title: Historical ESWT Paradigms Are Overcome: A Narrative Review.
abstract: Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated.
authors: European Sportscare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany; Institute for Sport and Sport Sciences, Albert-Ludwigs-Universität Freiburg im Breisgau, Schwarzwaldstraße 175, 79117 Freiburg, Germany; European SportsCare, 68 Harley Street, London W1G 7HE, UK.
authors: Heinz
authors: 0000-0001-5949-4867
authors: H
authors: Lohrer
authors: European Sportscare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany; European SportsCare, 68 Harley Street, London W1G 7HE, UK.
authors: Tanja
authors: T
authors: Nauck
authors: Aspetar Orthopaedic and Sports Medicine Hospital, Sport City Street, P.O. Box 29222, Doha, Qatar; Institute for Postgraduate Studies in Manual Therapy, 111528 Athens, Greece.
authors: Vasileios
authors: V
authors: Korakakis
authors: European SportsCare, 68 Harley Street, London W1G 7HE, UK; Thessaloniki Sports and Exercise Medicine Clinic, Asklipiou 17, 54639 Thessaloniki, Greece; National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Kautatzoglion Stadion, Agiou Dimitriou 100, 54636 Thessaloniki, Greece; Sports Clinic, Rheumatology Department, Barts Health NHS Trust, Bancroft Road, London E1 4DG, UK; Centre for Sports and Exercise Medicine, Queen Mary, University of London, Bancroft Road, London E1 4DG, UK.
authors: Nikos
authors: N
authors: Malliaropoulos
mesh_terms: D050723:Fractures, Bone / Q000628:therapy*; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D009140:Musculoskeletal Diseases / Q000628:therapy*; D033262:Narration; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D016896:Treatment Outcome