Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review

Background: Tendinopathies affecting the hip and pelvis include proximal hamstring tendinopathy (PHT), gluteal tendinopathy (greater trochanteric pain syndrome [GTPS]), and calcific tendinopathy (CT). Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment described for the management of lower-extremity tendinopathies. Purpose: We sought to synthesize the evidence on ESWT used in the treatment of hip/pelvis tendinopathies, including protocols, outcomes, and safety. Methods: A comprehensive search of PubMed/Medline, EMBASE, and Cochrane Library databases was performed on November 1, 2024, for studies reporting ESWT data for hip/pelvis tendinopathies. Study design, population, and ESWT-related data (protocols, outcomes, and safety) were extracted. Results: Eighteen studies were included; 9 reported on GTPS, 7 on CT, and 5 on PHT. Most ESWT protocols (72% [n = 13]) implemented 3 to 4 weekly sessions and delivered 2000 to 3000 pulses/session (83% [n = 15]). Eleven studies used radial ESWT and 7 used focused ESWT. ESWT significantly improved pain and functional outcomes for GTPS, CT, and PHT in 17 level-I to level-V studies; only 1 level-V study showed no improvement. Six studies showed superior outcomes post-ESWT vs conservative treatment (PHT/GTPS), sham ESWT (GTPS), ultrasound therapy (GTPS/CT), or corticosteroid injection (GTPS). One study showed comparable outcomes between ESWT and eccentric exercise (GTPS). Two studies reported no outcome differences between radial ESWT and "minimal-dose" ESWT (GTPS) or combined ESWT (PHT). All studies assessing pain showed improvement from 0.5 to 27 months post-ESWT. Six of 18 studies reported adverse events, including increased pain and skin irritation (overall rate: 12% [n = 65/557]). Conclusions: The results of this systematic review suggest that ESWT may be safe and effective for hip/pelvis tendinopathies. Future research using validated outcome measures and ESWT parameters will aid in treatment optimization.