Shin Splints (Medial Tibial Stress Syndrome)


Shin splints can be extremely difficult to treat, but ESWT has proven to be very effective as an adjunct to treat this challenging problem. 

Extracorporeal Shockwave Therapy

Results (based on studies):

  • Studies in military cadets showed a single treatment increased the ability to run to 17 min 33 sec in 4 weeks, but stayed constant at 4 min 48 sec in the untreated group (12). 
  • A similar study in athletes looked at the ability to run 18 min without pain. The ESWT group was able to accomplish this in an average of 59.7 days whereas it took 91.6 days in the control (13).
  • Other studies showed pain significantly decreased compared to controls. 

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Results (based on studies):

  • 53% of patients were considered recovered or much improved (9), but when added to eccentric exercises it increased to an impressive 82% when compared to eccentric exercises alone (56%) (10).
  • 64% of patients suffering from insertional Achilles tendinopathy were fully recovered or much improved (11).

Indications for Treatment

Other


ESWT is proving to have positive outcomes in osteoarthritis, avascular necrosis, nonunion of fractures, and stress fractures. 

Results (based on study):

     Patients with >60% improvement: 63-100%. (1,2,5,6)

     

Results showed long term improvement when compared to cortisone injections (8). 

Treatment:

  • Treatment is initiated following 3 months of failed conservative treatment (7).
  • Takes about 10 minutes per session.
  • 2 sessions one week apart have been shown to be as effective as 3 or more; therefore, our protocol involves just 2 sessions (1).
  • There are no injections. Treatment protocol is based on tolerance to the procedure.
  • NSAID's such as ibuprofen are discouraged during recovery.
  • Normal activity can be resumed immediately following treatment. Impact activity such as jumping or running is discouraged for 2 weeks following last treatment.
  • Pain will decrease with time with the most significant improvement over 8-12 weeks.

Plantar Fasciitis


Treatment for plantar fasciitis or heel pain using radial ESWT has proven to be extremely effective in multiple studies(1-8).

Extracorporeal Shockwave Therapy (ESWT) has been around for decades, originally developed as lithotripsy to eliminate kidney stones. About 20 years ago, research started looking at using it for musculoskeletal conditions. It has proven to be so effective for recalcitrant or chronic plantar fasciitis (heel pain) that it has received FDA approval.

Achilles Tendonitis


Treatment for Achilles tendonitis using radial ESWT has proven to be extremely effective. Primary treatment of midsubstance tendinopathy originally resulted in a 53% improvement, but when added to a regimen of eccentric loading improved 

* There are many more studies, but we have included only the best.

1. Ibrahim et al: Chronic Plantar Fasciitis Treated with 2 sessions of rESWT. Foot and Ankle International. 31(5); 391-397; 2010.​

​2. Gerdesmeyer et al: rESWT is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis. Am J Sport Med. 36(11); 2100-2109; 2008.

​3. Gollwitzer et al: Extracorporeal Shock Wave Therapy for Chronic Painful Heel Syndrome: A Prospective, Double Blind, Randomized Trial Assessing the Efficacy of a New Electormagnetic Shock Wave Device. J Foot Ankle Surg. 46(5): 348-357; 2007.

​4. Gollwitzer et al: Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. JBone Joint Surg Am. 97(9): 701-708; 2015.

​5. Malliaropoulos et al: Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study. Biomed Res Int. 2016; 1-8.

6. Yalcin et al: Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rehumatol Int. 32(2): 343-347; 2012.

7. Saxena et al: Treatment of Plantar Fasciitis With Radial Soundwave "Early" Is Better Than After 6 Months: A Pilot Study. J Foot Ankle Surg. 56(5): 950-953; 2017.

8. Hocaoglu et al: Comparative Effectiveness of Radial Extracorporeal Shockwave Therapy and Ultrasound-Guided Local Corticosteroid Injection Treatment for Plantar Fasciitis. J Am Pod Med Assoc. 107(3): 192-199; 2017.

9. Rompe et al: Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 35(3): 374-383; 2007.

​10. Rompe et al: Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 37(3):463-70; 2009.

11. Rompe et al: Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am. 90(1): 52-61; 2008.

12. Gomez et al: Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial. Int J Surg.  5;46:102-109; 2017.

​13. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study. Br J Sports Med. 46(4):253-7; 2012.

​14. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial. J Sci Med Sports. 20(3):220-224; 2017.