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Patients with severe motor and intellectual disability (SMID) experience persistent spastic pain and severe malpositioning of the limbs, exacerbated by the lack of effective treatment for severe spastic palsy. This study (UMIN-CTR, UMIN000048842) aimed to evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for spastic palsy in these patients. rESWT was applied to the biceps brachii of 15 elbow joints with flexion pattern spastic palsy of Modified Ashworth Scale (MAS) grade 1+ or greater in 11 patients with SMID. The MAS score, elbow range of motion (ROM) and adverse events were monitored for up to 10 weeks. Electromyography signals at rest were recorded on 8 elbow joints. Following a single rESWT session, the spasticity of the elbow joint immediately decreased, the MAS score significantly decreased from 2 (range, 2–3) to 1 (range, 1–2), and the elbow ROM significantly increased by 10° (range, 0°–15°). Moreover, muscle activity decreased by 24% (range, 11–37%), being clinically meaningful in SMID. rESWT resulted in an immediate and clear improvement in the MAS score for approximately 8 weeks and in the elbow ROM, continuing even at 10 weeks. Our findings highlight rESWT as a non-invasive therapy for spastic palsy in patients with SMID.

ObjectivesWhile extracorporeal shockwave therapy (ESWT) may be an efficacious adjunctive treatment option for musculoskeletal injuries, current research is limited by significant heterogeneity within treatment protocols. This study aims to establish international expert consensus recommendations on ESWT terminology, parameters, procedural considerations, contraindications and side effects in the application of ESWT to sports injuries.MethodsA systematic literature search was performed on the use of ESWT for musculoskeletal and sports medicine injuries to identify potential panellists, followed by the development of a steering committee-led questionnaire. A three-stage, modified Delphi questionnaire was provided to a panel of 41 international clinical and research experts across 13 countries. Panellists had the opportunity to suggest edits to existing statements or recommend additional statements in Round 1. Consensus was defined as≥75% agreement.ResultsAll 41 panellists completed Rounds 1, 2 and 3. Consensus was reached on 69/118 statements (58.5%), including recommendations on terminology and fundamental concepts, indications for use, procedural aspects for tendinopathy and bone pathologies, treatment correlations with imaging, periprocedural and postprocedural considerations, absolute and relative contraindications and potential side effects. Of the 49 statements that did not reach consensus, 17/49 (34.7%) were related to procedural aspects of bone pathology.ConclusionThis international panel presents recommendations on ESWT terminology, indications and treatment considerations to guide ESWT use and decision-making by sports medicine clinicians. While our panel supported the use of ESWT in the treatment of bone pathologies, certain procedural aspects of ESWT specific to these injuries did not reach consensus and require further investigation.

Background. The superiority of focused shockwave therapy (F-SWT) versus radial shockwave therapy (R-SWT) for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of F-SWT versus R-SWT for the management of noncalcific rotator cuff tendinopathies. Methods. A total of 46 patients affected by noncalcific rotator cuff tendinopathies were randomly divided into 2 groups of 23 individuals. Patients in group A received 4 sessions of F-SWT, while patients in group B were treated by 4 sessions of R-SWT. In each session, mean energy flux density (EFD) for F-SW 3000 shots was 0.09±0.018 mJ/mm2 with 5.1±0.5 Hz, while average pressure for R-SW 3000 shots was 4.0±0.35 bar with 3.2±0.0 Hz. Pain level and shoulder function were assessed with the numerical rating scale (NRS) and Constant-Murley Scale (CMS). The primary endpoint was the change in the mean NRS pain score from baseline to 24 weeks after the intervention. Secondary endpoints were changes in the mean NRS pain scores at all other follow-up points, changes in the mean CMS scores, and radiographic findings. Results. There were no significant differences between the two groups regarding NRS pain score and CMS score within 24 weeks after intervention (all p>0.05). However, F-SWT resulted in significantly lower NRS compared with R-SWT at 24 weeks and 48 weeks after treatment (2.7±1.0 vs. 4.5±1.2 and 1.4±1.0 vs. 3.0±0.8, respectively, all p<0.001). Similar results were found in CMS changes and radiographic findings. Conclusions. Both F-SWT and R-SWT are effective in patients with noncalcific rotator cuff tendinopathy. F-SWT proved to be significantly superior to R-SWT at long-term follow-up (more than 24 weeks). This trial is registered with ChiCTR1900022932.

Background Knee osteoarthritis (KOA) is the most common degenerative joint disease. It is characterized by pain, stiffness, reduced joint motion, and muscle weakness. It also has the potential for long-term disability. Radial extracorporeal shock wave therapy (rESWT) is a noninvasive therapeutic modality widely used for the treatment of musculoskeletal disorders. However, the role of rESWT in the treatment of knee osteoarthritis remains controversial in previous clinical trials. This trial will investigate the efficacy of rESWT in improving the symptoms, function, and bone metabolic status of participants with knee osteoarthritis. Methods The study is a randomized, double-blind, controlled trial. Thirty participants with knee osteoarthritis will be randomized to receive either rESWT or sham rESWT on the affected knee once per week for 4 weeks. All participants will undergo professional physiotherapy once a week during the treatment period. The primary outcome is the visual analogue scale score for pain. Secondary outcomes include the Western Ontario and McMaster Universities Osteoarthritis Index score, knee range of motion, the 10-m walk test results, and bone metabolism biochemical indicators. Outcomes will be measured at baseline (T0), 5 weeks post-intervention (T1), and 8 weeks post-intervention (T2). Discussion This study will investigate the effects of rESWT on pain, physical function, and bone metabolism biochemical indicators in participants with knee osteoarthritis, which is expected to reduce the pain of participants, improve the function of participants, and improve bone metabolism biochemical indicators. The information obtained will enhance our understanding of rESWT for the treatment of knee osteoarthritis and may be used to standardize clinical treatment protocols for knee osteoarthritis. Trial registration Chinese Clinical Trial Registry ChiCTR2300069997. Registered on 30 March 2023.

Objectives:To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy.Patients & methods:A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT.Results:A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT (p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased.Conclusion:ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

Persistent symptoms of lateral epicondylitis prompt patients to seek effective conservative treatment. The study aimed to determine the effects of focused shock wave (FSWT) and ultrasound therapies for lateral epicondylitis. Sixty patients with tennis elbow were randomly divided into three equal groups: A, B, and C. Group A received a total of 3 FSWT sessions, with 7 days between treatments; Group B received ultrasound therapy in 10 sessions over 2 weeks, while patients in Group C were treated with placebo ultrasound. All patients were also given deep friction massage. Before the start of therapy, and at 1, 3, 6, and 12 weeks after its completion, pain intensity and function of the affected upper limb were assessed in all patients. Wrist extensor and flexor strength and grip strength were measured in the affected and unaffected limb. Significant reductions in pain and significant improvements in the function of the affected limb compared to baseline values were observed in all study groups at 6 and 12 weeks after the completion of therapy. Analysis of percentage changes in these variables showed significant differences between Groups A and B in favor of Group A. The strength of wrist extensors and grip strength of the affected limb at 6 and 12 weeks after treatment completion was significantly higher in Groups A and B compared to pre-therapy values. However, there were no statistically significant differences between the groups regarding percentage changes in muscle strength in the affected limb. Pain reduction and function improvement in patients with lateral epicondylitis were significantly greater after FSWT (0.2 mJ/mm 2 / 4 Hz / 2000 shocks) than after sonotherapy (3 MHz / 0.5 W/cm 2 / 20%). Increases in wrist extensor strength and grip strength of the affected limb were comparable after both therapies. Given the greater therapeutic effect in the subjective evaluation, we recommend a combination therapy of FSWT with deep friction massage. Trial registration The trial was prospectively registered in the ISRCTN registry (no. ISRCTN11907358 registration date 30.07.2020).

ObjectivesTo assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy.Methods200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0–10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months.ResultsThe primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (−0.02, 95% CI −1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI −0.49 to 1.53) and exercise versus advice plus customised foot orthoses (−0.11, 95% CI −1.11 to 0.89) at 6 months.ConclusionIn patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain.Trial registration number NCT03472989.

SummaryIt has been proved that extracorporeal shock wave therapy (ESWT) could promote new bone formation. Therefore, we designed an experiment to test the efficiency of ESWT on BMD in postmenopausal osteoporotic patients. The results showed that ESWT could effectively improve the local bone mass of the treated bone area within a short duration.IntroductionThis study evaluated the short-term effectiveness of extracorporeal shock wave therapy (ESWT) on bone mineral density (BMD).MethodsA total of 64 postmenopausal osteoporotic patients were recruited and randomized into 3 groups in 2015. Groups A (n = 20) and B (n = 21) patients received a single-session of low- or high-energy flux density (EFD) ESWT in the left hip, respectively, whereas group C (n = 23) patients served as controls without the ESWT treatment. All patients self-administered alendronate sodium tablets orally for a year. The BMD of the lumbar spine (L2-L4), femoral neck, great tuberosity, and total left hip was measured before ESWT treatment and at 3, 6, and 12 months using dual energy X-ray absorptiometry (DEXA).ResultsAt 12 months, the lumbar spine, femoral neck, great tuberosity, and total left hip BMD in all patients had increased (p < 0.01). The increase in lumbar spine BMD in group A patients was higher than that in group B patients (p = 0.03); other between-group differences were not observed (p = 0.73, group A vs. C; p = 0.06, group B vs. C). The femoral neck, great tuberosity, and total left hip BMD increases in group B patients were higher than that in either group A or C (p < 0.01, group B vs. A; p < 0.01, group A vs. C).ConclusionThis study showed that ESWT could efficiently improve the local BMD; relatively, the high dosage was effective.

Although peloidotherapy and ESWT are effective treatments for plantar fasciitis, there is no comprehensive research that directly compares their effectiveness. Our study aimed to compare the effectiveness of ESWT and peloidotherapy on pain, quality of life and functional status in individuals diagnosed with plantar fasciitis (PF). A total of 78 patients, aged between 18 and 65 years, diagnosed with PF after a thorough anamnesis and physical examination and experiencing heel pain for at least 3 months or longer and who presented to the Clinic between January 2021 and January 2023, were included in the study. Patients were randomly allocated to two groups. The peloidotherapy group received 15 sessions of peloid therapy five days a week for three weeks, while the ESWT group received three sessions of radial-type ESWT once a week for three weeks. Additionally, all patients were given a home exercise program. All patients were evaluated three times for treatment efficacy. Pain levels were assessed using the Visual Analog Scale (VAS) and Heel Tenderness Index (HTI), functional status and quality of life were assessed using the Foot Ankle Outcome Score (FAOS) and Short Form 36 (SF-36), respectively. In both treatment groups, there was a statistically significant improvement in VAS, HTI, FAOS and SF-36 scores at the end of treatment and during the one-month follow-up, compared to the initial baseline values. A statistically significant difference in favor of peloidotherapy was observed in post-treatment symptom and pain scores ( p  = 0.046). However, this difference did not persist at the one-month follow-up. Both active treatment methods were similarly effective and no superiority was observed between them ( p  > 0.05). Peloidotherapy and ESWT treatments, along with a home exercise program, were found to be effective for patients with plantar fasciitis. In the conservative treatment of PF, both peloidotherapy and ESWT can be recommended as effective and reliable options.

Coronary heart disease (CHD) affects a large number of patients, and their survival period with the condition is relatively long. Cardiac shock wave therapy (CSWT) is an anti-myocardial ischemic therapy. This study aims to investigate the rehabilitative effects and underlying mechanisms of CSWT combined with exercise rehabilitation in patients undergoing percutaneous coronary intervention (PCI) for CHD. The study was a prospective randomized controlled trial conducted at Yunnan Fuwai Cardiovascular Hospital from 2020 to 2022, enrolling 74 patients who underwent PCI for CHD. They were randomly assigned to two groups: a control group of 37 patients and a study group of 37 patients. The intervention consisted of CSWT combined with exercise rehabilitation. Following the intervention, patients in the study group demonstrated increases in peak oxygen uptake (peak VO2), high-density lipoprotein cholesterol (HDL-C) and other parameters compared to pre-treatment levels. The combination of CSWT and exercise rehabilitation was found to improve myocardial markers, related anti-inflammatory and anti-atherosclerotic indicators in patients with CHD. Moreover, it alleviated myocardial ischemia while enhancing parameters such as oxygen uptake in cardiopulmonary exercise testing (CPET). These findings may offer novel insights into anti-ischemic treatment and cardiac rehabilitation for patients with CHD in future clinical practice.