A critical appraisal evaluating the efficacy of extracorporeal shock wave therapy in coccydynia

Coccydynia is referred to as pain in the region of the coccygeal bone. It is usually managed conservatively with physiotherapy, education and medication. Symptoms can last a couple of weeks or up to five years. For severe cases, invasive interventions such as injections or surgery are currently the main options. The use of extracorporeal shock wave therapy (ESWT) is emerging as a successful, non-invasive treatment for a variety of musculoskeletal conditions. A systematic review by Nikouei et al., (2022) aimed to establish if ESWT was effective at alleviating pain for patients with coccydynia. This commentary provides a critical evaluation of the methods employed in this review and discusses the findings of the review in context to the four pillars of advanced practice: clinical practice, leadership and management, education, and research in physiotherapy.