Summary
Brodie examines a study on sex differences in shockwave therapy outcomes for runners with Achilles or hamstring tendinopathy. The retrospective cohort study followed 88 runners (48 female, 40 male) treated by a single physician from 2017-2021, looking at whether gender, hormonal contraceptives, menopause, or triad-related risk factors influenced treatment response. The key finding was that males and females responded equally well to shockwave, and triad-related risk factors did not influence outcomes. However, female runners using oral contraceptives were significantly less likely to achieve clinically significant improvement, potentially due to estrogen's impact on collagen synthesis and tendon healing. The episode also reviews how shockwave works through angiogenesis, cell signaling via ATP, and analgesic effects through nitric oxide release, and discusses ideal protocols of 3-4 weekly sessions with full effects seen at 12 weeks.
Key Points
- Males and females respond equally to shockwave therapy for Achilles and hamstring tendinopathies
- Female runners on oral contraceptives were significantly less likely to achieve clinically meaningful improvement
- Estrogen impacts collagen synthesis and turnover, potentially affecting tendon healing with ESWT
- Shockwave works through angiogenesis, ATP-mediated cell signaling, and nitric oxide-mediated analgesia
- Standard protocol is 3-4 weekly sessions with follow-up at 3 months and full effects at 12 weeks
- Patients should avoid NSAIDs during treatment to preserve the inflammatory healing cascade
- Combining shockwave with progressive loading exercise yields the best long-term outcomes
Key Moments
Oral contraceptives significantly reduce shockwave therapy effectiveness
A study of 88 runners found that female runners using oral contraceptives were significantly less likely to achieve clinically meaningful improvement from shockwave therapy, likely due to estrogen's impact on collagen synthesis and tendon healing.
"Female runners who used an oral contraceptive were significantly less likely to achieve this clinically significant difference."
Shockwave mechanisms include angiogenesis, ATP signaling, and nitric oxide
Shockwave therapy elicits healing through multiple mechanisms: destruction of calcifications, angiogenesis during tendon repair, activation of cell signaling via ATP release, and anti-inflammatory and analgesic effects through nitric oxide release.
"or likely elicit various healing mechanisms, including the destruction of calcifications, angiogenesis, which is like the generation or proliferation of blood vessels. So angiogenesis in the inflammatory phase of tendon repair."
Males and females respond equally to shockwave for tendinopathy
Contrary to concerns about hormonal influences, the study found no difference in shockwave outcomes between male and female runners, and triad-related risk factors did not influence treatment response.
"as hypothesized, no difference was found in achieving the minimal clinical difference between sexes. So males and females responded equally."
