Combination Therapy of Extracorporeal Shock Wave Therapy and Platelet-Rich Plasma for Musculoskeletal Disorders: A Narrative Review

Extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) have each been used for musculoskeletal disorders, but the role of their combination remains incompletely defined.This narrative review summarizes the PubMed-indexed evidence cited in the present manuscript regarding the biological rationale, current clinical evidence, treatment sequence, and remaining challenges of ESWT+PRP therapy.ESWT acts through mechanotransduction and may promote pain modulation, angiogenesis, tissue repair, and bone formation, whereas PRP provides growth factors that may support inflammation regulation, cell migration, angiogenesis, and extracellular matrix formation.Direct clinical combination studies are currently available mainly for patellar tendinopathy, lateral epicondylitis, partial rotator cuff tears, and aseptic nonunion of long bones.These studies suggest potential additive effects in early pain relief, functional recovery, and bone union.In contrast, for Achilles tendinopathy and plantar fasciitis, the literature largely compares ESWT and PRP monotherapies, and direct evidence for the combination remains limited.Bone disorders show strong biological plausibility and provide the clearest direct clinical support for aseptic nonunion.Overall, ESWT+PRP should currently be viewed as a promising but non-standardized strategy.Its clinical use appears most reasonable in selected chronic tendinopathies and biologically compromised bone healing, while standardized protocols and higher-quality comparative studies remain necessary.