Compare Radial And Focused Shock Wave Therapy For Trochanteric Pain Syndrome (Gluteal Tendinopathy)

Radial Shock Wave Therapy:

Radial shock wave therapy is a form of Extracorporeal Shock Wave Therapy (ESWT) that uses a low to a medium-energy shock wave that spreads out from the point of application in a radial pattern. Radial ESWT means that the fast sound wave energy, the shock, is dispersed over a wider area, making it valuable in treating conditions that affect more significant areas of the body, such as muscle pain. Due to the spreading nature of the wave, the energy doesn't penetrate very deep. This shallow sweet spot means Radial ESWT may not work consistently in areas with:

• Large amounts of skin/fat sitting on top of the muscle 
• Athletes with larger muscles 

Also, due to the extra skin stimulation, the comfort levels during Radial ESWT are low, with some clients showing skin blotching, bruising or erythema (red skin) for two to three days post-session.

Focused Shock Wave Therapy:

Focused shock wave therapy uses a high-energy shock wave focused on a specific point within the body. This type of therapy delivers a more concentrated and intense shock wave that effectively treats smaller zones or intense zones such as:

Small/ Focal focused ESWT Examples:

• heel spurs/ plantar fasciitis, 
• most tendinopathy, 
• Deep-focused ESWT treatment examples -
• trachantric pain syndrome .

Comparison:

Radial shock wave therapy is typically a less powerful but more intense treatment sensation than focused shock wave therapy and is designed to treat larger areas of the body. Radial ESWT, like focused ESWT, is often used to promote the healing of soft tissues, such as muscles, tendons, and ligaments, by stimulating blood flow but has a better effect on promoting the production of collagen at skin levels. 

Focused shock wave therapy, on the other hand, is more powerful (deeper penetration) and targeted and is primarily used to treat localised areas of pain and inflammation that are either deep or small, such as chronic plantar fasciitis, tennis elbow, hip tendinopathy but also calcifications and thicker fibrosis/ scar tissue within the body.

Overall, both types of shock wave therapy can effectively treat various musculoskeletal conditions. Still, the choice between radial and focused shock wave therapy will depend on the specific situation being treated and the patient's needs. 

The clinic in Wimbledon, London, offers both types, but the focused ESWT wins out in 95% of cases as it's more efficient, has better outcomes and is more comfortable.

What Shock Wave Therapy Type, Radial or Focused, Is Better for Gluteal Tendinopathy, According To Studies

Limited research directly compares the effectiveness of radial versus focused shock wave therapy for gluteal tendinopathy. However, here are some quotes from studies that have investigated each treatment individually for this condition:

Radial Shock Wave Therapy:

• "Extracorporeal shock wave therapy is an effective treatment option for greater trochanteric pain syndrome (gluteal tendinopathy) with long-term benefits for pain and function" (5)
• "Radial shock wave therapy may provide an alternative treatment option for recalcitrant greater trochanteric pain syndrome (gluteal tendinopathy) when conservative therapy has failed" (6)

Focused Shock Wave Therapy:

• "EPAT (focused shock wave therapy) is a safe and effective treatment option for patients with chronic gluteal tendinopathy, resulting in significant improvements in pain, function, and quality of life" (7)
• "EPAT (focused shock wave therapy) is a highly effective and safe treatment option for recalcitrant gluteal tendinopathy, providing long-term improvement in pain and function" (8)
• "80% of the patients with GTPS in the study by Carlisi et al. showed calcific tendinopathy around the trochanter on ultrasound evaluation, highlighting the importance of applying F-ESWT instead of radial pressure waves for GTPS. (9) 

Overall, radial and focused shock wave therapy has shown promise in treating gluteal tendinopathy, with each treatment having advantages and limitations. However, the available research suggests that Focused shock wave therapy (ESWT) may be more effective in providing long-term pain relief and functional improvement for this condition.

If the focused shock wave therapy type is better than radial for gluteal tendinopathy, what are the outcomes like, according to studies? 

Studies are essential, and we, of course, use the knowledge gained to decide whether F-ESWT would work for each individual's trochanteric pain syndrome (gluteal tendinopathy). Studies in 2020 published in Journal for Bone Joint Surgery noted two monthly follow-up outcomes as - 64% of patients in the F-ESWT group showed an excellent or good result at one month, improving to 86.8% at two months.

The outcomes of the 1-month follow-up were excellent in this study. The two monthly follow-ups are much better, which is the trend we see after ESWT stimulation. Shock wave therapy has a carry-over effect because it stimulates natural repair instead of healing by itself. 

Because of the fantastic trend in pain relief, it is essential to think of focused ESWt as a door opener to your healing journey for trochanteric pain (gluteal tendinopathy). And we certainly push this with our client base as a small minority of trochanteric pain cases co-exist with gluteal muscle damage or tendon tears. Sadly in these cases, short-term discomfort post-session is expected. We use orthopaedic tests to rule out clients with extra trauma, but some very stoic clients or athletes may fool the clinical testing, and an MRI may be advised to create a consistent release from pain.

If you have trochanteric pain or have been diagnosed with Gluteal tendinopathy by a professional, clinically or via MRI, you are a candidate for Focused shock wave therapy f-ESWT.

You can get in contact with the London Shock wave & Sports Injury Department At Wimbledon Clinic by clicking the contact button/ link:

https://shock-wave-therapy-london.co.uk/contact-us

References; 

1. Journal for Bone Joint Surgery Am. 2020;102:1305-11(https://nt-e.nl/assets/blogfiles/Focussed-shockwave-treatment-for-greater-trochanteric-pain-syndrome.-Ramon-et-al.-2020.pdf)
2. Carlisi E, Cecini M, Di Natali G, Manzoni F, Tinelli C, Lisi C. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clin Rehabil. 2019 Apr;33(4):670-80. Epub 2018 Dec 26.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191922/
4. https://pubmed.ncbi.nlm.nih.gov/32524221/
5. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835247/
6. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/
7. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/
8. Source: https://pubmed.ncbi.nlm.nih.gov/32524221/
9. Source: https://pubmed.ncbi.nlm.nih.gov/30585498/