Shockwave Therapy (ESWT)

A non-surgical solution to persistent problems

Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment where a hand-held device is applied outside the body, introducing energy to painful areas and promoting the body to heal itself. Regardless of the cause; injuries can be debilitating and, if left untreated, may affect your daily life. Shockwave is a non-surgical, non-invasive treatment option for a wide variety of conditions with no downtime.

COMMON PROBLEMS THAT SHOCKWAVE TREATS:`

• Achilles Tendonitis • Plantar Fasciitis (Heel Pain) • Patellar Tendonitis (Jumper’s Knee) • Back Pain • Medial Tibial Stress Syndrome (Shin Splints) • Epicondylitis (Tennis or Golfers Elbow) • Periarticular Shoulder Pain • Tendinosis Calcarea (Calcific Tendonitis) • Greater Trochanteric Pain Syndrome (Hip)

In having a long-term injury many people think that surgery is their only option to get better but there is risk involved and a long recovery time associated with this. “Shockwave Therapy (ESWT) offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity.” FDA

HOW SHOCKWAVE THERAPY WORKS

Shockwave Therapy has emerged as a powerful treatment option for various persistent issues. This non-invasive procedure uses high-energy acoustic waves to stimulate healing and provide pain relief.

Shockwave Therapy works by:

Increasing blood flow to the affected area
Triggering healing processes through stem cell activation
Reducing pain by modulating nerve fibers
Breaking down scar tissue
Accelerating healing time

As a treatment protocol, Shockwave Therapy is recommended by the National Institute for Clinical Excellence (NICE). Most patients require 3-6 sessions of Shockwave Therapy, spaced one week apart. The number of sessions may vary depending on the duration of symptoms.

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CLINICALLY PROVEN

Shockwave Therapy is clinically proven, recognised by the top orthopaedic hospitals and used by high-profile professional sports bodies.

WHAT ARE SHOCKWAVES?

Shockwaves are high-energy sound waves which are transmitted to the affected area to accelerate healing. The treatment increases blood flow, decreases localised pain and stimulates cell regeneration - this encourages the body to repair itself. Shockwaves also break down injured tissue and calcifications.

ON WHAT PARTS OF THE BODY CAN SHOCKWAVE THERAPY BE USED?

Shockwave Therapy can treat conditions in the hips, knees, shoulders, elbows, Achilles, forearms, shins, back and feet.

IS SHOCKWAVE PAINFUL?

You may experience some discomfort during treatment but the pain should be tolerable. Due to the analgesic effect of Shockwave Therapy many patients report immediate pain relief following treatment.

CAN SHOCKWAVE TREAT OLD/PERSISTENT INJURIES?

Shockwaves can treat both long-term chronic conditions and newer injuries, there is a great deal of evidence to show that Shockwave Therapy can achieve great results even with historical conditions.

SHOCKWAVE THERAPY: TOP 3 TREATABLE CONDITIONS

We use Shockwave Therapy in our clinic to treat a range of debilitating conditions. Here are some guides to the 3 most common problems we see, and how Shockwave treatment can help.

Plantar Fasciitis

Plantar fasciitis is a common foot condition that causes heel pain and discomfort. By addressing the root causes of inflammation and promoting the body’s natural healing processes, Shockwave Therapy provides a non-invasive solution that can significantly improve quality of life for plantar fasciitis sufferers.

What is Plantar Fasciitis?

Plantar fasciitis occurs when the plantar fascia, a thick band of tissue connecting your heel bone to your toes, becomes inflamed or irritated. This condition can cause significant pain and discomfort, affecting your daily activities and quality of life.

Causes of Plantar Fasciitis

Several factors can contribute to the development of plantar fasciitis:

Engaging in high-impact activities like running
Having high arches or flat feet
Spending long periods standing or walking
Wearing poorly fitting or unsupportive shoes
Having tight leg muscles or Achilles tendons
Certain types of inflammatory arthritis

Symptoms of Plantar Fasciitis

The primary symptom of plantar fasciitis is heel pain, which may:

Feel sharp and stabbing
Be worse when taking first steps after waking or being inactive
Increase throughout the day
Worsen when walking barefoot or going up stairs
Improve with rest

Shockwave Therapy works by targeting the affected area, addressing the inflammation at its source and supporting the natural healing process. Contact us to book an appointment.

Achilles Tendonitis/Tendinopathy

Achilles tendinopathy is a common condition affecting the Achilles tendon, which connects the calf muscles to the heel bone. This injury can cause significant discomfort and limit physical activity, especially in athletes and active individuals.

Causes of Achilles Tendinopathy

Achilles tendinopathy is primarily caused by:

Overuse and repeated stress on the tendon
Sudden increases in exercise intensity or duration
Tight or weak calf muscles
Poor ankle flexibility
Age-related tendon degeneration

Symptoms of Achilles Tendinopathy

Common signs of Achilles tendinopathy include:

Pain and stiffness in the heel area, especially in the morning
Swelling around the tendon and ankle
Tenderness when touching the affected area
A grating or creaking sensation during movement
Difficulty bearing weight on the affected leg

Extracorporeal Shockwave Therapy (ESWT) has emerged as a highly effective treatment for chronic Achilles tendinopathy, particularly when other conservative methods have failed. This non-invasive procedure offers several benefits:

Pain Reduction - Studies show that shockwave therapy can significantly reduce pain, with patients experiencing an average pain reduction of 5 on a 10-point scale.
Improved Function - ESWT has been found to enhance tendon function and overall mobility in patients with Achilles tendinopathy.
Long-lasting Results - The benefits of Shockwave Therapy continue to improve for several years after treatment, with a low recurrence rate.
Complementary to Exercise - When combined with eccentric exercises, Shockwave Therapy produces better outcomes than exercise alone.
Quick and Non-invasive: The treatment typically involves three short sessions over three consecutive weeks.

For those suffering from persistent Achilles tendinopathy, Shockwave Therapy offers a clinically proven, non-surgical solution to alleviate pain and promote healing. Talk to one of our qualified physiotherapists to determine if this innovative treatment is right for you.

Tennis Elbow

Tennis elbow, also known as lateral epicondylitis, is a common condition causing pain and tenderness on the outer part of the elbow. Despite its name, this condition affects people of all ages and professions, not just tennis players. Tennis elbow can also be known as golfer’s elbow given its prevalence among people who play golf.

Causes of Tennis Elbow

Tennis elbow typically results from repetitive arm movements that strain the forearm muscles and tendons1. Common activities that can lead to tennis elbow include:

Racquet sports (tennis, racquetball, squash)
Golf
Weightlifting
Carpentry
Typing
Painting
Knitting

Symptoms of Tennis Elbow

The main symptoms of tennis elbow include:

Pain and tenderness on the outer part of the elbow
Discomfort when lifting objects or gripping
Pain when straightening the wrist or hand
Difficulty with everyday tasks like opening doors or shaking hands

Research has shown that Shockwave Therapy can be more effective than placebo treatments and as effective as other standard treatments like corticosteroid injections and physical therapy. A study published in the Journal of Orthopaedic Surgery and Research demonstrated that both radial and focused Shockwave Therapy effectively reduced pain and improved function in patients with chronic lateral epicondylitis.

For those suffering from persistent tennis elbow that hasn't responded to conventional treatments, Shockwave Therapy offers a safe, effective, and non-invasive alternative. This cutting-edge treatment can help patients return to their daily activities – and favourite sports – with reduced pain and improved function. Talk to one of our team to book an appointment with us.

Shockwave Therapy (ESWT): Frequently Asked Questions

A practical guide for anyone considering Shockwave Therapy at our London clinic for the first time. If your question isn't answered here, please get in touch – a short conversation often helps decide whether this is the right next step for you.

About the treatment

What exactly is Shockwave Therapy?

Shockwave Therapy – known clinically as Extracorporeal Shockwave Therapy (ESWT) – is a non-invasive treatment that uses high-energy acoustic pressure waves to stimulate healing in tendons, ligaments, muscles and bone. A handheld device is pressed against the skin (with gel as a conductor) and delivers short bursts of mechanical pulses to the injured area. 'Extracorporeal' simply means 'from outside the body' – nothing is injected, cut or inserted.

The technology was originally developed in the 1980s to break up kidney stones, and is now an established treatment in physiotherapy and orthopaedics for stubborn musculoskeletal conditions.

How does it actually work?

The shockwaves create a controlled, localised micro-stimulus in the tissue. Your body responds by:

Increasing blood flow and metabolism in the area, which accelerates the natural healing process.
Breaking down calcium deposits (calcifications) that can build up in long-standing tendon problems.
Triggering the release of growth factors that promote tendon and tissue repair.
'Overstimulating' the local nerves, which can reduce pain sensitivity in the treated area.

In simple terms, Shockwave gives a stalled healing process a deliberate nudge.

Is this recommended by NICE and used on the NHS?

Yes. The National Institute for Health and Care Excellence (NICE) has issued guidance recognising ESWT as a treatment option for several chronic musculoskeletal conditions, including refractory plantar fasciitis and Achilles tendinopathy. NICE has deemed the procedure safe. It is offered within the NHS – including at Guy's and St Thomas', St George's, and the Royal National Orthopaedic Hospital – as well as in private practice across London.

Will it hurt? What does it actually feel like?

Is Shockwave Therapy painful?

This is the question almost everyone asks first, so let's be honest about it. Shockwave Therapy can be uncomfortable, but it is not what most people would call severely painful. Patients typically describe it as a series of rapid, firm tapping or 'pulsing' sensations against the skin – sometimes likened to a tiny jackhammer. The device is also noticeably loud, which can feel surprising on a first session.

Importantly, the energy level can be adjusted in real time: if it becomes too sore, tell your physiotherapist and they will turn the intensity down. Most people tolerate it well, especially once they know what to expect.

What does a session actually involve?

A typical first appointment in our London clinic follows the same broad pattern:

A brief assessment to confirm the diagnosis and check there are no reasons not to proceed.
The physio therapist locates the precise point of injury, often with their hands.
A water-based gel is applied to the skin to help transmit the shockwaves.
The handheld probe is placed against the area and the shockwaves are delivered. The actual shockwave delivery takes around 5 minutes, though the full appointment is usually 20–30 minutes.

You can get up and walk out straight afterwards. No anaesthetic, no recovery room, no hospital stay.

Will I feel anything afterwards?

It's common – and a good sign – to feel some mild soreness, redness, warmth, swelling or temporary numbness in the treated area for a day or two after a session. This is part of the body's healing response, not a problem to be worried about.

Some patients also experience a brief 'flare-up' where their original symptoms feel worse for 24–72 hours before improving. This is a known and well-documented response, consistent with the inflammatory healing process that Shockwave Therapy deliberately triggers. If anything feels much more than mild – or if numbness or pain persists beyond a week – let your physiotherapist know.

Is it safe? Could it make me worse?

How safe is Shockwave Therapy?

Very safe when delivered by a trained clinician. NICE has reviewed the evidence and considers the procedure safe, with side effects typically limited to bruising, pain and minor skin reactions at the treatment site. Because the treatment is non-invasive, there's no risk of infection from incisions, no anaesthetic risk and no recovery downtime.

Is there anyone Shockwave Therapy isn't suitable for?

Yes, and this is why we screen carefully before starting. Shockwave Therapy is not advised if you:

Are pregnant or trying to conceive.
Are under 18 years of age.
Have had a steroid injection into the area within the last 6–12 weeks (NHS guidance commonly cites 12 weeks).
Have a bleeding disorder such as haemophilia, or are taking blood-thinning medication.
Have a cardiac pacemaker, defibrillator or other implanted heart device.
Have a fracture, tumour, infection or open wound at the treatment site.
Have a current blood clot (thrombosis) in the area.
Have epilepsy.
Are taking fluoroquinolone antibiotics (such as ciprofloxacin), which can affect tendon integrity.
Have a condition causing fragile bones, such as osteogenesis imperfecta.
Have significantly altered skin sensation over the treatment area.

If any of these apply, we'll discuss alternatives rather than proceed. Caution is also needed if you have metalwork (pins, plates, prostheses) in the treatment area or a history of significant tissue rupture at the injury site.

Could it make my injury worse?

In rare cases, especially with high-energy treatment or already-weakened tissue, there is a small risk of irritating a tendon or ligament, which is again why screening matters. The temporary 'worse before better' flare-up that some patients experience in the first few days is not the same thing as the injury getting worse; it tends to settle within 72 hours and is followed by gradual improvement. If pain progressively worsens over the days following treatment rather than improving, that's a signal to pause and reassess — please contact us.

What conditions does it help with?

What problems is Shockwave Therapy used for?

Shockwave Therapy is best evidenced for chronic tendon and soft-tissue conditions that haven't responded to conventional treatment. Commonly treated conditions include:

Plantar fasciitis (heel pain) – one of the most established uses, covered by NICE guidance.
Achilles tendinopathy – also covered by NICE guidance.
Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis).
Patellar tendinopathy (jumper's knee).
Greater trochanteric pain syndrome (lateral hip pain) and gluteal tendinopathy.
Proximal hamstring tendinopathy.
Calcific tendinopathy of the shoulder (calcium deposits in the rotator cuff).
Shin splints (medial tibial stress syndrome).
Adductor and distal biceps tendinopathies.

Shockwave Therapy is generally considered most appropriate for problems that have persisted for at least 3–6 months and haven't responded to first-line treatments such as physiotherapy, exercise, rest, ice, orthotics or pain medication.

Do I need a scan or referral before starting?

A formal referral isn't always required for private treatment, but a clear diagnosis is. Your physiotherapist will assess you and confirm whether Shockwave is appropriate – this may include reviewing any existing imaging (ultrasound or MRI) you have. If you've already seen a GP or consultant about the problem, please bring any letters or scan reports along.

How well does it actually work?

Clinical studies and clinical guidance consistently support Shockwave Therapy for plantar fasciitis and several chronic tendinopathies, with positive outcomes commonly reported in around 70% of cases, and some clinics and studies citing higher rates. NICE has flagged that outcomes vary depending on the condition, how long you've had it, and how well you stick to the accompanying exercise programme. Shockwave tends to work best when combined with a structured rehabilitation programme, not as a standalone fix.

How long does it take? How many sessions will I need?

How many sessions will I need?

Most patients need a course of 3-6 sessions, typically delivered once a week. The exact number depends on your condition, how long you've had it, and how you respond. Some people report meaningful improvement after the first session; for others, the benefits build progressively across the course and continue to develop in the weeks after treatment ends, as the body's healing response unfolds.

Why weekly? Could I have them closer together?

The weekly interval is intentional. Shockwave triggers a healing response that takes days to play out in the tissue, and the body needs that time between sessions to do its work. Bunching sessions too close together would interrupt that process rather than speed it up.

How quickly will I feel better?

It typically varies. Some patients feel immediate pain relief after the first session, others notice gradual change across the course, and improvements often continue for weeks or months after the final session. This isn't a treatment that delivers an instant, one-off fix – it's a programme that works with your body's biology over time.

What about cost and insurance?

Will private health insurance cover it?

Often, yes. Shockwave Therapy is commonly authorised by major UK insurers including Bupa, AXA Health, WPA and The Exeter, although cover varies considerably by policy. Some insurers require a referral from a GP or consultant. We'd recommend checking with your insurer in advance and we'll provide any documentation needed.

Is it good value compared with other options?

It's worth knowing that Shockwave is typically considered when first-line approaches haven't worked and the alternatives being weighed up are steroid injections, more invasive procedures, or surgery. Compared with those routes, a course of Shockwave is non-invasive, has minimal downtime, and addresses the underlying tissue rather than just masking pain.