The combined effect of radial extracorporeal shockwave therapy and exercise in lateral epicondylitis: A randomized controlled trial.

Abstract

This study aimed to determine whether adding radial Extracorporeal Shockwave Therapy (ESWT) to a structured exercise program provides superior clinical benefits in patients with lateral epicondylitis compared with exercise alone. In this prospective randomized controlled trial, 66 patients were assigned to either an exercise program (n = 32) or a combined exercise + ESWT protocol (n = 34). The intervention lasted 12 weeks, with assessments conducted at baseline, 6 weeks, and 12 weeks. Pain intensity measured by the Visual Analog Scale (VAS) served as the primary outcome. Secondary outcomes included functional status assessed by the QuickDASH questionnaire and patient-perceived improvement measured by the Global Rating of Change (GRC) scale. The combined ESWT and exercise group achieved significantly greater pain reduction than the exercise group at 6 weeks (p = 0.005) and 12 weeks (p < 0.001). Change-score analyses similarly showed larger pain decreases in the combined group at both follow-ups (6 weeks: p = 0.038; 12 weeks: p = 0.016). Functional outcomes also favored the combined protocol (6 weeks: p = 0.020; 12 weeks: p = 0.009), though functional change scores were not significant. Most improvements occurred during the treatment phase and were subsequently maintained. Baseline age, BMI, and symptom duration showed no meaningful associations with outcomes (all p > 0.05). Incorporating radial ESWT into a structured exercise program provides greater pain relief and enhances functional recovery compared with exercise alone.