As long as I have been in the profession, clinicians have continued to search for the next best thing to reduce pain and inflammation, as well as, improve any number of clinical factors. Unfortunately, the medical literature is filled with trials showing non significant effects as many of these devices have failed to outperform proven Physical Therapy interventions or some cases even a placebo. Clinicians unfamiliar with the evidence continue to utilize these devices at the patient’s expense delaying proven treatments and prolonging recoveries.
Shock wave therapy was initially introduced in the 1980s to treat urological conditions before being applied in orthopedic patient populations. The effects of this modality are under debate but proposed mechanisms include improvements in circulation, cell turn over, and tissue remodeling. While early studies showed promise with bone healing after fracture, most of the clinical applications found today involve treatment of soft tissue injuries including tendinopathy. A recent Cochrane Review was conducted to determine the strength of evidence supporting its’ use in rotator cuff injuries.
Surace and colleagues publisher their findings last year in the Cochrane Database of Systematic Reviews (2020). The authors reviewed 25 total trials focusing on the effects of shock wave therapy compared to placebo. They found no study reported > 30% improvement in patient pain scores. Significant bias and methodological limitations prevented extrapolation from the studies. Despite this low to moderate quality evidence, the authors concluded there was very few clinical benefits after the utilization of shock wave therapy for rotator cuff disease. Authors expressed uncertainty on the safety of its’ utilization.
Patients are encouraged to work with more proven interventions for rotator cuff pain including Physical Therapist prescribed strength training exercises.
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