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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.

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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