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.
NICE guidance does not treat shockwave therapy as a cure-all. For several common indications, NICE highlights that serious safety concerns are not the main issue, but that evidence of effectiveness can be inconsistent and should be discussed clearly with patients. That is why I use shockwave selectively, with proper assessment, consent and review of outcomes.
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
If you are not sure, that’s exactly why proper assessment comes first
This approach is in line with NICE guidance
NICE recommends shockwave therapy for selected conditions only, when used appropriately as part of a wider treatment plan.
Common Questions
Is shockwave therapy suitable for my problem?
Shockwave therapy may be suitable for selected tendon and soft tissue conditions, particularly when symptoms have become persistent and have not improved with appropriate rehabilitation, activity modification or load management. It is commonly considered for problems such as Achilles tendinopathy, plantar fasciitis, tennis elbow, patellar tendinopathy, gluteal tendinopathy and selected shoulder tendon problems. It is not suitable for every painful area and should only be used when there is a clear clinical reason.
Do I need an assessment before shockwave therapy?
Yes. At Chris Heywood Physio, shockwave therapy is only considered after an appropriate assessment. This helps determine whether shockwave is likely to be useful, whether it is safe, and whether it fits within your wider treatment plan. If shockwave is not suitable, this will be explained clearly and a more appropriate option will be discussed.
Can I book shockwave therapy as a standalone treatment?
Shockwave therapy is not usually offered as a standalone treatment. It is most effective when used as part of a wider physiotherapy plan, which may include diagnosis, education, load management, rehabilitation exercises and advice about activity. If shockwave is appropriate, it may form part of your treatment, but it should not replace proper clinical assessment.
What conditions can shockwave therapy help with?
Shockwave therapy is most commonly used for persistent tendon-related problems and some soft tissue pain conditions. These may include Achilles tendinopathy, plantar fasciitis, tennis elbow, patellar tendinopathy, gluteal tendinopathy and selected shoulder tendon conditions. It is not usually appropriate for acute injuries, suspected fractures, significant tissue tears, infection, unexplained pain or conditions where the diagnosis is unclear.
How many shockwave therapy sessions will I need?
Many shockwave treatment plans involve around 3 to 6 sessions, depending on the condition, how long symptoms have been present, how you respond to treatment and what else is included in your rehabilitation plan. More treatment is not automatically better. If symptoms are not improving as expected, the plan should be reviewed rather than simply continued.
Is radial shockwave the same as focused shockwave?
No. Radial shockwave therapy and focused shockwave therapy are different. Radial shockwave spreads mechanical energy into the tissues from the treatment head and is commonly used in physiotherapy clinics for tendon and soft tissue problems. Focused shockwave delivers energy more precisely to a deeper target. Patients should be clear about which type of shockwave is being used.
Do I need a scan before shockwave therapy?
Not always. Many tendon and soft tissue problems can be assessed clinically without imaging. However, a scan may be useful if the diagnosis is unclear, symptoms are unusual, symptoms are worsening, there has been trauma, or there is concern about a tear, fracture or another condition that would make shockwave therapy inappropriate.
Is shockwave therapy evidence-based?
Shockwave therapy has evidence for some persistent tendon and soft tissue conditions, but the evidence is not equally strong for every condition. It should not be presented as a guaranteed cure. The most appropriate use of shockwave is selective: the right diagnosis, the right patient, the right timing and the right rehabilitation plan.
Does shockwave therapy hurt?
Shockwave therapy can feel uncomfortable, particularly over sensitive tendon or soft tissue areas. The intensity can usually be adjusted so that treatment remains tolerable. Some short-term soreness after treatment can be normal, but severe or worsening pain should be reviewed.
What should I avoid after shockwave therapy?
After shockwave therapy, you may be advised to avoid heavy loading, high-impact activity or aggravating exercise for a short period. The advice will depend on the area treated, your diagnosis and your current level of activity. The aim is usually sensible loading rather than complete rest.
Can I take anti-inflammatory medication after shockwave therapy?
Anti-inflammatory medication may be discouraged around the time of shockwave therapy because the treatment aims to stimulate a local tissue response. This depends on your medical history and the reason you take the medication. You should not stop prescribed medication without appropriate medical advice, but you should mention any anti-inflammatory medication before treatment.
Can I have shockwave therapy after a steroid injection?
Shockwave therapy is usually avoided for a period after a corticosteroid injection, particularly around tendons and soft tissues. Steroid injections can affect tissue quality, and treatment too soon after injection may not be appropriate. You should always tell your clinician if you have recently had a steroid injection near the area being considered for shockwave therapy.
When is shockwave therapy not safe or not appropriate?
Shockwave therapy may not be appropriate if you are taking anticoagulant medication, have a bleeding or clotting disorder, have infection or an open wound near the treatment area, have a suspected fracture, recent surgery, suspected tendon tear, cancer near the treatment site, altered sensation, thrombosis, pregnancy-related considerations, or certain implanted medical devices. Proper screening is important before treatment starts.
When is shockwave therapy not safe or not appropriate?
Shockwave therapy may not be appropriate if you are taking anticoagulant medication, have a bleeding or clotting disorder, have infection or an open wound near the treatment area, have a suspected fracture, recent surgery, suspected tendon tear, cancer near the treatment site, altered sensation, thrombosis, pregnancy-related considerations, or certain implanted medical devices. Proper screening is important before treatment starts.
Can shockwave therapy make symptoms worse?
Shockwave therapy can make symptoms worse if it is used for the wrong condition, at the wrong stage, in the wrong area, or without proper clinical screening. Mild temporary soreness can be normal, but inappropriate use may irritate symptoms or be unsafe in some situations. This is why assessment and clinical reasoning are essential before treatment.
What happens if shockwave therapy is not suitable for me?
If shockwave therapy is not suitable, this will be explained clearly. Alternative options may include rehabilitation, load management, activity modification, further assessment, imaging, GP review or onward referral where appropriate. The aim is to choose the safest and most useful next step, not to use shockwave when it is unlikely to help.
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.