Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

Objective: This study aimed to compare the effects of extracorporeal shockwave therapy (ESWT) on pain, pressure pain threshold (PPT), muscle strength, and functional improvement in patients with lateral epicondylitis. Design: Randomized controlled trial Methods: A total of 42 participants diagnosed with lateral epicondylitis were randomly assigned to one of three groups: the trigger point (TP) group (n=14), pain point (PP) group (n=14), and ESWT pain point (EPP) group (n=14). Each group received focused ESWT twice a week for 3 weeks, totaling 6 sessions. Treatments consisted of 2000 shocks per session, with intensity adjusted to maintain pain levels at or below a numeric pain rating scale (NPRS) of 3. Primary outcomes, including the NPRS, PPT, wrist extensor strength, grip strength, and patient-rated tennis elbow evaluation (PRTEE), were measured before and after the intervention. Results: All groups showed significant improvements in NPRS, wrist extensor strength, and PRTEE after the application of extracorporeal shockwave therapy compared to before the application (p<0.05). The EPP group showed significant improvements in NPRS, pressure pain threshold, and wrist extensor strength compared to the TP and PP groups(p<0.05). No significant differences in grip strength or PRTEE were observed between groups. Conclusion: Focused ESWT applied to precisely identified painpoints demonstrated enhanced pain reduction and functional improvement, particularly in the EPP group. These findings suggest that the accurate localization of treatment sites may optimize the therapeutic outcomes of ESWT inpatients with lateral epicondylitis.