RADIAL PROTOCOL
Radial protocol values
Treatment frequency: Several times (standard up to 3 sessions, maximum 5)
Pressure: 2–4 bar, depending on the device technology and the patient's pain sensation
Frequency: Up to a maximum of 10 Hz
Pulses: 2000–3000 per session
Interval between sessions: Every 1–2 weeks
Localization: Patient-oriented targeting based on imaging; additionally, complementary treatment of myofascial trigger points.
FOCAL PROTOCOL
Focal protocol values
Treatment frequency: Once or several times (standard up to 3 sessions, maximum 5)
Energy flux density (EFD): 0.10 – 0.25 mJ/mm², depending on device technology and patient pain sensitivity
Frequency: Up to a maximum of 5 Hz
Pulses: 1500–2500 per session
Interval between sessions: Every 1–2 weeks
Medical Information
Synonyms:
Ischial tuberosity origin tendinopathy, proximal hamstring tendinopathy (PHT), hamstring tendinosis.
Definition:
"Hamstrings": origin of three tendons at the ischial tuberosity:
M. biceps femoris (long head)
M. semitendinosus
M. semimembranosus
Function: hip extension and knee flexion.
Clinical features:
Pain in the ischial area
Pain when sitting (e.g., while driving)
Pain when climbing stairs and bending over
"Deep gluteal pain"
Often radiating toward the back of the knee
Crucial to differentiate from sciatica.
Genesis:
Primarily due to sports trauma: soccer, skiing, sprinters, boxers, hurdlers
Due to repetitive overloading or bending activities (e.g., gardening)
Degenerative structural changes of the tendon
Differential diagnoses:
Sciatic nerve conditions: disc herniation/neuroforaminal or recessal stenosis/spinal stenosis
Ischial or stress fractures
Hip joint conditions: centrocaudal osteoarthritis
Inflammations or tumors
Diagnosis:
Magnetic Resonance Imaging (MRI)
X-ray
Therapy:
Load adjustment and patient education
Extracorporeal Shockwave Therapy (ESWT), complemented by stretching exercises and physiotherapy
Surgical: optional in case of complete hamstring group rupture in young high-performance athletes.
Shockwave Therapy (ESWT)
Indication:
Treatment-resistant symptoms; indication established by a specialist physician.
Contraindications:
Malignant tumor in the treatment area, osteomyelitis.
Spatial requirements:
Medical practice certification criteria, for example:
Hygiene plan
Emergency management available according to DIN standards
Patient preparation:
Differentiated and documented information and education (onset of effect may take weeks)
Physician and assistant staff:
ESWT must be performed personally by a qualified physician with specialized expertise.
Execution of therapy:
Without local anesthesia
Cryotherapy if necessary
Complications:
In rare cases: hematoma, intensification of pain, nerve irritation.
Aftercare:
Load adaptation
Modification of sports activity
Clinical success monitoring after 8 to 12 weeks
STUDIES
Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N The effectiveness of extracorporeal shockwavetherapy in common lower limb conditions: a systematic review including quantification of patient-ratedpain reduction.Br J Sports Med. 2017 Sep 27. pii: bjsports- 2016-097347. doi: 10.1136/bjsports-2016-097347.
Startzman AN, Fowler O, Carreira D. Proximal hamstring tendinosis and partial ruptures. Orthopedics. 2017 Jul 1;40(4):e574-e582. doi: 10.3928/01477447-20170208-05. epub 2017 Feb 14.
Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. Shockwavetherapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Am J Sports Med. 2011 Jan;39(1):146-53. doi: 10.1177/0363546510379324. epub 2010 Sep 20.
Mitchkash M, Robinson D, Tenforde AS. Efficacy of extracorporeal pulse-activated therapy in the management of lower-extremity running-related injuries: findings from a large case cohort. J Foot Ankle Surg. 2020; 59:795-800.