Summary
Brodie, an online physiotherapist who overcame proximal hamstring tendinopathy himself, provides a comprehensive look at shockwave therapy for tendon injuries. He interviews shockwave expert Benoit Mathieu and reviews research on who makes a good candidate for ESWT, specifically people with chronic (3+ months), low-level, localized, stubborn tendinopathy that hasn't responded to progressive loading. The episode examines a study on shockwave outcomes for proximal hamstring tendinopathy showing that 85% of patients experienced at least 50% pain reduction compared to only 10% with traditional conservative treatment. Brodie emphasizes that shockwave provides short-term pain relief while strength training is essential for long-term tendon resilience, and combining both approaches yields the best outcomes.
Key Points
- Best candidates for shockwave have chronic (3+ months), low-level, localized, stubborn tendinopathy unresponsive to loading
- A study showed 85% of PHT patients had at least 50% pain reduction with ESWT vs 10% with conservative treatment alone
- Shockwave provides short-term pain relief through analgesic effects and promotes neovascularization
- Strength training is critical for long-term tendon resilience and preventing recurrence
- Combining shockwave with progressive strength training yields the best patient outcomes
- Minimum of three weekly sessions is needed for therapeutic benefit, with improvements plateauing after five to six sessions
- Full effects of shockwave may take up to 12 weeks after the last session
Key Moments
Who is a good candidate for shockwave therapy
Good candidates for shockwave have chronic tendinopathy lasting 3+ months with low-level (1-2 out of 10), localized, stubborn pain that doesn't respond to progressive loading. Acute, highly sensitive, or widespread pain is not well-suited for ESWT.
"lateral hip, proximal hamstring tendinopathy. That's pretty much, and I do treat, might not be relevant for runners. I do treat a lot of groin patient on adductor tendon as well. So that might not be relevant for, so those are the areas where it's very reasonable to try shockwave, especially if they're filled with good quality rehab. Okay. So we're looking at those areas that you listed and we're looking for a kind of low level, achy, high functioning area."
85% pain reduction with shockwave vs 10% with conservative treatment
Research shows 85% of proximal hamstring tendinopathy patients experienced at least 50% pain reduction with ESWT compared to only 10% in a traditional conservative treatment group that included exercise.
"quite a significant group, I would say at least one in four or at least 20 to 30% of patients where despite good rehabilitation, they were still struggling with pain. Obviously, they had improvement. So this is sort of nine, 10 years ago. So I'm talking about patients with runners with Achilles tendon and lateral hip pain and peltier tendon. And many of them didn't want injections or PRP and things like that. So"
Combining shockwave with strength training yields the best outcomes
While shockwave provides effective short-term pain relief, strength training is vital for long-term tendon resilience. Combining both approaches produces the best patient outcomes for tendinopathies.
"evidence-based like real strength-based rehab programs. Is that right? Of course. Of course. We know that, you know, progressive loading shockwave, I keep it simple with my patients say shockwaves for pain relief and kickstart the healing. Whereas the function on the long-term recovery and also getting back into that full sport can only come from exercise and progressive loading. Shockwave is not going to make you stronger and it's not going to get you into the performance area as well. The two points I would like to pick up here is the,"
