Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study

Abstract

Objective The purpose of this study was to describe the results of two treatment regimens for medial tibial stress syndrome (MTSS); a graded running programme and the same running programme with additional shockwave therapy (extracorporeal shockwave therapy; ESWT). Design A prospective observational controlled trial. Setting Two different sports medicine departments. Participants 42 athletes with MTSS were included. Intervention Patients from one hospital were treated with a graded running programme, while patients from the other hospital were treated with the same graded running programme and focused ESWT (five sessions in 9 weeks). Main Outcome Measures Time to full recovery (the endpoint was being able to run 18 min consecutively without pain at a fixed intensity). Results The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a graded running programme, respectively 59.7±25.8 and 91.6±43.0 days (p=0.008). Conclusions This prospective observational study showed that MTSS patients may benefit from ESWT in addition to a graded running programme. ESWT as an additional treatment warrants further investigation in a prospective controlled trial with the addition of randomisation and double blinding.

The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

“…Moen et al 18 reported that five sessions of focused ESWT added to a graded running programme reduced significantly the time to full recovery (mean 32 days) compared with the running programme in isolation, as assessed by a treadmill running test. On the contrary, a high-quality, low risk of bias RCT20 that used the same ESWT protocol without additive controlled intervention reported no significant differences at 10-week follow-up between ESWT and sham dose ESWT groups in pain during muscle pressure (patient-rated improvement of ‘no change’ and ‘minimally improved’, respectively), pain-limited distance run and self-perception of change.…”

“…One study19 used the same low-energy protocol of radial ESWT for three sessions (energy flux density 0.1mJ/mm 2 ), while the other18 used a graded energy protocol of focused ESWT for five sessions (energy flux density from 0.1 to 0.3 mJ/mm 2 ), resulting in more than the double total energy flux. Contradictory results at short-term follow-up were presented by the only RCT20 that used the same ESWT protocol as a non-randomised study 18. Several considerations are raised regarding the effectiveness of ESWT as well as the dose of the mechanical energy to be transferred.…”

Acoustic field characterization of the Duolith: Measurements and modeling of a clinical shock wave therapy device

“…37 Nominal levels of 14-31 MPa were used to explore shock wave treatment for tibial stress syndrome in athletes. 38 Characterization of the acoustic fields produced by medical devices is usually performed in water and then the results are translated (derated) into tissue, where direct measurements are impossible in most cases. In recent studies, numerical modeling combined with measurements has been actively used to characterize acoustics fields from highpower ultrasound medical devices.…”

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

“…rESWT has been used to treat numerous other tendinopathies, such as epicondylitis,22,26 plantar fasciitis,26–28 patellar tendinopathy,21,26,29 shoulder calcific tendinitis,19,30,31 proximal hamstring tendinopathy,32 and medial tibial stress syndrome 20,33. However, to the authors’ knowledge, to date, no studies on rESWT and trigger digit have been conducted.…”