title: ESWT for tendinopathy: technology and clinical implications.
abstract: OBJECTIVE
  The general consensus that tendinopathy, at least in the chronic stage, is mainly a degenerative condition and inflammation plays a minor role has led to a shift from treatments that target inflammation towards treatment options that promote regeneration. One of these treatments is extracorporeal shockwave therapy (ESWT), a physical therapy modality that uses pressure waves to treat tendinopathy. This review was undertaken to give an overview of the literature concerning this treatment, and special attention is given to the differences between focused and radial ESWT.
  
  
  METHODS
  A narrative description of wave characteristics, generation methods and in vitro effects of ESWT is given. The literature on ESWT as a treatment for one common tendinopathy, patellar tendinopathy, was systematically reviewed.
  
  
  RESULTS
  Waves that are generated for focused and radial ESWT have very different physical characteristics. It is unclear how these characteristics are related to clinical effectiveness. Studies into the biological effects of ESWT have mainly used focused shockwave therapy, showing a number of effects of shockwaves on biological tissue. The systematic review of studies into the clinical effects of ESWT for patellar tendinopathy showed conflicting evidence for its effectiveness.
  
  
  CONCLUSIONS
  Physical characteristics of focused and radial waves differ substantially, but effect on clinical effectiveness is unclear. Whereas in vitro studies often show the effects of ESWT on tendon tissue, results of clinical studies are inconsistent. Based on the review of the literature, suggestions are given for the use of ESWT in clinical practice regarding timing and treatment parameters.
authors.affiliation: Center for Sports Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. h.van.der.worp@umcg.nl
authors.forename: Henk
authors.initials: H
authors.lastname: van der Worp
authors.forename: Inge
authors.initials: I
authors.lastname: van den Akker-Scheek
authors.forename: Hans
authors.initials: H
authors.lastname: van Schie
authors.forename: Johannes
authors.initials: J
authors.lastname: Zwerver
mesh_terms: D002114:Calcinosis / Q000628:therapy; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D059408:Pain Management; D012038:Regeneration / Q000528:radiation effects; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D014464:Ultrasonic Therapy / Q000379:methods*; D014463:Ultrasonography