Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled Trial

BACKGROUND: Proximal hamstring tendinopathy (PHT) presents as localized lower buttock pain with tasks such as running and sitting. PURPOSE: To investigate the effectiveness of individualized physiotherapy compared with shockwave therapy on pain and function in PHT. METHODS: This prospective parallel-group, assessor-blinded randomized controlled trial (RCT) was set in 10 primary care physiotherapy practices in Victoria, Australia. A total of 100 participants with PHT were randomly assigned to receive 6 sessions of either individualized physiotherapy or shockwave therapy, with both groups receiving standardized advice and education. Primary outcomes were global rating of change on a 7-point Likert scale and the Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy at 4, 12, 26, and 52 weeks postrandomization. Analyses were by intention-to-treat using linear mixed models. RESULTS: All except 1 patient received the allocated intervention, and the participant follow-up rate was 88% at 12 months. There were no significant differences between groups in primary outcomes at any time point. For secondary outcome measures, participants in the shockwave group had statistically significantly greater satisfaction with treatment at 26 weeks, satisfaction with results of treatment at 4 and 26 weeks, and general health at 52 weeks. Responder analyses of participants achieving clinically significant improvements showed no significant differences between groups at any time point. CONCLUSION: This RCT found no difference in effectiveness of individualized physiotherapy compared with shockwave therapy on global effect or function in PHT. Future trials on PHT appear feasible but could explore a different sample population or other intervention and/or comparison groups. REGISTRATION: ACTRN12621000846820 (Australian New Zealand Clinical Trials Registry).