Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: a systematic review

Background: This systematic review evaluates the available evidence for extracorporeal shockwave therapy (ESWT) use in the treatment of medial tibial stress syndrome (MTSS). Method: PubMed, EMBASE, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) database searches were performed without a time limit in August 2021. Two independent researchers performed the search, screening, and final eligibility of the articles. Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by two reviewers using the Physiotherapy Evidence Database scale (PEDro). Results: Three studies were identified that compared 23, 12, and 22 participants in the intervention group with 19, 12, and 20 participants in the control group, respectively. The mean age of participants in these studies was 26.51 yr, and the mean duration of symptoms in the two studies that reported this was 16.36 mo. All studies used focus shockwave therapy. Conclusions: Extracorporeal shockwaves reduced pain and time to recovery and increased patient satisfaction. No study reported adverse effects. Based on the limited studies, ESWT may reduce pain and shorten recovery duration in MTSS. Further randomized clinical trials with sham control may substantiate these findings in other patient populations.