A critical appraisal evaluating the efficacy of extracorporeal shockwave therapy in coccydynia

Coccydynia is referred to as pain in the region of the coccygeal bone. It is usually managed conservatively with physiotherapy, education and medication. Symptoms can last a couple of weeks or up to 5 years. For severe cases, invasive interventions such as injections or surgery are currently the main options. The use of extracorporeal shockwave therapy (ESWT) is emerging as a successful, non-invasive treatment for a variety of musculoskeletal conditions. A systematic review by Nikouei et al (2022) aimed to establish if ESWT was effective at alleviating pain for patients with coccydynia. This commentary provides a critical evaluation of the methods employed in this review and discusses its findings in the context of the four pillars of advanced practice: clinical practice, leadership and management, education and research in physiotherapy. While the review highlights the potential of ESWT in reducing pain for coccydynia, limitations such as methodological weaknesses and the lack of condition-specific protocols present challenges for advanced practitioners in determining its optimal timing and integration into practice.