Achilles tendinopathy & extracorporeal shock wave therapy: a prospective, randomized, double-blind clinical trial.

PURPOSE This is a prospective study on the use of Extracorporeal Shock Wave Therapy (ESWT) for common chronic soft tissue injuries in athletes, who failed to improve after prolonged (at least 6 months) nonoperative treatments. MATERIAL / METHOD 102 consecutive athletes (30 women and 72 men; 43 competitive, 59 recreational) with a mean age of 46 years (range, 18 to 70 years) received 3 sets of ESWT consisting of 2000 impulses of an energy flux density of 0.25 mJ/mm2 in the painful area, at weekly intervals. A 100-point scoring system that included pain, motion and strength, was used for clinical evaluation. Average follow-up was 24 weeks (range, 23-25). RESULTS Pathologies observed in the current study were: calcifying tendinitis of the shoulder, achilles tendinopathies, painful heel syndromes, lateral epicondilitis, patellar tendinopathies, medial epicondilitis, distal enthesitis of anterior tibialis muscle, proximal enthesitis of rectus femoris, proximal enthesitis of the medial collateral ligament of the knee, distal enthesitis of gracilis muscle, distal enthesitis of flexor ulnaris carpi muscle. Remarkably good results were obtained in almost all treated pathologies although nearly one third of cases were physically unable to resume sports activities at the same previous level. Patellar tendon tendinopathy revealed to be relatively resistant to ESWT. Overall results were: 44.1% excellent, 27.4% good, 28.4% fair, none poor. CONCLUSION Our results favourably compare with those obtained after surgical treatment of most chronic tendinopathies. Time for sports resumption appears to be significantly reduced when compared with surgically treated patients. ESWT seems to be an effective, non invasive alternative to surgical treatment of most sports-induced chronic soft injuries, although more studies with longer follow-up are necessary to assess the durability of results