What is it?
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment in which a device is used to pass acoustic shockwaves at a set frequency through the skin to the affected area. It is purely a mechanical wave, not an electric one. Shockwave is an accepted intervention in the UK and treatment provides pain relief for chronic tendinopathies and plantar fascia pain.
How does it work?
The treatment initiates a pro inflammatory response in the affected tissue. This promotes healing by increasing the circulation which accelerates the body’s own healing processes. The shockwaves also break down injured tissues and calcifications and give a temporary analgesic effect. This immediate pain relief is known as ‘hyper-stimulation anaesthesia’.
How is the shockwave delivered?
The painful area is located by palpation. The treatment is delivered via a compressed air impulse through a hand held piece attached to the shockwave machine. The shockwave radiates out through the head into the affected area. Contact gel will be applied to the skin to improve the transmission of the shockwave.
Why chose ESWT?
Shockwave therapy stimulates and supports the body’s self-healing mechanisms. ESWT is a non-invasive treatment modality and there are no medications such as cortisone or surgery involved. There are no major safety concerns associated with ESWT. It is common to have some immediate pain relief and studies have shown positive outcomes in approx. 70% to 90% of cases. It is included in the NICE (nice.org.uk) guidelines for the management of refractory (chronic) conditions such as plantar fasciitis, Achilles tendinopathy and tennis elbow and can be used for any common tendinopathies including Patella and gluteal tendinopathies.
Frequently Asked Questions:
How long does the treatment session last?
The ESWT application lasts 3-4 minutes to deliver the set 2500 impulses of shockwave energy and you must attend for 3 sessions over 3 consecutive weeks. Some people require an additional 1-3 sessions.
Is the shockwave treatment painful?
ESWT treatment can be painful during application and the treatment is delivered according to patient response. If a patient is unable to tolerate the pain, the settings are adjusted to reduce the discomfort. A mild ache may occur later that day but should pass after a day. A patient may therefore take analgesic pain relief afterwards if required or before attending their next sessio
What are the criteria for referral for ESWT?
Generally, shockwave is administered in patients who have a chronic condition who have suffered for more than 3 months from an on-going tendinopathy, or calcification whilst conservative treatments (physiotherapy, injection therapy or orthotics) have failed so far to provide pain relief.
Are there any Contraindications or Precautions to be aware off?
ESWT is not allowed if you are pregnant.
ESWT application is also not indicated if the following criteria apply:
- Lung tissue in direction of sound fields
- Has had a Cortico-Steroid injection in the area in past 3 months
- Over or near bone growth centers until bone growth is complete
- If you have a pace maker you should let your therapist know.
- Malignancy is known to be present in or near the treatment area
- Treatment site has open wounds, skin rashes, swollen, inflamed, or infected areas
- Over ischemic tissues in individuals with vascular disease
- Coagulation disorder or taking anticoagulant/antiplatelet medications
- Infection at the treatment site to avoid the risk of spreading
- History of allergy to contact gel solution
What to do following the treatment?
There are no restrictions after the treatment session and you may continue with your normal activities. You may use simple painkillers if still in pain. Do not use anti-inflammatory medication such as Ibuprofen/Voltarol, Naproxen or use ICE on the treated area as both will affect the body’s inflammatory and healing process stimulated by the shockwave treatment. Use of such products should be avoided for 3 months after treatment as they will interfere with the healing process that shockwave has started. If you are taking anti-inflammatory medication for other conditions you will need to discuss this with your clinician or G.P as they may affect the outcome of shockwave therapy.
Many people experience improvement in symptoms immediately, while others take a few weeks to respond. You may notice a reddenining or swelling of the area with some patients experiencing a brief increase in pain. Long term effects are normally seen after 3 months. All patients should be reviewed after 6-12 weeks by their referring clinician after having completed the course of shockwave treatment.