Dr. Andrew Bruns Chiropractic

09/13/2026

Association between radial extracorporeal shock wave therapy combined with physical therapy and treatment outcomes in lateral epicondylitis of the humerus: A propensity score-matched analysis

Makoto Takahashi et al. J Bodyw Mov Ther. 2026 Jul.

Background and objective: Few studies have evaluated the combined effects of radial extracorporeal shock wave therapy (rESWT) and physical therapy for lateral epicondylitis while adequately controlling for confounding factors. This study aimed to investigate the association between physical therapy combined with rESWT and treatment outcomes in patients with lateral epicondylitis of the humerus.

Methods: This retrospective observational study used propensity score-matched analysis and included 111 patients with lateral epicondylitis who underwent rehabilitation between 2010 and 2024. Patients received either physical therapy alone or physical therapy combined with rESWT delivered using a MasterPuls MP100 device. Treatment outcomes were assessed using patient-reported pain improvement on the Numerical Rating Scale, tenderness on palpation, and the chair test.

Results: After propensity score matching, a total of 86 patients were analyzed (43 per group). Patients who received rESWT demonstrated significantly higher odds of achieving a favorable treatment outcome than those who did not receive rESWT (odds ratio, 10.41; 95% confidence interval, 3.80-32.52; p < 0.001).

Discussion: Physical therapy combined with rESWT was associated with a substantially higher likelihood of pain improvement in patients with lateral epicondylitis. These findings provide preliminary evidence suggesting that the addition of rESWT to physical therapy may be associated with improved clinical outcomes.

06/09/2026

06/04/2026

Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain.

Participants: Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study.
Intervention: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment.

Main measures: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention.

Results: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, - 0.4; p< 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14,138.7; p < 0.01) than in the placebo group.

Conclusion: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Cláudio Gregório Nuernberg Back et al. Clin Rehabil. 2024 Aug.

05/28/2026

“Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. The subjects were divided into two groups: 32 subjects who followed a program of functional rehabilitation based on low- and medium-frequency electrotherapy, ultrasound and laser therapy, along with a physical therapy program lasting approximately 3 weeks, and 32 subjects who followed a functional rehabilitation program based on shockwave therapy and specific physical therapy exercises lasting approximately 3 weeks. Results: Following the protocols applied to the two groups, the pain reported by the patients decreased, while the functional parameters of the knee improved, better results being obtained in the group that performed shock wave therapy together with specific physical therapy programs (Cohen Index 5916, p < 0.001).”

“A total of 2000 pulses were delivered per session at a frequency of 10–15 Hz. The intensity was progressively increased from 0.2 to 0.5 BAR depending on patient tolerance. Therapy sessions were conducted twice per week for three weeks, with two days between sessions. Patients were positioned supine, with the affected leg in slight knee flexion and a towel under the popliteal area. Shockwaves were applied to the patellar tendon and the quadriceps insertion.”

“Conclusions: This study indicates that radial shockwave therapy combined with physiotherapy may provide additional benefits for patellofemoral syndrome, including greater pain reduction and improved joint mobility, compared to traditional treatments. However, further research is needed to confirm these findings and their broader clinical applicability.”

Marius Neculăeș et al. J Clin Med. 2024.

05/26/2026

“BACKGROUND Myofascial pain syndrome (MPS) is a common cause of chronic low back pain with trigger points in the muscles and fascia. This study compared outcomes after radial extracorporeal shock wave therapy (rESWT) plus physical therapy versus infrared therapy plus physical therapy among patients with myofascial low back pain.

MATERIAL AND METHODS Overall, 112 patients were randomly assigned to the experimental group (n=56) or control group (n=56). For 6 weeks, the experimental group received physical therapy combined with rESWT (2000 pulses, 2.0-2.5 bar, twice weekly), whereas the control group received physical therapy combined with infrared therapy (15 minutes per session, twice weekly). Primary outcomes were pain intensity (Numerical Rating Scale [NRS]), functional disability (Oswestry Disability Index [ODI]), and patient-reported improvement (Patient Global Impression of Change [PGIC]).

RESULTS The rESWT group showed greater improvements than the control group in pain (ANRS: 0.68+0.81 vs 0.13+0.66, P

04/14/2026

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“rESWT combined with physical therapy could be effective in relieving pain and improving function in muscle-related TMD patients.”

https://www.mdpi.com/2076-3417/12/8/3821

03/22/2026

“Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing.
Specifically, to characterize patients according to demographic and clinical variables; to describe pain evolution using the visual analog scale (VAS); to compare radiological changes using the Montoya scale at one, three, and six months; and to determine patient functionality and satisfaction.

Methods: A descriptive, longitudinal, and prospective study was conducted in 15 patients treated at the Instituto Vivir
Mejor between January 2022 and January 2025. The protocol included rESWT (BTL 5000 SWT Power, 4 bar, 15 Hz,
4,000 impulses, five weekly sessions), nutritional supplementation, and physiotherapy. Variables analyzed included sociodemographic characteristics, pain (VAS), radiological consolidation (Montoya scale), functionality, and satisfaction.

Results: Sixty percent of patients were young adults (19–40 years), with a predominance of males (53.3%). The most
frequent diagnosis was delayed union (80%). Pain decreased significantly, from 33.3% with moderate pain at baseline
to 93.3% pain-free at six months (p < 0.001). Radiologically, 93.3% reached Montoya grade 4 at six months (p < 0.001).
Functionality improved progressively, with 100% of patients no longer requiring assistive devices and 93.3% reporting
being “very satisfied” at six months.
Conclusions: rESWT, combined with nutritional support and physiotherapy, appears to be a safe, effective, and
minimally invasive alternative in superficial nonunions and delayed consolidations. Its benefits include pain reduction,
accelerated bone healing, improved functionality, and high patient satisfaction. Controlled, multicenter studies are
recommended to confirm these findings and standardize clinical protocols.“

Radial Pressure Waves: The Invisible Frontier Between Bone
Healing and Nonunion
Mary S Chávez et al. SVOA Orthopaedics 2025 Oct.

https://sciencevolks.com/orthopaedics/pdf/SVOA-OR-05-018.pdf

03/06/2026

“All three systematic reviews concluded that there is no significant difference between the two treatments regarding symptom severity and functional status in the short term. Only one SR reported significantly better scores for symptom severity and functional status in the mid and long term (>1 month to >6 months). Two SRs measured electrodiagnostic parameters such as DML, SNAPA, CMAPA, and CMAPL which only changed inconsistently over the two SRs [132], [133],
[136]. Three SRs conducted a subgroup analysis to compare rESWT to fESWT [132], [134], [136].
Two SRs concluded that rESWT is more effective than fESWT in improving the VAS, BCTQS, and BCTQf score in the mid to long term (> 1 month to >6 months) [134], [136]. Kim et al. reported no significant difference between rESWT and fESWT [132].“

https://pmc.ncbi.nlm.nih.gov/articles/PMC12833726/

03/06/2026

Radial extracorporeal shock wave therapy alters plantar pressure distribution in chronic plantar fasciitis: a biomechanical analysis

He Shang et al. Front Rehabil Sci. 2026.

Objective: This study aimed to investigate the impact of radial extracorporeal shockwave therapy (rESWT) on plantar pressure distribution in patients with chronic plantar fasciitis
(PF). While prior research has established rESWT’s clinical efficacy in pain relief, its specific biomechanical effects on plantar loading patterns remain less quantified. This study addresses that gap by providing objective pedobarographic evidence of rESWT-induced pressure redistribution.
Methods: A cohort of 42 patients with unilateral chronic PF was enrolled. Plantar pressure parameters-including total foot pressure, forefoot pressure, rearfoot pressure, peak pressure point, mean pressure, and contact area-were assessed using a plantar pressure measurement system before and after a standardized rESWT protocol. Evaluations compared the affected limb with the contralateral unaffected limb.

Results: Following rESWT, significant changes were observed:

on the affected side, forefoot pressure increased (p = 0.001)
and rearfoot pressure decreased (p = 0.001); on the
unaffected side, forefoot pressure also increased (p = 0.002)
and rearfoot pressure decreased (p = 0.003). Total foot
pressure decreased on the affected side (p = 0.032) but
increased on the unaffected side (p = 0.032). Contact area
increased significantly only on the unaffected side (p < 0.001).

No significant alterations were found in peak pressure point location or mean pressure (p > 0.05). Effect size analysis (Cohen’s d > 0.5) confirmed clinically meaningful improvements in forefoot and rearfoot pressure shifts.
Conclusion: rESWT effectively ameliorates abnormal plantar pressure distribution in PF patients, promoting a forward shift in the pressure center and improving gait symmetry. These findings provide a biomechanical rationale for its clinical use.
Future studies should incorporate patient-reported outcomes and longer follow-up to link these biomechanical changes to functional improvement.

https://pubmed.ncbi.nlm.nih.gov/41583729/