It uses high-energy acoustic soundwaves to target painful areas of the body to help facilitate pain relief, tendon healing and improved functional recovery.

ESWT is safe, easy to administer and tolerated by most patients. Evidence supports the use of ESWT to facilitate tendon regeneration in chronic tendinopathies.

How does it work?

ESWT helps aid the healing process of the tendon by stimulating an acute and controlled inflammatory response in the area, allowing appropriate cells to flood the area, remove debris and support tissue regeneration.

What can we treat with ESWT?

ESWT can be used to treat a variety of tendinopathies when conservative management has failed to improve symptoms.

Conditions we can treat include:

• lateral epicondylalgia (tennis elbow)
• medial epicondylalgia (golfer’s elbow)
• gluteal tendinopathy
• Achilles tendinopathy
• plantar fasciopathy.

When is it appropriate to start ESWT?

ESWT is recommended when other conventional management strategies have failed after four to six months and the condition has been present for this amount of time or longer.

Conventional treatments include relative rest, ice and a progressive tendon-loading exercise programme through physiotherapy.

What can I expect?

Your physiotherapist will begin by asking about your symptoms and pain level on a scale of 0 to 10, where 0 is no pain.

They will then examine the affected area to identify where it is most sensitive.

Your physiotherapist will then apply ultrasound gel to the affected area and begin the ESWT treatment.

You will feel a repeated pulse-like sensation and treatment will usually last between two and five minutes.

Immediately following treatment, you may experience reduced pain or a numb sensation in the area. However, the pain may return within a few hours.

What are the potential side effects?

Some of the potential side effects include:

• reddening of the skin near the treatment site
• local mild swelling
• bruising
• pain
• short-term numbness or altered sensation
• more rarely, tendon rupture or a temporary increase in blood pressure.

Mild side effects are most often short term and will likely resolve by the time of your next appointment.

There is a small risk of tendon rupture. However, current available research has found only a few instances where this has occurred, most commonly following repeated steroid injections into the same tendon before ESWT treatment.

What are the contraindications for treatment?

The National Institute for Health and Care Excellence (NICE) has deemed this treatment safe.

However, ESWT may not be appropriate for everyone.

The following are contraindications for ESWT:

• first trimester of pregnancy or trying to conceive
• under 18 years of age
• steroid injection to the area within the last three months
• three or more steroid injections to the same site
• haemophilia, bleeding disorder or risk of haemorrhage
• cardiac pacemaker or other cardiac device
• unstable heart condition
• malignant tumour in the treatment site
• infection in the treatment site
• brain or spinal tumour
• acute inflammation in the area
• current thrombosis
• epilepsy
• taking anticoagulants
• taking antiplatelet medication, for example aspirin or clopidogrel
• taking certain types of antibiotics
• osteogenesis imperfecta
• powered implant
• recent fracture near the treatment area, underlying prosthetic joint or broken skin
• peripheral neuropathy or impaired/altered sensation.

You may not be allowed to have this treatment if you have one of the following conditions:

• inflammatory disease
• previous Achilles rupture or acute tendon/plantar fascia tear
• osteoporosis – hip ESWT is not offered to those with known hip osteoporosis on a DEXA scan.

What am I expected to do following treatment?

After your treatment, you should avoid any non-steroidal anti-inflammatory medication or gels (for example ibuprofen or naproxen) and avoid applying ice to the affected area for 48 hours.

Using these may delay the healing response of the ESWT treatment.

You can continue with your normal activities following treatment. However, try to avoid very painful or strenuous activities for 48 hours afterwards.

You should continue to complete the exercises prescribed by your physiotherapist.

Giving informed consent

Your physiotherapist should outline all the risks and benefits involved in ESWT treatment and discuss whether the treatment is appropriate for you and your symptoms.

Please ask any questions or raise any concerns before treatment begins so that your physiotherapist can address them.

Should you choose to begin ESWT treatment, you will be asked to sign a consent form confirming your understanding of the risks associated with ESWT.