicondylitis. Meth0d.s: Adults with lateral epicondylitis were randomised to receive either active treatment (1 500 pulses ESWT at 0.12 mJ/ mm2) or sham therapy, monthly for three months. All were assessed before each treatment and one month after completion of therapy. Outcome measures consisted of visual analogue scores for pain in the day and at night.Results: Seventy-five subjects participated and there were no significant differences between the two groups at baseline. The mean duration of symptoms was 15.9 and 12 months in the ESWT and sham groups, respectively. Both groups showed significant improvements from two months. No significant difference existed between the groups with respect to the degrees of change in pain scores over the study period. In the ESWT group the mean (SD, range) pain score was 73.4 (14.5, 38-99) at baseline and 47.9 (31.4, 3-100) at three months. In the sham group the mean (SD, range) pain score was 67.2 (21.7, 12-100) at baseline and 51.5 (32.5, 3-100) at three months.At three months, 50% improvement from baseline was noted in 35% of the ESWT group and 34% of the sham group with respect to pain.Conclusions: There appears to be a significant placebo effect of moderate dose ESWT in subjects with lateral epicondylitis but there is no evidence of added benefit of treatment when compared to sham therapy.

We have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm2) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (+/-SD; range) change in SPADI of 16.1 +/- 27.2 (0 to 82) in the treatment group and 24.3 +/- 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 +/- 25.9 (-24 to 69) and 30.4 +/- 31.2 (-12 to 88), respectively. Similar results were noted for night pain. We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment.

CLBP is the leading cause of absenteeism from the workplace. The present study using a modified randomised control trial design investigated exercise training frequency for participants with CLBP. One lumbar extension training session per week is sufficient for strength gains and reductions in low back pain in CLBP patients.

Resistance exercise may acutely enhance muscle contractile activity, which is known as postactivation potentiation (PAP). Postactivation potentiation augments important skills that require power production that are necessary during soccer performance. The aim of this study was to determine the optimal recovery time to elicit PAP after a bout of high-intensity resistance exercise in professional soccer players. Twenty-two senior professional soccer players (mean [SD]; age, 23 [4.5] years; stature, 1.83 [6.6] m; body mass, 80.9 [7.8] kg) were randomized to either an experimental (n = 11) or a control group (n = 11). Both groups performed a standardized warm-up and baseline countermovement jump (CMJ) followed by a 10-minute recovery. The control group then performed a CMJ at 15 seconds and at 4, 8, 12, 16, and 20 minutes, whereas the experimental group performed a 3 repetition maximum (RM) squat and then an identical CMJ protocol. No significant differences were found between the groups for CMJ peak power (p > 0.05) or jump height (p > 0.05). No time effect for peak power (F(6,60) = 2.448; p = 0.063) or jump height (F(6,60) = 2.399; p = 0.089) was observed throughout the experimental group trials. Responders (n = 6) displayed individualized PAP profiles at 4 (n = 3), 12 (n = 1), and 16 (n = 2) minutes after conditioning contraction, whereas nonresponders (n = 5) did not. A set of 3RM squats failed to acutely potentiate all participants CMJ performance. Both PAP responders and nonresponders were identified and have individualized PAP time constants. This is not consistent with the previous literature, which used identical protocols. Strength and conditioning practitioners need to individualize recovery "windows" and identify athletes who respond to PAP before undertaking a complex training intervention.