Radial Pressure Wave and Focused Shockwave Therapy for Proximal Hamstring Tendinopathy: The Role of Patient Positioning, a Narrative Review and Clinical Commentary.

Only six studies exist and only two are randomised trials; the rest are retrospective reviews and case reports, which cannot show that a treatment works. The studies used different devices, doses, numbers of impulses and outcome measures, so their results cannot be pooled or directly compared, and the review itself only describes them. The two retrospective reviews came from the same institution, so some of the 217 patients may be counted twice. No study compared one patient position against another, and none reported outcomes using the side-lying position the authors recommend, so the paper's central suggestion is untested. The two cases describe single athletes who returned to sport; that is not evidence that the shockwave caused the improvement. The authors are reporting their own clinical preference for positioning, and no patient-reported outcomes using that position have been published.

The authors declare they have nothing to disclose. No funding source is reported. The corresponding author works in clinical regenerative medicine at the Mayo Clinic.

Do not take this paper as evidence that patient positioning changes outcomes. The side-lying position it recommends has never been tested: no study has reported outcomes using it, and none has compared one position with another. The recommendation comes from the authors' reasoning about how the waves travel and how deep the tendon sits, not from patient results.