Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review

Abstract

Extracorporeal shock waves are high-intensity mechanical waves (500–1000 bar) of a microsecond duration with a morphology characterized by a rapid positive phase followed by a negative phase. Background: Extracorporeal shock waves have been used for pain treatment for various sub-acute and chronic musculoskeletal (MSK) problems since 2000. The aim of this article is to update information on the role of extracorporeal shock wave therapy (ESWT) in the treatment of various pathologies that cause MSK pain. Methods: Given that in the last two years, articles of interest (including systematic reviews and meta-analyses) have been published on less known indications, such as low back pain, nerve entrapments, osteoarthritis and bone vascular diseases, a literature search was conducted in PubMed, the Cochrane Database, EMBASE, CINAHL and PEDro, with the aim of developing a narrative review of the current literature on this topic. The purposes of the review were to review possible new mechanisms of action, update the level of evidence for known indications and assess possible new indications that have emerged in recent years. Results: Although extracorporeal shock waves have mechanical effects, their main mechanism of action is biological, through a phenomenon called mechanotransduction. There is solid evidence that supports their use to improve pain in many MSK pathologies, such as different tendinopathies (epicondylar, trochanteric, patellar, Achilles or calcific shoulder), plantar fasciitis, axial pain (myofascial, lumbar or coccygodynia), osteoarthritis and bone lesions (delayed union, osteonecrosis of the femoral head, Kienbock’s disease, bone marrow edema syndrome of the hip, pubis osteitis or carpal tunnel syndrome). Of the clinical indications mentioned in this review, five have a level of evidence of 1+, eight have a level of evidence of 1−, one indication has a level of evidence of 2− and two indications have a level of evidence of 3. Conclusions: The current literature shows that ESWT is a safe treatment, with hardly any adverse effects reported. Furthermore, it can be used alone or in conjunction with other physical therapies such as eccentric strengthening exercises or static stretching, which can enhance its therapeutic effect.

Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach

“…The ANN model was useful for guiding authors in recommending ESWT, with high predictive ability and an anticipation of the outcome based on patients’ characteristics [ 22 ]. The results revealed that age before ESWT was the most influential factor in deciding the probability of success of MCST; this finding agrees with another paper, cited in a recent review [ 47 ], where it was noted that the greater probability of success had been achieved by the youngest participant [ 48 ]. However, the CMS score, VAS, and RM at the time of the ESWT were also very influential factors in deciding the probability of success of the minimum clinically successful therapy (MCST), that is, a reduction in VAS of 40% from the baseline.…”

Bodily maps of exercise-induced sensations

“…Following exercise, increased (in relation to baseline) experience of activeness and sinewiness was felt in the torso area, whereas experience of relaxation was increased in the head area. Sensations of pain and discomfort decreased in shoulder and back area, supporting the role of exercise in pain management [45]. Interestingly, experience of exhaustion increased in the lower limbs but decreased in the head area, likely reflecting the mental component of the exertion.…”

The effectiveness of extracorporeal shock wave therapy for rotator cuff calcific tendinopathy. A systematic review with meta‐analysis

“…Several studies have demonstrated the safety and effectiveness of ESWT in pain relief, clinical improvements and calcification resorption in patients with RCCT (Auersperg & Trieb, 2020;De la Corte-Rodríguez et al, 2023;Ioppolo et al, 2014). The mechanism of action and effects of F-and R-SWT may differ because the bioeffects are related to the pressure waveform (Moya et al, 2018;d'Agostino et al, 2015).…”