Shock Wave Therapy - A Pro
Inflammatory Treatment
CAUSING AN INJURY TO CURE AN INJURY - A FUNNY OLD WORLD!
Targeted treatment for stubborn tendon and soft tissue problems.
Shockwave therapy can help reduce pain, improve function and support recovery in some persistent tendon and soft tissue problems that have not settled with time, exercise or previous hands-on treatment.
It is one of the tools I may use as part of a broader physiotherapy assessment and treatment plan, rather than something that should usually be booked in isolation without understanding the problem first.
Or ask a question first
Targets the source
Aimed at selected tendon and soft tissue problems that can be slow to settle.
Evidence based
Supported by good quality research for a number of tendon-related conditions.
Part of a bigger plan
Usually used alongside assessment, load management, hands-on treatment and rehabilitation.
Delivered by an expert
Over 25 years of physiotherapy experience in assessing, treating and managing musculoskeletal problems.
What is Shockwave Therapy?
Shockwave therapy is a treatment that uses high-energy acoustic pressure waves delivered through the skin to stimulate a response in painful or persistent soft tissue problems.
At Chris Heywood Physio, I use radial extracorporeal shockwave therapy, often referred to as radial ESWT or radial pressure wave therapy. This is different from focused shockwave therapy, which uses a more concentrated form of energy and is usually delivered with different equipment.
Radial ESWT spreads acoustic energy through the tissues from the treatment head. It is commonly used for selected tendon and soft tissue problems where symptoms have not settled as expected with time, exercise, load management or previous treatment.
It may help reduce pain, improve function and support the body’s natural repair processes in areas that have become stubborn or slow to recover.
I am often contacted by people asking for shockwave therapy because they have seen it advertised, been told it might help, or read about it online. Sometimes, once I explain what radial ESWT is actually intended to do, how it works, and which types of problems it is most suited to, it becomes clear that it is unlikely to be the right treatment for their particular problem.
Shockwave Therapy (ESWT) May Help With:
Tendon problems such as Achilles tendinopathy, patellar tendinopathy, tennis elbow and plantar fasciitis.
Some shoulder tendon and rotator cuff-related problems.
Calcific tendinopathy, where appropriate.
Hip tendinopathy, including gluteal tendon problems.
Some other persistent soft tissue or overuse problems, where assessment suggests radial ESWT is appropriate.
If you are not sure whether shockwave therapy is right for you, that is exactly why proper assessment comes first. It should be used for the right problem, at the right stage, and as part of a wider treatment plan rather than as a standalone guess.
That matters. Shockwave therapy is sometimes marketed as if it is a miracle cure for almost anything painful. It is not. NICE guidance on ESWT for conditions such as Achilles tendinopathy, plantar fasciitis and tennis elbow describes no major safety concerns, but also highlights uncertainty or inconsistency in the evidence for effectiveness and stresses the importance of careful patient information, governance and outcome review. In other words: it should be used selectively, not fired at every painful body part like a therapeutic confetti cannon.
I use a Chattanooga Mobile 2 RPW shockwave system, which allows targeted treatment of the affected area. Most people tolerate treatment well, although it can feel uncomfortable or intense over sensitive tissues.
How Does Shockwave Therapy Work?
Shockwave therapy is not simply a pain-relieving machine. It is designed to create a controlled mechanical stimulus in the tissues being treated.
With radial ESWT, there is a small metal projectile inside a sealed applicator. This projectile is driven rapidly up and down inside the barrel at a preselected speed and power. When it strikes the treatment end of the sealed applicator, the impact creates an acoustic pressure wave. That pressure wave then passes through the treatment head, through the skin and into the tissues being treated.
The treatment can be adjusted depending on what is being treated and what response is needed. Different applicator heads, treatment angles, energy levels and settings can alter how the pressure wave is delivered through the tissues. In other words, it is not just a case of pointing the machine at pain and hoping for the best, despite this being a worryingly popular business model in parts of healthcare.
This mechanical stimulus can affect local tissue activity, pain sensitivity, blood flow and the body’s repair processes. It can also encourage a short-term pro-inflammatory response. That phrase can sound odd, because most people think inflammation is always bad. It is not that simple. After a new injury, acute inflammation is usually part of the normal early healing process. It helps start repair. In many long-standing tendon problems, however, the issue is different. The tissue may have become painful, overloaded and slow to adapt, but not necessarily “inflamed” in the simple way people often imagine.
In those more persistent problems, the aim of shockwave therapy is to provide a carefully controlled stimulus that may help encourage a more active repair response. That is why shockwave is usually considered for chronic or stubborn tendon and soft tissue problems, rather than as a first-line treatment for every new ache, strain or flare-up.
Shockwave therapy is also not without risk. I would not be comfortable applying shockwave therapy to tissues where I felt there was a realistic possibility of an existing tear, or where the tissue appeared so chronically degenerative, weakened or vulnerable that treatment could plausibly make the problem worse. In those situations, shockwave therapy may not just be unhelpful; it may be the wrong thing to do.
I am often contacted by people asking for shockwave therapy because they have seen it advertised, been told it might help, or read about it online. Sometimes, once I explain what radial ESWT is actually intended to do, how it works, and which types of problems it is most suited to, it becomes clear that it is unlikely to be the right treatment for their particular problem.
That matters because shockwave therapy is sometimes marketed as if it is a miracle cure for almost anything painful. It is not. It should be used for the right problem, at the right stage, and as part of a wider treatment plan rather than as a standalone guess.
I would only apply shockwave therapy if I was satisfied that it was clinically appropriate and likely to be the best course of treatment for your condition. Clinical judgement still matters. The machine does not get to make the decision.
Shockwave Therapy Is Not A Miracle, Nor Does It Work On Everything Chronic
Shockwave therapy can be highly effective, but only when it is used appropriately. Its benefits are often overstated, and it is sometimes applied outside recognised clinical guidance or offered simply because other treatments have failed. If the diagnosis, timing, tissue state, or treatment target is wrong, shockwave is unlikely to help and, in some cases, could make symptoms worse or be unsafe. That is why proper assessment and clinical reasoning matter before treatment is started.
Shockwave therapy may be useful if:
You have a persistent tendon or soft tissue problem that hasn’t settled.
You’ve already tried rest, exercise, load management or other treatment with limited improvement.
You’re looking for a treatment that may help avoid injections or surgery where appropriate.
You want a treatment option that supports recovery rather than simply masking pain.
Not sure if it’s right for you? Let’s assess first.
Part of a comprehensive approach
Shockwave therapy is usually most effective when it is part of a wider plan, not used as a standalone treatment.
Your treatment may include:
Accurate diagnosis and problem understanding.
Hands-on treatment to reduce pain and improve movement.
Personalised rehabilitation and exercises.
Advice on load management, activity and return to sport or work.
The goal is not just pain relief, but longer-term improvement and reduced recurrence.
Shockwave therapy may not be useful if you have or are:
Had a steroid injection into the treatment area within the last 6 weeks to 3 months*.
Taking anticoagulant medication, such as warfarin, rivaroxaban or apixaban, or you have a bleeding or clotting disorder.
Pregnant or trying to conceive.
A pacemaker or implanted electronic device.
Cancer or a tumour near the treatment site.
Infection, open wounds or skin problems over the area.
Current thrombosis.
Altered sensation or epilepsy.
Recent surgery or fracture near the area.
A suspected tissue tear in the area to be treated.
Anti-inflammatory medication, such as ibuprofen, may need to be avoided before and during treatment. This should be discussed before treatment.
*Depending on the problem and clinical context.
Your safety and results come first
This approach is in line with NICE guidance, which recommends shockwave therapy for selected conditions only, when used appropriately as part of a wider treatment plan.
If you are not sure, that’s exactly why proper assessment comes first
Common Questions
Do I need a diagnosis before booking?
No. You do not need to diagnose yourself before booking. Working out what is likely going on is part of the appointment and my job!
Will I get treatment at the first appointment?
Usually, if it is appropriate. The first priority is to assess and understand the problem properly. Treatment may then include hands-on work, exercise, advice, rehabilitation planning or other options depending on the findings.
Do I need a scan first?
Usually not. Some problems need imaging, but many do not. Scans are most useful when they are likely to change management. If imaging or onward referral seems appropriate, this can be discussed after assessment.
How many sessions will I need?
That depends on the problem, your goals and how your symptoms respond. Some people only need one or two appointments. Others need a longer rehabilitation plan. You will not be pushed into routine packages or unnecessary repeat bookings.
What if I am not sure which service to choose?
Choose the closest fit or send a practical question before booking. Most clinic appointments allow time to assess the problem and adjust the plan if a different treatment route is more appropriate.
Can you help if I need a consultant referral or scan?
Yes. If your symptoms suggest that imaging, further investigation or a consultant opinion may be appropriate, I will explain this clearly and help you understand the most sensible next step.
Many painful problems do not need a scan straight away, and imaging can sometimes show age-related changes that are not actually the main cause of pain. Equally, some cases do need further investigation, especially where symptoms are severe, worsening, unusual, not responding as expected, or suggest a more specific structural or medical concern.
Where appropriate, I can advise you on the type of specialist who may be relevant, such as an orthopaedic consultant, spinal consultant, sports physician or other healthcare professional. I can also signpost patients towards trusted consultants and imaging providers where I have direct experience of their work and feel comfortable doing so.
If a consultant, clinic or imaging provider is not listed on my trusted recommendations page, that should not be taken as a negative judgement. It may simply mean I have not worked with them directly, do not know them well enough to comment, or have not been given permission to include them on the site. The most important thing is that you feel confident in the clinician or provider you choose. I can give guidance based on my own clinical experience, but the final decision should always be yours.
Do you work with health insurance companies?
I work with a small number of selected insurers, including WPA and First Health, which is used by some Mercedes employees and associated schemes. Most of my patients, however, choose to self-fund their care.
Like many experienced clinicians nowadays, I do not work with every insurance provider. Some larger insurers use a single fixed rate for physiotherapy, regardless of whether the clinician is newly qualified or has decades of advanced clinical experience. As my appointments are longer, more personalised and based on over 25 years of physiotherapy experience, my service is best suited to patients who value direct, specialist care rather than a volume-based insurance model.
If you intend to use insurance, please check before booking so I can confirm whether your provider is one I currently work with.
Can physiotherapy help if I have had symptoms for a long time?
Often, yes, but the plan may be different. Longer-standing problems usually need clear explanation, graded rehabilitation, confidence-building and realistic progression rather than chasing quick fixes.
Common Questions
Alongside private practice, I also work on Mondays and Tuesdays in an advanced role as a First Contact Practitioner (FCP) in Musculoskeletal Primary Care within the NHS, assessing, diagnosing, and triaging patients without the need for a GP appointment.
The easiest way to see my private physiotherapy appointment availability in real time, and book, is to visit the book an appointment page. If you need to make contact directly for questions and queries you are very welcome to call, but when I am in clinic my phone is always on silent so I can give my full attention to the patient I am seeing at the time. For this reason, it is usually quicker to reach me via the contact form, email or WhatsApp, where I can often read and respond in gaps.
Whichever way you get in touch, I will respond as soon as possible — and during the working week that is almost always the same day.