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Shockwave Enhances Recovery for Muscle Injuries in Athletes

One of the most common overuse injuries is the muscle strain. Muscle injuries account for 10% to 55% of all acute sports injuries [1], and the majority of those injuries are muscle strains or bruises [2]. The treatment of muscle strains can be challenging because “muscle tissue is often unable to fully regenerate to its pre-injury state” [3]. For example, people recovering from hamstring injuries have a re-injury rate of approximately 30% [3]. Similarly, scar tissue starts to form in as little as six weeks after a muscle injury [3]. These challenges are made more difficult in those over the age of 40, as increased age has been shown to predispose athletes to muscle injury [4]. So the treatment modality considered should be one that not only achieves return-to-play, but also rejuvenates the muscle.

ESWT has been shown to improve muscle repair and recovery after a muscle strain. Clinical studies have shown that ESWT treatments alone [5] and in combination with other treatment modalities [6,7] facilitate muscle repair and rejuvenation. When ESWT is incorporated into the treatment regimen, athletes experience less pain after injury [6,7], improved muscle tone [5], improved muscle strength [6], less muscle tightness [7] and increased muscle elasticity [5], and are able to return to activity [6]. In one clinical study, physical therapy improved muscle tightness transiently after muscle injury, but when physical therapy was combined with ESWT, long-term improvements in muscle tightness were achieved [7]. ESWT has even been shown to decrease muscle spasticity in those suffering from a stroke [8]. The exact biologic mechanisms responsible for these improvements are unknown, though ESWT has been shown to increase blood flow in muscle tissues [9].


1. Maffulli N, Del Buono A, Oliva F, et al. Muscle Injuries: A Brief Guide to Classification and Management. Transl Med UniSa. 2014 Sep 1;12:14-8.

2. Delos D, Maak TG, Rodeo SA. Muscle injuries in athletes: enhancing recovery through scientific understanding and novel therapies. Sports Health. 2013 Jul;5(4):346-52.

3. Silder A, Thelen DG, Heiderscheit BC. Effects of prior hamstring strain injury on strength, flexibility, and running mechanics. Clin Biomech (Bristol, Avon). 2010 Aug; 25(7):681-6.

4. Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2014 Feb 24;3(4):346-50.

5. Notarnicola A, Covelli I, Maccagnano G, et al. Extracorporeal shockwave therapy on muscle tissue: the effects on healthy athletes. J Biol Regul Homeost Agents. 2018 Jan-Feb;32(1):185-193.

6. Astur DC, Santos B, de Moraes ER, et al. Extracorporeal Shockwave Therapy to Treat Chronic Muscle Injury. Acta Ortop Bras. 2015 Sep-Oct;23(5):247-50.

7. Kim YW, Chang WH, Kim NY, et al. Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study. Yonsei Med J. 2017 May;58(3): 644-649.

8. Lee CH, Lee SH, Yoo JI, Lee SU. Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke. PM R. 2019 Apr;11(4):363-371.

9. Kisch T, Wuerfel W, Forstmeier V, et al. Repetitive shock wave therapy improves muscular microcirculation. J Surg Res. 2016 Apr;201(2):440-5.

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