title: The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review.
abstract: BACKGROUND
  There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT).
  
  
  OBJECTIVE
  To evaluate the effectiveness of ESWT for lower limb tendinopathies.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.
  
  
  RESULTS
  A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (<12 months) and long (>12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone.
  
  
  CONCLUSIONS
  Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed.
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
authors.forename: Sethu
authors.initials: S
authors.lastname: Mani-Babu
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK d.morrissey@qmul.ac.uk.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Waugh
authors.affiliation: School of Engineering and Materials Sciences, Queen Mary University of London, London, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Screen
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK Complete Sports Care, Melbourne, Australia Pure Sports Medicine, London, UK Lower Extremity Gait Studies, La Trobe University, Melbourne, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Barton
mesh_terms: D000125:Achilles Tendon; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006621:Hip Joint; D006801:Humans; D035002:Lower Extremity; D017847:Patellar Ligament; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome
keywords: Achilles tendinopathy; extracorporeal shock wave therapy; greater trochanteric pain syndrome; patellar tendinopathy