Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners

Abstract

Bone stress injury (BSI) is a common overuse injury that can result in prolonged time away from sport. Limited studies have characterized the use of extracorporeal shockwave therapy (ESWT) for the treatment of BSI. The purpose of this study was to describe the use of ESWT for the management of BSI in runners. A retrospective chart review was performed to identify eligible patients in a single physician’s clinic from 1 August 2018 to 30 September 2022. BSI was identified in 40 runners with 41 injuries (28 females; average age and standard deviation: 30 ± 13 years; average pre-injury training 72 ± 40 km per week). Overall, 63% (n = 26) met the criteria for moderate- or high-risk Female or Male Athlete Triad categories. Runners started ESWT at a median of 36 days (IQR 11 to 95 days; range 3 days to 8 years) from BSI diagnosis. On average, each received 5 ± 2 total focused ESWT treatments. Those with acute BSI (ESWT started <3 months from BSI diagnosis) had an average return to run at 12.0 ± 7.5 weeks, while patients with delayed union (>3 months, n = 3) or non-union (>6 months, n = 9) had longer time for return to running (19.8 ± 14.8 weeks, p = 0.032). All runners returned to pain-free running after ESWT except one runner with non-union of grade 4 navicular BSI who opted for surgery. No complications were observed with ESWT. These findings suggest that focused ESWT may be a safe treatment for the management of BSI in runners.

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“…Beling et al [52] conducted a study investigating focused shockwave treatment for Bone Stress Injuries (BSI) in runners. The study incorporated 40 runners with majority having injury to metatarsal or posteromedial tibia and underwent ESWT treatment for 5-7 treatments.…”

“…4(5).2024 expected. Studies with larger sample studies would be indicated to further investigate focused shockwave treatment for Bone Stress Injuries (BSI) [52]. Sansone et al [53] studied 86 patients with 3 treatments of high energy ESWT treatment to the medial knee showing 86% reduction in bone marrow edema compared to 41% in control after 6 months.…”