Three sessions of radial extracorporeal shockwave therapy gives no additional benefit over “minimal-dose” radial extracorporeal shockwave therapy for patients with chronic greater trochanteric pain syndrome: a double-blinded, randomized, controlled trial

Objective: To investigate the outcomes following three weekly sessions of radial extra-corporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the UK.

Design: Double-blinded randomised controlled trial

Setting: A single NHS Sports Medicine Clinic, in the United Kingdom.

Patients: 120 patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS that had failed to improve with a minimum of three months of rehabilitation were enrolled in the study, randomised equally to the intervention and treatment groups. Mean age 60.6±11.5years, 82% female, mean duration of symptoms 45.4±33.4 months (range: 6months-30years.)

Interventions: Participants were randomised to receive either three sessions of ESWT at either the “recommended”/“maximally comfortably tolerated” dose or at “minimal-dose”. All patients received a structured home exercise programme involving flexibility, strength and balance exercises.

Main outcome measures: Follow-up was 6-weeks, 3-months, and 6-months. Outcome measures included local hip pain, validated hip PROMs (OHS, NAHS, VISA-G) and wider measures of function including sleep (PSQI) and mood (HADS).

Results: Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures including activity or mood.

Conclusion: There were no time*group interaction effects seen between the groups at any time-point, indicating that 3 sessions the “recommended-dose” rESWT had no measurable benefit compared to “minimal-dose” rESWT in this group of patients with GTPS. The underlying reason remains unclear, it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that “minimal-dose” rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.