Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) directs mechanical sound waves — not
electricity — through the skin to an injured area. The waves are intended to increase blood
flow to the area and support the body's healing response in tissue that has stopped
responding to first-line treatment.
What it is
A handheld applicator is pressed against the painful area (with coupling gel, much like an ultrasound probe) and delivers a series of low-energy acoustic pulses. It's an outpatient procedure — no incision, no anesthesia, and you go home the same day. Exactly how the waves encourage healing is still being studied; what matters for you is the track record in clinical use, described below.
When we may recommend it
• Chronic Achilles tendinopathy — pain, stiffness, and weakness at the calf-to-heel tendon.
• Plantar fasciitis — stubborn heel and arch pain that hasn't responded to physiotherapy, orthotics, rest, ice, or medication.⁸
• Generally a second-line option: it's offered when symptoms haven't improved enough with other non-surgical treatment — not a starting point.
What a session involves
A commonly used course is three treatments spaced one to two weeks apart. Your clinic's protocol may differ. You'll feel some pain or thudding discomfort during the pulses — most people find it manageable, and your therapist adjusts intensity to your tolerance. Afterward the area may be red, bruised, swollen, or briefly numb; these effects typically settle within a week.
Expected outcomes
Be measured about this one: studies reported by Guy's and St Thomas' NHS found ESWT effective for roughly 5 to 7 in 10 patients with chronic Achilles tendinopathy and plantar fasciitis.8 Relief, when it comes, typically builds over the weeks following the course rather than instantly. There is also a small chance that the condition may get worse after treatment — one reason the pre-treatment screening and follow-up questionnaires matter. ESWT is one option in a sequence that may also include continued physiotherapy, and surgery remains a fallback in selected cases where ESWT fails.
Good to know
ESWT isn't suitable for everyone. The screening criteria used by the Guy's and St Thomas' service exclude treatment if you are pregnant, take anti-platelet or anticoagulant medicine (excluding aspirin 75mg), have a blood-clotting disorder, are under 18, have cancer or an infection in the area to be treated, have a previous Achilles tendon or plantar fascia ligament rupture, or have had a steroid injection into the area within the previous 12 weeks.⁸ Your clinician explains the benefits and risks in detail before the treatment is offered — ask any questions you have.
Sources
1. Cleveland Clinic — Functional Electrical Stimulation (FES) —
https://my.clevelandclinic.org/health/treatments/21163-functional-electrical-stimulation-fes
2. Cambridge University Hospitals — Advice on Using a TENS Machine — https://www.cuh.nhs.uk/patient-infor
mation/advice-on-using-a-transcutaneous-electrical-nerve-stimulation-tens-machine/
3. Cleveland Clinic — Should You Use Ice or Heat for Pain? —
https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic
4. Physiopedia — Gait Training in Stroke — https://www.physio-pedia.com/Gait_Training_in_Stroke
5. Cleveland Clinic — Gait Disorders — https://my.clevelandclinic.org/health/diseases/21092-gait-disorders
6. Cleveland Clinic — Vestibular Rehabilitation Therapy —
https://my.clevelandclinic.org/health/treatments/15298-vestibular-rehabilitation
7. Johns Hopkins Medicine — Vestibular Therapy — https://www.hopkinsmedicine.org/physical-medicine-rehabi
litation/specialty-areas/physical-therapy/vestibular-therapy
8. Guy's and St Thomas' NHS Foundation Trust — Extracorporeal Shockwave Therapy — https://www.guysandst
thomas.