title: The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review.
abstract: BACKGROUND
  Achilles tendinopathy is a pathological state resulting from repetitive loading or stress on the tendon. Extracorporeal shock wave therapy (ESWT) is hypothesized to be an effective alternative intervention to surgery when other conservative therapies fail. This systematic review investigated the effectiveness of ESWT in the treatment of insertional and noninsertional Achilles tendinopathies.
  
  
  METHODS
  Articles were electronically searched from the Cochrane Controlled Trials Register, MEDLINE, CINAHL, EMBASE, and SPORTDiscus using a comprehensive search strategy. Studies were included if they were prospective clinical trials examining the effectiveness of ESWT for insertional or noninsertional Achilles tendinopathies. Methodological quality of included studies was assessed using PEDro scale and Modified McMaster tool. The strength of the evidence was reported using the National Health and Medical Research Council body of evidence framework. A narrative summary of the findings was presented.
  
  
  RESULTS
  Four of the included studies were randomized controlled trials, and 2 were pre-post study designs. Common methodological deficiencies included not blinding the clinician and participants. There was consistent evidence from 4 reviewed studies on the effectiveness of ESWT in the management of patients with chronic Achilles tendinopathies at a minimum 3 months' follow-up.
  
  
  CONCLUSIONS
  Overall, our review showed satisfactory evidence for the effectiveness of low-energy ESWT in the treatment of chronic insertional and noninsertional Achilles tendinopathies at a minimum 3 months' follow-up before considering surgery if other conservative management fails. However, combining ESWT with eccentric loading appears to show superior results.
  
  
  METHODS
  Level 1, systematic meta-analysis.
authors: King Fahad Medical City, Riyadh, Saudi Arabia. hmalabbad@kfmc.med.sa
authors: Hani
authors: H
authors: Al-Abbad
authors: Joel Varghese
authors: JV
authors: Simon
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology*; D002908:Chronic Disease; D004185:Disability Evaluation; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D010147:Pain Measurement; D052256:Tendinopathy / Q000503:physiopathology / Q000628:therapy*