{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:52:09Z","timestamp":1791582729715,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Bone stress injury (BSI) is a common overuse injury that can result in prolonged time away from sport. Limited studies have characterized the use of extracorporeal shockwave therapy (ESWT) for the treatment of BSI. The purpose of this study was to describe the use of ESWT for the management of BSI in runners. A retrospective chart review was performed to identify eligible patients in a single physician\u2019s clinic from 1 August 2018 to 30 September 2022. BSI was identified in 40 runners with 41 injuries (28 females; average age and standard deviation: 30 \u00b1 13 years; average pre-injury training 72 \u00b1 40 km per week). Overall, 63% (n = 26) met the criteria for moderate- or high-risk Female or Male Athlete Triad categories. Runners started ESWT at a median of 36 days (IQR 11 to 95 days; range 3 days to 8 years) from BSI diagnosis. On average, each received 5 \u00b1 2 total focused ESWT treatments. Those with acute BSI (ESWT started &lt;3 months from BSI diagnosis) had an average return to run at 12.0 \u00b1 7.5 weeks, while patients with delayed union (&gt;3 months, n = 3) or non-union (&gt;6 months, n = 9) had longer time for return to running (19.8 \u00b1 14.8 weeks, p = 0.032). All runners returned to pain-free running after ESWT except one runner with non-union of grade 4 navicular BSI who opted for surgery. No complications were observed with ESWT. These findings suggest that focused ESWT may be a safe treatment for the management of BSI in runners.<\/jats:p>","DOI":"10.3390\/bioengineering10080885","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T01:11:26Z","timestamp":1690333886000},"page":"885","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3339-8679","authenticated-orcid":false,"given":"Alexandra","family":"Beling","sequence":"first","affiliation":[{"name":"Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amol","family":"Saxena","sequence":"additional","affiliation":[{"name":"Palo Alto Medical Foundation, Palo Alto, CA 94301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5682-9665","authenticated-orcid":false,"given":"Karsten","family":"Hollander","sequence":"additional","affiliation":[{"name":"Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, 20457 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3966-8070","authenticated-orcid":false,"given":"Adam S.","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/s41572-022-00352-y","article-title":"Bone Stress Injuries","volume":"8","author":"Hoenig","year":"2022","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1177\/0363546513490645","article-title":"Correlation of MRI Grading of Bone Stress Injuries with Clinical Risk Factors and Return to Play: A 5-Year Prospective Study in Collegiate Track and Field Athletes","volume":"41","author":"Nattiv","year":"2013","journal-title":"Am. J. Sport. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1177\/036354659502300418","article-title":"Tibial Stress Reaction in Runners. Correlation of Clinical Symptoms and Scintigraphy with a New Magnetic Resonance Imaging Grading System","volume":"23","author":"Fredericson","year":"1995","journal-title":"Am. J. Sport. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1177\/03635465030310063601","article-title":"Stress Injuries to Bone in College Athletes: A Retrospective Review of Experience at a Single Institution","volume":"31","author":"Arendt","year":"2003","journal-title":"Am. J. Sport. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1177\/0363546521993807","article-title":"Does Magnetic Resonance Imaging Grading Correlate with Return to Sports after Bone Stress Injuries? A Systematic Review and Meta-Analysis","volume":"50","author":"Hoenig","year":"2022","journal-title":"Am. J. Sport. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/JSM.0000000000000948","article-title":"The Male Athlete Triad-A Consensus Statement from the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play","volume":"31","author":"Fredericson","year":"2021","journal-title":"Clin. J. Sport Med. Off. J. Can. Acad. Sport Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/JSM.0000000000000085","article-title":"2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference Held in San Francisco, CA, May 2012, and 2nd International Conference Held in Indianapolis, IN, May 2013","volume":"24","author":"Nattiv","year":"2014","journal-title":"Clin. J. Sport Med. Off. J. Can. Acad. Sport Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1136\/bjsports-2022-106328","article-title":"Return to Sport Following Low-Risk and High-Risk Bone Stress Injuries: A Systematic Review and Meta-Analysis","volume":"57","author":"Hoenig","year":"2023","journal-title":"Br. J. Sport. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1177\/0363546506297540","article-title":"Extracorporeal Shock Wave Therapy for Resistant Stress Fracture in Athletes: A Report of 5 Cases","volume":"35","author":"Taki","year":"2007","journal-title":"Am. J. Sport. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.2106\/JBJS.H.00111","article-title":"Electrical Stimulation for Long-Bone Fracture-Healing: A Meta-Analysis of Randomized Controlled Trials","volume":"90","author":"Mollon","year":"2008","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.ultrasmedbio.2008.12.002","article-title":"Shock Waves in the Treatment of Stress Fractures","volume":"35","author":"Moretti","year":"2009","journal-title":"Ultrasound Med. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0022-5347(17)53841-0","article-title":"First Clinical Experience with Extracorporeally Induced Destruction of Kidney Stones by Shock Waves","volume":"127","author":"Chaussy","year":"1982","journal-title":"J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/0090-4295(92)90009-L","article-title":"Influence of Shock Waves on Fracture Healing","volume":"39","author":"Haupt","year":"1992","journal-title":"Urology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.fcl.2010.07.002","article-title":"Shock Wave Therapy as a Treatment of Nonunions, Avascular Necrosis, and Delayed Healing of Stress Fractures","volume":"15","author":"Furia","year":"2010","journal-title":"Foot Ankle Clin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.2106\/JBJS.H.00841","article-title":"Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions","volume":"91","author":"Cacchio","year":"2009","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s00402-001-0365-4","article-title":"Use of Extracorporeal Shock-Wave Therapy (ESWT) in the Treatment of Non-Unions. A Review of the Literature","volume":"122","author":"Birnbaum","year":"2002","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_17","first-page":"39","article-title":"Stress Fractures: Diagnosis, Treatment, and Prevention","volume":"83","author":"Patel","year":"2011","journal-title":"Am. Fam. Physician"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/RMR.0b013e3180421c8c","article-title":"Stress Fractures in Athletes","volume":"17","author":"Fredericson","year":"2006","journal-title":"Top. Magn. Reson. Imaging TMRI"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.pmrj.2012.02.003","article-title":"Use of an Antigravity Treadmill for Rehabilitation of a Pelvic Stress Injury","volume":"4","author":"Tenforde","year":"2012","journal-title":"PM&R"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1177\/03635465010290010201","article-title":"Low-Risk Stress Fractures","volume":"29","author":"Boden","year":"2001","journal-title":"Am. J. Sport. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"344","DOI":"10.5435\/00124635-200011000-00002","article-title":"High-Risk Stress Fractures: Evaluation and Treatment","volume":"8","author":"Boden","year":"2000","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/01.blo.0000180451.03425.48","article-title":"Shock Wave Therapy for Chronic Achilles Tendon Pain: A Randomized Placebo-Controlled Trial","volume":"440","author":"Costa","year":"2005","journal-title":"Clin. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1302\/0301-620X.84B5.0840744","article-title":"Osteonecrosis of the Humeral Head after Extracorporeal Shock-Wave Lithotripsy","volume":"84","author":"Durst","year":"2002","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1177\/1071100712470917","article-title":"A Complication Due to Shock Wave Therapy Resembling Calcaneal Stress Fracture","volume":"34","author":"Erduran","year":"2013","journal-title":"Foot Ankle Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1053\/j.jfas.2017.06.009","article-title":"Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries","volume":"56","author":"Saxena","year":"2017","journal-title":"J. Foot Ankle Surg. Off. Publ. Am. Coll. Foot Ankle Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1350-4177(02)00089-5","article-title":"Surface Acoustic Cavitation Understood via Nanosecond Electrochemistry. Part III: Shear Stress in Ultrasonic Cleaning","volume":"9","author":"Maisonhaute","year":"2002","journal-title":"Ultrason. Sonochem."},{"key":"ref_27","first-page":"140","article-title":"Acoustic Cavitation: A Possible Consequence of Biomedical Uses of Ultrasound","volume":"5","author":"Apfel","year":"1982","journal-title":"Br. J. Cancer Suppl."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/230949900601400205","article-title":"Extracorporeal Shock Wave Treatment for Defective Nonunion of the Radius: A Rabbit Model","volume":"14","author":"Bulut","year":"2006","journal-title":"J. Orthop. Surg. Hong Kong"},{"key":"ref_29","first-page":"474","article-title":"Effect of Extracorporeal Shock Waves on Callus Formation during Bone Lengthening","volume":"8","author":"Narasaki","year":"2003","journal-title":"J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1161\/CIRCULATIONAHA.106.628623","article-title":"Low-Energy Shock Wave for Enhancing Recruitment of Endothelial Progenitor Cells: A New Modality to Increase Efficacy of Cell Therapy in Chronic Hind Limb Ischemia","volume":"114","author":"Aicher","year":"2006","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/01.blo.0000073344.50837.cd","article-title":"Effect of Extracorporeal Shock Wave Therapy on Osteoblastlike Cells","volume":"413","author":"Martini","year":"2003","journal-title":"Clin. Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.orthres.2003.10.005","article-title":"Recruitment of Mesenchymal Stem Cells and Expression of TGF-Beta 1 and VEGF in the Early Stage of Shock Wave-Promoted Bone Regeneration of Segmental Defect in Rats","volume":"22","author":"Chen","year":"2004","journal-title":"J. Orthop. Res. Off. Publ. Orthop. Res. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3055","DOI":"10.1161\/01.CIR.0000148849.51177.97","article-title":"Extracorporeal Cardiac Shock Wave Therapy Markedly Ameliorates Ischemia-Induced Myocardial Dysfunction in Pigs In Vivo","volume":"110","author":"Nishida","year":"2004","journal-title":"Circulation"},{"key":"ref_34","first-page":"220","article-title":"An Overview of Shock Wave Therapy in Musculoskeletal Disorders","volume":"26","author":"Wang","year":"2003","journal-title":"Chang Gung Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3810\/psm.2010.04.1770","article-title":"Prophylactic Use of NSAIDs by Athletes: A Risk\/Benefit Assessment","volume":"38","author":"Warden","year":"2010","journal-title":"Phys. Sportsmed."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/jbmr.3616","article-title":"Nonsteroidal Anti-Inflammatory Drug Prescriptions Are Associated with Increased Stress Fracture Diagnosis in the US Army Population","volume":"34","author":"Hughes","year":"2019","journal-title":"J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1177\/0363546514562739","article-title":"Epidemiology of Stress Fracture Injuries among US High School Athletes, 2005\u20132006 through 2012\u20132013","volume":"43","author":"Changstrom","year":"2015","journal-title":"Am. J. Sport. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"966","DOI":"10.4085\/1062-6050-52.8.01","article-title":"The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004\u20132005 Through 2013\u20132014 Academic Years","volume":"52","author":"Rizzone","year":"2017","journal-title":"J. Athl. Train."},{"key":"ref_39","first-page":"948","article-title":"Associations between the Female Athlete Triad and Injury among High School Runners","volume":"9","author":"Rauh","year":"2014","journal-title":"Int. J. Sport. Phys. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/0363546516676262","article-title":"Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes","volume":"45","author":"Tenforde","year":"2017","journal-title":"Am. J. Sport. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1359\/JBMR.041005","article-title":"Males Have Larger Skeletal Size and Bone Mass than Females, despite Comparable Body Size","volume":"20","author":"Nieves","year":"2005","journal-title":"J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1249\/MSS.0b013e3182963d75","article-title":"Identifying Sex-Specific Risk Factors for Stress Fractures in Adolescent Runners","volume":"45","author":"Tenforde","year":"2013","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/S1440-2440(00)80036-5","article-title":"Stress Fractures and Bone Health in Track and Field Athletes","volume":"3","author":"Nattiv","year":"2000","journal-title":"J. Sci. Med. Sport"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1249\/mss.0b013e318074e54b","article-title":"Risk Factors for Stress Fracture among Young Female Cross-Country Runners","volume":"39","author":"Kelsey","year":"2007","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/036354658701500107","article-title":"Stress Fractures in Athletes. A Study of 320 Cases","volume":"15","author":"Matheson","year":"1987","journal-title":"Am. J. Sport. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1177\/0363546520971782","article-title":"Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty","volume":"49","author":"Popp","year":"2021","journal-title":"Am. J. Sport. Med."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/8\/885\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:18:39Z","timestamp":1760127519000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/8\/885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["bioengineering10080885"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10080885","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}