The Long-Term Effects of Eccentric Exercise Vs. Extracorporeal Shockwave Therapy in Athletes Aged 18-50 with Lower Extremity Tendinopathy: A Meta-Analysis and Systematic Review

Background: Establishing the most effective treatments for patellar tendinopathy (PaT) is critical because of its high prevalence in as an orthopedic condition, particularly in jumping athletes. Two increasingly popular and researched therapy interventions are extracorporeal shockwave therapy (ESWT) and eccentric exercise (EE). Yet it has not been established how the two compare to each other. Objective: The purpose of this study was to compare via meta-analysis the long-term effects of EE on both pain and function to those of ESWT in athletes with PaT and to also compare with a systematic review the same PICO components with the addition of Achilles Tendonopathy (AT). Data Sources: Search procedures followed PRISA guidelines using the PubMed, CINAHL, and Cochrane Library databases. Study Selection: Athletes ages 18-50 years, PaT for >3 months, EE, ESWT, Visual Analog Scale (VAS) measuring pain, Victorian Institute of Sport Australia – Patella (VISA-P) measuring function. Results: A fixed effects model was used to compare the interventions. Eccentric Exercise was found to have very large effect sizes of 2.363 (1.075, 3.651) and 18.790 (8.604, 28.977) for improving pain and function respectively when compared with extracorporeal shockwave therapy. Conclusion: Eccentric exercise is the treatment of choice for athletes with patellar tendinopathy, while extracorporeal shockwave therapy is a viable secondary option for patients that fail to respond to eccentrics alone