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

Researchers in Australia compared two common treatments for proximal hamstring tendinopathy, that sharp pain deep in the buttock that runners and desk workers know well. They enrolled 100 people and randomly assigned them to either six sessions of physiotherapy tailored to their individual needs, or shockwave therapy, with both groups also receiving standard advice and education. Over the course of a full year of follow-up, both treatments appeared equally effective at reducing pain and improving function.

The only real difference that emerged was that people who received shockwave therapy reported somewhat higher satisfaction with their treatment and results at certain points in time. Since both approaches seem to work about the same, the door is now open for future research to explore whether other treatments, different patient populations, or new comparisons might reveal something we're currently missing.

If you have been living with that stubborn pain in the lower buttock, especially when running or sitting for long periods, you might have wondered whether physiotherapy or shockwave therapy would be the better choice. This study followed 100 people with this exact problem over a full year and found that both treatments helped people improve in roughly equal measure.

On paper, the two approaches worked equally well at easing pain and restoring function. Interestingly, the people who had shockwave therapy did report feeling more satisfied with their treatment at some points along the way, though this did not necessarily translate into them getting better faster or more completely.

The honest takeaway is that either approach appears reasonable, and what matters most may come down to your own preference, what is available to you, and how your body responds over time.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This well-conducted parallel-group trial offers a clear picture on a question many of us field in practice: does individualized physiotherapy stack up against shockwave for proximal hamstring tendinopathy? The answer, at least for this cohort, is that they appear equivalent on the primary measures that matter most. Both the global rating of change and the Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy showed no significant difference between groups across all four follow-up windows, with good retention and intention-to-treat analysis lending weight to the findings.

The secondary outcomes do show a small but potentially meaningful edge for shockwave on satisfaction metrics and general health at 52 weeks, though responder analyses (looking at clinically meaningful change) revealed no difference between the two. What is worth noting for clinical practice is that this does not indicate one modality is superior, but rather that the choice between them may be driven by factors beyond raw efficacy, such as patient preference, accessibility, or the specific clinical context.

The authors themselves call for future research exploring different populations and comparisons, which suggests the field remains open to discovering nuance in this question.