Evaluation of the efficacy of shockwave therapy in patellofemoral pain

In this study, it was aimed to evaluate the effects of extracorporeal shockwave therapy (ESWT) application on pain and functional capacity of the knee joint in patients with patellofemoral pain (PFP). Thirty-six volunteers between the ages of 18-45 were randomized to Exercise (n=12), Exercise + ESWT (n=12) and ESWT (n=12) groups. Those in the exercise group were given a home exercise program for PFP. In the ESWT group a total of 5 sessions of radial shock wave therapy was applied to and around the patellofemoral joint in 5 days intervals. The initial dose was planned as 1.8-2 bar, 2000 pulses, 8 Hz, and it was continued by increasing the dosage to 0.2 bar and 200 pulses in each session as long as the patient could tolerate it. In the Exercise + ESWT group, both treatments were applied. Pain status was evaluated with visual analog scale (VAS) and functional status of the knee was evaluated with Kujala scoring before and at 1 and 8 weeks after treatment. In addition, quadriceps isometric strength was measured at 60˚ knee flexion angle on isokinetic dynamometer before and after treatment. A statistically significant decrease in VAS scores (p<0.001) and a statistically significant increase in Kujala scores (p<0.01-0.001) were detected in all three groups compared to before and at 1st and 8th weeks after treatment. There was no statistically significant difference between the three groups in terms of changes in VAS and Kujala scores before and at the 1st and 8th weeks after treatment (p>0.05). A statistically significant increase in peak torque of quadriceps isometric strength at 60˚ flexion was detected only in the Exercise group when compared with before and after treatment (p<0.001). There was no statistically significant change in peak torque of quadriceps isometric strength at 60˚ flexion in the Exercise + ESWT and the ESWT group before and after treatment (p>0.05). As a result of this study, it was found that ESWT was effective in reducing pain and improving functional capacity of the knee in PFA treatment; however, it has been shown that it is not superior to exercise therapy when applied alone or in combination with exercise therapy. In addition, it could be said that ESWT has no positive or negative effect on knee isometric strength in 60˚ flexion. More randomized controlled studies are needed to evaluate the efficacy of ESWT in the treatment of PFA. Keywords: patellofemoral pain, extracorporeal shockwave therapy, quadriceps isometric strength