When to Use PRP Combined With Shockwave Therapy

 

​Platelet-Rich Plasma (PRP) and Shockwave Therapy (ESWT/EPAT) are regenerative treatments that can be paired to improve tissue healing, reduce pain, and speed recovery. PRP provides biologic growth factors, while shockwave therapy provides mechanical stimulation that enhances circulation, cellular activation, and tissue remodeling.

 

Clinical studies show the combination often produces superior results compared to either therapy alone.

 

Why Combine PRP and Shockwave?

 

Synergistic healing: ESWT increases blood flow and activates healing pathways, supporting PRP distribution and effectiveness.

 

Enhanced growth factor release: Preclinical data suggest shockwave may increase release of PRP-derived growth factors.In vitro evidence: Shockwave increased TGF-β1 and PDGF-ββ release from PRP.

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Faster outcomes: Several human studies show quicker pain reduction when both therapies are combined.

 

Conditions That Benefit Most From PRP + Shockwave

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• Patellar tendinopathy
  Randomized Controlled Trial: PRP + ESWT produced faster pain reduction vs PRP alone.
  Link: https://pubmed.ncbi.nlm.nih.gov/39690426/

• Tennis elbow (lateral epicondylitis)
  Randomized Controlled Trial: PRP + ESWT + exercise showed superior pain and function improvement vs ESWT alone.
  Link: https://pubmed.ncbi.nlm.nih.gov/39842562/

• Rotator cuff partial tears
  Prospective comparative study: PRP + ESWT improved ROM and inflammation markers more than PRP alone.
  Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC10820784/

• Plantar fasciitis
  Case reports in runners: Adding PRP to ESWT resulted in significant improvement and return to running.
  Link:
  https://www.germanjournalsportsmedicine.com/archive/archive-2023/issue-2/use-of-combined-shockwave-therapy-and-platelet-rich-plasma-injection-for-management-of-chronic-plantar-fasciitis-in-runners-two-case-reports/2. Joint Degeneration

• Knee osteoarthritis (KOA)
  Human study: Combined PRP + ESWT significantly outperformed either treatment alone.
  Link: https://pubmed.ncbi.nlm.nih.gov/31823552/

• KOA with meniscus degeneration
  Retrospective analysis: Combined therapy resulted in greater pain and functional improvement.
  Link: https://pubmed.ncbi.nlm.nih.gov/38356839/

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Ideal Timing: When the Combination Works Best​

• Before PRP: 1 shockwave sessions can prime the tissue for better biologic response.

• After PRP: Shockwave can resume 7-10 days later to reinforce remodeling. for 3 more treatments

• Chronic injuries: Alternating PRP and shockwave sessions helps maximize long-term structural healing.