What is extracorporeal shockwave therapy (ESWT)?
ESWT is a procedure where shock waves are passed through the skin to the injured part of the foot, using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric; they are audible, low energy sound waves, which work by increasing blood flow to the injured area. This accelerates the body’s healing process. You will usually require a course of three to five treatments, one to two weeks apart.
What musculoskeletal conditions would benefit from shockwave therapy?
Shockwave therapy treats many problems within soft tissue areas which have proved resistant to more conventional treatments, these include:
heel pain (plantar fasciopathy)
Achilles tendon pain (Achilles tendinopathy)
tennis elbow (lateral epicondylgia)
calcium build up in tendons (calcific tendinopathy)
pain in the tendon below the knee cap (patellar tendinopathy)
pain in the side of your thigh(Gluteal tendinopathy)
Why should I have ESWT?
ESWT is offered to patients who have not responded well enough to other treatments such as rest, ice therapy, pain relief medication, physiotherapy and orthotics (insoles or leg braces). Shockwave therapy can eliminate the need for steroid injections or surgical intervention and aid a faster return to normal activities.
It is a minimally invasive treatment carried out on an outpatient basis, which means you can go home the same day.
What happens during ESWT?
The treatment will be given at 1 of our PSJ Physiotherapy clinics. Usually the painful area is located by palpation (the use of hands or fingers to examine the area).
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 of the probe into the affected area. Contact gel will be applied to the skin to improve the transmission of the shockwave. Each treatment session will take approximately 10 to 15 minutes.
How does ESWT work?
The treatment initiates a pro-inflammatory response in the affected tissue. The body responds by increasing the blood circulation and metabolism in the affected area which accelerates the body’s own healing processes. The shockwaves can break down injured tissues and calcifications. As a result of cellular tissue micro-trauma, it can provide a temporary analgesic (pain relief) effect on nerves, providing immediate pain relief, known as ‘hyperstimulation anaesthesia’.
What is the evidence for ESWT?
Shockwave Therapy is clinically proven, recognised by the top orthopaedic hospitals and used by high-profile professional sports bodies. ESWT has been recommended by NICE and the FDA. Further information regarding this can be found on the NICE website
How successful is the treatment?
Statistics vary based on the condition being treated - varying from 60-90% success rate. Studies have shown 90% of patients with Achilles Tendonitis (Heel pain) will experience a full recovery or significant reduction in their pain and injury.
Can Shockwave treat old/persistent injuries?
Shockwaves are used to treat chronic conditions (conditions which have been there for more than 3 months) and there is a great deal of evidence to show that Shockwave Therapy can achieve great results even with historical conditions.
On what parts of the body can ESWT be used?
Shockwave Therapy can treat conditions in the hips, knees, shoulders, elbows, achilles, forearms, shins, back and feet.
What are the risks/side effects?
Shockwave therapy is safe and effective. You will experience some pain/discomfort during the treatment, but the pain should be bearable. The treatment is delivered according to your response; if you are unable to tolerate the pain levels, the settings will be adjusted to reduce the discomfort.
Following the treatment, you may initially experience more pain, redness, bruising, swelling and numbness to the area. These side effects should resolve within a week, before your next treatment.
Possible side effects are:
tendon rupture (rare)
These are very uncommon and usually will not happen.
When should I not have ESWT and when do I need to be careful about treatment?
ESWT is NOT allowed if you:
have had a steroid injection to the same area in the last three months
have an infection, wound or tissue problems at the proposed treatment site
are under 18
have poor sensation (neuropathy) or hypersensitivity in the target area.
A tumour at site of treatment
You must tell the clinician if you:
have a cardiac pacemaker
are taking any anti-coagulant (blood thinning) medication are taking any anti-inflammatory medication.
How can I prepare for ESWT?
You will need to be available for the full course of treatment which is at least 3 sessions over 3 consecutive weeks.
You should not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, for 24 hours before your first procedure, and 48 hours after your treatment. If you are unsure if any of your medicines contain NSAIDs, then please check with your physiotherapist.
Who will carry out the procedure?
Your ESWT will be performed by a physiotherapist who has undertaken special training to carry out the procedure.
Will I be in pain after the treatment?
You will normally experience a reduced level of pain or no pain at all immediately after the treatment, but a dull and diffuse pain may occur a few hours later. This dull pain can last for a day or so and in rare cases a little bit longer.
What shall I do if I am in pain after the treatment?
If necessary, you may use ordinary prescription-free pain killers. Do not use anti-inflammatory medication or ice on treated area as this will interfere with the body’s self healing abilities
What do I need to do after treatment?
You will be able to return to your usual activities straight away and can return to work immediately. However, we advise you not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours following the procedure.
You can drive immediately after the treatment.
If you experience a sudden onset of pain to the area or any loss of function, please contact the physiotherapist or your GP or A&E.
You may feel pain relief from the treatment straightaway but long-term effects are normally felt after three months. You will have a follow up appointment in clinic every few weeks after your treatment.
How fast does ESWT work?
Many patients get an initial degree of improvement almost immediately, the effect is usually temporary, although not always, and is associated with an anaesthesia effect from the hyper stimulation of the tissue by the ESWT. It takes several days for the injuries to begin to heal but many patients see an improvement before the end of the second week. The healing process can however take weeks or even months to complete.
Other advice and useful sources of information
There are NICE (National Institute for Health and Care Excellence) recommendations on ESWT for patients with Achilles tendinopathy and plantar fasciitis. See the NICE website www.nice.org.uk