Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis

Document Type : Original Article


Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. Materials and Methods: This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm2, 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm2, 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs) and the visual analog scale (VAS) was reassessed 1 week after the last session and 12 weeks after finishing the treatment. Results: The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups (P = 0.001). Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. Conclusion: Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.


Rompe JD, Decking J, Schoellner C, Theis C. Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players. Am J Sports Med 2004;32:734-43.  Back to cited text no. 1
Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am 2005;87:1297-304.  Back to cited text no. 2
Mudoo AD, Jing Y, Le-hua Y. Extracorporeal shock wave therapy for musculoskeletal disorders. Journal of Clinical Rehabilitative: Tissue Engineering Research Journal 2011;5:6222-5.  Back to cited text no. 3
Rompe JD, Maffulli N. Repetitive shock wave therapy for lateral elbow tendinopathy (tennis elbow): A systematic and qualitative analysis. Br Med Bull 2007;83:355-78.  Back to cited text no. 4
Crowther MA, Bannister GC, Huma H, Rooker GD. A prospective, randomised study to compare extracorporeal shock-wave therapy and injection of steroid for the treatment of tennis elbow. J Bone Joint Surg Br 2002;84:678-9.  Back to cited text no. 5
Faro F, Wolf JM. Lateral epicondylitis: Review and current concepts. J Hand Surg Am 2007;32:1271-9.  Back to cited text no. 6
Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH; Extracorporeal Shock Wave Therapy Clinical Trial Group. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis. J Bone Joint Surg Am 2002;84-A: 1982-91.  Back to cited text no. 7
Speed CA, Nichols D, Richards C, Humphreys H, Wies JT, Burnet S, et al. Extracorporeal shock wave therapy for lateral epicondylitis--a double blind randomised controlled trial. J Orthop Res 2002;20:895-8.  Back to cited text no. 8
Stasinopoulos D, Johnson MI. Effectiveness of extracorporeal shock wave therapy for tennis elbow. Br J Sports Med 2005;39:132-6.  Back to cited text no. 9
Vahdatpour B, Sajadieh S, Bateni B, Karami M, Sajjadieh H. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Med Sci 2012;17:834-8.  Back to cited text no. 10
Hsu RW, Hsu WH, Tai CL, Lee KF. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res 2004;22:221-7.  Back to cited text no. 11
Ohtori S, Inoue G, Mannoji C, Saisu T, Takahashi K, Mitsuhashi S, et al. Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neurosci Lett 2001;315:57-60.  Back to cited text no. 12
Dorotka R, Sabeti M, Jimenez-Boj E, Goll A, Schubert S, Trieb K. Location modalities for focused extracorporeal shock wave application in the treatment of chronic plantar fasciitis. Foot Ankle Int 2006;27:943-7.  Back to cited text no. 13