Extracorporeal shockwave therapy (ESWT)

ESWT works through two main physiological mechanisms:

• Pain reduction (Hyperstimulation analgesia): The rapid sound wave impulses overstimulate local nerve endings, reducing the quantity of nerve fibers that transmit pain signals to the brain and producing immediate and long-term pain relief.
• Tissue regeneration and vascularization: The mechanical energy creates micro-trauma at a cellular level. This triggers the body's healing response, stimulating collagen production and promoting neovascularisation (the formation of new microscopic blood vessels) to improve blood supply, oxygenation, and tissue repair in chronic, poorly-vascularised tendons.

ESWT is widely used across specialist orthopaedic and sports medicine clinics to treat conditions including:

• Plantar fasciitis and heel spurs: Chronic pain on the underside of the heel and foot arch.
• Achilles tendinopathy: Mid-portion or insertional inflammation and degeneration of the Achilles tendon.
• Tennis elbow (Lateral epicondylitis) & Golfer’s elbow (Medial epicondylitis): Persistent tendon pain on the outer or inner elbow.
• Calcific tendonitis of the shoulder: Painful calcium deposits within the rotator cuff tendons.
• Patellar tendinopathy (Jumper’s knee): Chronic pain at the base of the kneecap.
• Greater trochanteric pain syndrome (Hip bursitis/tendinopathy): Pain along the outer hip.
• Bone healing disorders: Delayed-union or non-union fractures, as well as stubborn stress fractures that have failed to fuse naturally.

Shockwave therapy is performed as a fast, out-patient procedure in the clinic setting, requiring no local anaesthetic, admission, or prolonged downtime.

During the session

1. Locating the target area: Your consultant or specialist physiotherapist cleans the skin and palpates the precise area of maximum tenderness to ensure accurate placement.
2. Applying ultrasound gel: A small amount of coupling gel is applied to the skin over the target site to facilitate the smooth transfer of acoustic waves.
3. Delivering shockwaves: A specialized hand-held probe is pressed gently against the skin. The device delivers rapid acoustic pulses into the underlying target tissue.
4. Duration and frequency: Each treatment session typically lasts between 5 to 15 minutes (delivering roughly 1,500 to 3,000 shockwave pulses per session).

A standard treatment protocol usually involves 3 to 5 weekly sessions, depending on your consultant’s assessment and the chronicity of your condition.

ESWT does not require local anaesthetic. During the procedure, you will feel a rapid tapping or thumping sensation from the probe.

While the treatment can be uncomfortable or mildly painful, especially over bony prominences or highly inflamed tendons, your practitioner can easily adjust the energy level and pulse frequency to keep discomfort tolerable. Taking standard painkillers (such as paracetamol) prior to your appointment can help manage any minor discomfort.

Important note on painkillers: Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) immediately before or during your shockwave treatment course, as these can interfere with the body's natural inflammatory healing process triggered by ESWT.

Shockwave therapy is a remarkably safe, non-invasive procedure with minimal side effects. Potential minor complications include:

• Temporary reddening or bruising: Transient skin redness, mild bruising, or minor localized swelling at the application site.
• Post-treatment tenderness: A temporary ache or heightened soreness for 24 to 48 hours following a session.
• Skin numbness or tingling: Transient alteration in skin sensation around the treated area, which rapidly resolves.

ESWT is generally not recommended for individuals who:

• Are pregnant.
• Have an active infection or open wound over the treatment site.

• Have a blood clotting disorder or take major blood-thinning medications (e.g., warfarin).
• Have received a steroid injection into the target area within the previous 6 weeks.
• Have a cardiac pacemaker or major nerve/blood vessel structures directly over the target treatment zone.

Your specialist will review your complete medical history to ensure ESWT is entirely safe for you.