Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial.
Baraa Alsulaimani, Luke Perraton, Patrick Vallance and 2 others
PMID 39704142WHAT IT FOUND
Adding shockwave therapy to exercise and education made no difference to pain or function compared to sham at 12 weeks.
Both groups improved similarly. Shockwave therapy offers no benefit over recommended care for insertional Achilles tendinopathy.
Key findings
01There were no significant differences between the shockwave and sham groups in the primary outcome of pain and function at either 6 or 12 weeks.
02No secondary outcomes, including worst pain, physical activity, or psychological factors, showed significant differences between the groups.
03Sham treatment was less painful than active shockwave therapy, but the difference did not translate into different clinical outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sham procedure still caused substantial pain (mean 7.3/10) compared to active treatment (mean 3.8/10), which may have reduced the perceived difference between groups. The physiotherapists delivering the shockwave or sham treatment were not masked to allocation, although they used a script. The exact energy dose delivered to the tendon insertion is uncertain due to device variability. Participants were excluded if they had previously received shockwave therapy, which may limit generalisability to those who have tried it before.
Declared interests
Funding was provided by DJO Global (AUD 20,000), a manufacturer of medical devices including shockwave therapy equipment. The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret the lack of difference as evidence that exercise and education are ineffective. Both groups improved significantly from baseline, suggesting the recommended care was effective, but shockwave therapy added no further benefit.