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Extracorporeal shockwave therapy

This guide explains more about the use of extracorporeal shock wave therapy (ESWT) to treat tendinopathy and plantar fasciitis. It includes information on the benefits, risks and any alternative treatments, as well as what you can expect when you come to our clinic for treatment. 

What is ESWT?

ESWT is a procedure where shock waves are passed through the skin to the injured tendon or plantar fascia, using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric. They are audible, low-energy sound waves, which work by increasing blood flow to the injured area and improve healing. It is suggested that the beneficial effects of ESWT are partly also due to the stimulation of an inflammatory response which can kickstart the ‘stalled’ repair sequence associated with chronic tendon problems.

Why should I have ESWT?

Tendon problems can be troublesome to resolve. Many patients come to see us having tried a variety of other treatments with limited effect. ESWT is offered to patients who have not responded well enough to other treatments such as rest, exercise, manual therapy, acupuncture, injections, orthotics (insoles or leg braces), ice therapy and medication.

It is a minimally invasive treatment that is carried out in clinic and is an alternative to more invasive treatments, such as surgery or injection. ESWT can offer relief from pain and other symptoms. When combined with appropriate exercises research has shown it be be very effective in the management of tendinopathy and plantar fasciitis. Links to independent articles on the effectiveness of ESWT can be found at the bottom of this page.

Which conditions can benefit from ESWT?

Conditions that have been shown to benefit from ESWT include;

  • Plantar Fasciitis
  • Achilles Tendinopathy/ Tendonitis
  • Jumper’s Knee /Patella Tendinopathy
  • Greater Trochanteric Pain Syndrome
  • Tennis Elbow
  • Golfers Elbow
  • Shoulder impingement/tendonitis
  • Tibialis Posterior tendinopathy

If you are unsure whether your problem will benefit from ESWT please do not hesitate to get in touch

Will I require any additional treatment?

Exercise is without question the most powerful medicine we have for treating tendon problems. Many tendon problems are caused by the tendons inability to cope with the demands being placed upon it. Ultimately the only way to increase a tendons ability to cope with these demands is to strengthen it. In addition to the ESWT you will be provided with a comprehensive graded exercise programme to be completed alongside your treatment.

How many sessions will I need?

You will usually require a course of 3 to 5 treatments, one to two weeks apart.

What are the risks/side effects?

Many people report an immediate reduction in pain with treatment however you may experience some mild pain or discomfort during the treatment. Following the treatment a small number of people initially experience a slight increase in pain, redness, bruising, swelling and numbness to the area. These side effects should resolve within a couple of days. This increase in pain is likely due to the inflammatory response that the ESWT is intended to create as part of the treatment goal of kickstarting the ‘stalled’ healing response. There is a very small risk of tendon rupture or ligament rupture and damage to the soft tissue.

How can I prepare for ESWT?

Current research suggests that the optimum dose is between 3 and 5 sessions. You should not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen while receiving treatment. If you are unsure if any of your medicines contain NSAIDs then please check with your doctor, nurse or pharmacist. Wear comfortable clothing as you will need to expose the affected area.

Who will carry out the procedure?

Your ESWT will be carried out by one of our physiotherapists, all of which have undertaken special training to carry out the procedure.

What happens during ESWT?

You will be asked to lie or sit in a comfortable position with the affected body part exposed and supported. The clinician will put some ultrasound gel on the injured area and then place the hand piece of the device on the gel. The ESWT is delivered using this hand piece – it delivers compressed air pulses through the ultrasound gel. Each treatment will take approximately five to 10 minutes.

Video of shockwave for achilles tendinopathy

Video of shockwave for plantar fasciitis

Will I feel any pain?

Most patients do experience some mild pain and discomfort during the procedure. You will be asked how much pain you are experiencing during the treatment, and we will attempt to adjust the treatment to help manage this.

Are there any reasons why I can’t have ESWT?

You must not have ESWT for Tendinopathy or plantar fasciitis if you:

  • are pregnant
  • are taking antiplatelets excluding aspirin 75mgs (for example, clopidogrel) or anticoagulants (such as warfarin or rivaroxaban)
  • have a blood clotting disorder
  • are under the age of 18
  • have been diagnosed with bone cancer
  • have an infection in your foot
  • have a history of Achilles tendon or plantar fascia ligament rupture
  • have had a steroid injection into the affected area in the previous 12 weeks

These will be discussed with you by your healthcare professional when the treatment is offered.

Your physiotherapist will discuss the benefits and risks of the procedure with you in more detail – please let them know if you have any questions or would like any further information.

What happens after ESWT?

After the treatment you will be able to get up and walk straight away. If you do experience discomfort following the shockwave treatment you can take over the counter painkillers (such as paracetamol) but don’t take anti-inflammatory medication (such as ibuprofen) as this can interfere with the body’s healing process

What do I need to do after I go home?

You will be able to return to your usual activities straight away and can return to work immediately. However we advise you not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours following the procedure.

How much will it cost?

Each session is charged at £60. Most clients will require a minimum of 3 and a maximum of 5 treatments to achieve the desired results. We can provide your first treatment at you initial assessment if it is clinically indicated.

Our ESWT machine is made by BTL, a leading medical technology manufacturer. Further information on the treatments effectiveness can be found on the BTL website;

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Please see the current NICE guidance on ESWT for further information.

If you have any further questions or need any further information please do not hesitate to get in touch.

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