Summary
Dr. Jeremy Schroeder interviews Dr. Adam Tenforde, director of running medicine at Spalding National Running Center and co-director of Harvard Sports Medicine, about the current state of extracorporeal shockwave therapy in sports medicine. Dr. Tenforde explains the evolution from lithotripsy-based OR procedures to portable outpatient focused shockwave devices that can treat a broad range of musculoskeletal conditions without anesthesia. The discussion covers the critical distinctions between radial pressure waves and focused shockwave, their different FDA classifications, and the expanding applications across tendinopathies, bone stress injuries, avascular necrosis, and joint conditions. Dr. Tenforde highlights the growing scientific consensus that radial pressure waves are not true shockwaves and emphasizes the importance of understanding proper dosing, device physics, and post-treatment rehabilitation for optimal outcomes.
Key Points
- Shockwave therapy originated from lithotripsy for kidney stones in the 1980s and has rapidly expanded into sports medicine
- Radial pressure waves are not true shockwaves and differ significantly from focused shockwave in energy delivery and tissue penetration
- Focused shockwave can treat bone pathologies including stress fractures, avascular necrosis, and bone stress injuries
- Three types of focused shockwave devices exist: electromagnetic, electrohydraulic, and piezoelectric
- Shockwave is being used across cardiology, urology, neurology, dermatology, and sexual health
- Combined use of radial pressure wave with focused shockwave plus rehabilitation produces the best outcomes
- Future research priorities include bone stress injury treatment, combining orthobiologics with shockwave, and optimizing post-treatment rehabilitation
Key Moments
Origins of shockwave in sports medicine and the shift from OR to outpatient
Dr. Tenforde traces shockwave from lithotripsy in the 1980s to modern portable devices that can be used in outpatient clinics without anesthesia, explaining why this shift has made ESWT accessible and safe for sports medicine applications.
"So shockwave has been a concept in the general medicine world since the early 80s when it was used to treat kidney stones."
Radial pressure waves are not true shockwaves
Dr. Tenforde clarifies the scientific consensus that radial pressure waves are not true shockwaves and explains the three types of focused shockwave generators (electromagnetic, electrohydraulic, piezoelectric) and their different clinical applications.
"Our real understanding of the science is that the radial pressure waves are not a true shock wave. They're offered by a number of individuals, including non-physicians, and they don't create the same type of true shock wave that a focus device creates."
Focused shockwave treats bone pathologies beyond soft tissue
Dr. Tenforde explains how focused shockwave expands treatment to bone stress injuries, fractures, avascular necrosis, and joint conditions, with applications growing across cardiology, urology, neurology, and sexual health.
"but also to treat bone pathologies. So we can treat fractures, we can treat bone stress injuries, we can treat avascular necrosis, we can treat other joint conditions."
