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Updated: Sep 23, 2026
A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy
Published on: August 2, 2024
Systematic Review and Meta-analysis Assessing the Effects of Focal and Radial Extracorporeal Shockwave Therapy on
Adam Friedman1, Seth Spicer1, Jared Garfinkle1
1Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ.
Objective:
To evaluate the effectiveness of focal or radial extracorporeal shockwave therapy (ESWT) in improving pain and function in individuals with patellar tendinopathy (PT) through a systematic review and meta-analysis.
Data Sources:
A comprehensive literature search was conducted in PubMed, Embase, and Web of Science up to May 27, 2025. Search terms were related to ESWT and PT. Additional gray literature was assessed using Google Scholar.
Study Selection:
Studies were included if they used focused or radial ESWT to treat PT and reported pre- and posttreatment outcomes using the visual analog scale (VAS) and/or the Victorian Institute of Sport Assessment (VISA). Randomized controlled trials, prospective cohort studies, and retrospective chart reviews were eligible. Thirteen studies (n=530 for VAS; n=369 for VISA) met the inclusion criteria.
Data Extraction:
Two authors independently extracted VAS, VISA, SDs, and sample sizes. Data from 12- to 16-week follow-up were prioritized when multiple follow-up points were reported.
Data Synthesis:
A random-effects meta-analysis was performed across 13 studies totaling 899 participants (530 for VAS, 369 for VISA). ESWT demonstrated a significant VAS reduction of 2.53 (from 5.24 to 2.71) and VISA increase of 20.22 (from 54.65 to 74.86), both exceeding minimal clinically important difference thresholds (VAS: 1.2; VISA: 7.3). Effect sizes were large (VAS d=-1.54; VISA d=1.76). Randomized trials generally had a low risk of bias; nonrandomized studies had higher bias but minimal influence on pooled effects. Certainty of evidence was rated using Grading of Recommendations Assessment, Development, and Evaluation: 4 high, 6 moderate, and 3 low-quality studies. Heterogeneity was high, but most ESWT arms showed consistent clinical benefit.
Conclusions:
ESWT significantly reduces pain and improves function in patients with PT, with effect sizes exceeding clinically meaningful thresholds. It represents a viable noninvasive treatment option for individuals not responding to conservative care. Future research should focus on standardizing ESWT protocols and follow-up intervals to enhance reproducibility and clinical translation.
