Radial versus combined shockwave therapy in the management of proximal hamstring tendinopathy: Similar functional outcomes in running cohort

Abstract

Background. Proximal hamstring tendinopathy is a common cause of gluteal pain. Extracorporeal shockwave therapy may be an effective treatment in proximal hamstring tendinopathy. However, published outcomes are primarily limited to evaluating radial shockwave, and the use of combined treatment (focus and radial treatment) and outcomes for management in runners are not well described. The purpose of this report was to characterize functional outcomes using radial and combined shockwave in the management of proximal hamstring tendinopathy in runners. We hypothesized that runners who received R-SWT or C-SWT would experience improvement in functional outcomes using the VISA-H. Methods. This study is a quality improvement initiative evaluating clinical outcomes in a single outpatient clinic. Sixty-three runners (mean and standard deviation for age and duration of symptoms 42.8 ± 14.7 years and 16.9 ± 23.8 months, respectively), were identified as receiving treatment for management of unilateral or bilateral proximal hamstring tendinopathy. Patients were treated with either radial (n = 40) or combined shockwave therapy (n = 23) using similar post-procedure protocols, including recommendations to complete physical therapy exercises of core and lumbopelvic stabilization with gradual progression to eccentric strengthening of the hamstring complex. Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H) was used to assess treatment outcomes, evaluated as differences between treatment cohorts by mean values from baseline to follow-up after shockwave treatment. The number in both treatment groups who met minimal clinical important difference (MCID) was defined as a gain of 22 points or more on VISA-H. Results. Patients in both radial and combined shockwave groups received a similar average number of treatments (5.0 ± 2.2 vs 5.2 ± 1.9; p = 0.740). The radial and combined shock-wave groups’ mean VISA-H scores were similar at baseline (39.4 ± 17.4 vs 40.7 ± 17.0) and achieved similar final scores (62.6 ± 19.7 vs 63.4 ± 21.3; p = 0.812), and nearly all had measured increases of VISA-H with treatment (P < 0.0001). The MCID was met in a majority of patients who received either radial (62.5%) or combined treatment (56.5%). Conclusions. Overall findings suggest radial and combined shockwave treatment with physical therapy exercises can be effective in the management of proximal hamstring tendinopathy in runners.