Shockwave Therapy

Shockwave Therapy is a non-invasive treatment that may be considered for selected persistent tendon and soft-tissue problems. It uses controlled acoustic pressure waves delivered through the skin to the affected area using a handheld treatment device.

At Core Physio, Shockwave Therapy is not provided as a stand-alone solution or a replacement for proper rehabilitation. A physiotherapist will first assess your symptoms, movement, activity levels and previous treatment before deciding whether Shockwave Therapy is appropriate for you.

Where it is suitable, treatment will normally form part of a wider plan that can include education, activity modification, progressive exercise and strength rehabilitation.

Shockwave Therapy is available through our London Bridge clinic and our East Dulwich clinic.

What Is Shockwave Therapy?

Shockwave Therapy is also known as Extracorporeal Shockwave Therapy, or ESWT. The word “extracorporeal” means that the pressure waves are generated outside the body before being delivered through the skin.

The treatment device creates a series of mechanical acoustic waves rather than an electrical current. A handheld applicator is positioned over the affected area, and the intensity can be adjusted according to the treatment plan and your comfort.

You will usually hear a repeated clicking sound and feel a tapping or pulsing sensation while the treatment is being delivered.

The precise way Shockwave Therapy influences tendon pain and tissue recovery is not fully understood. It is thought to affect local tissue activity and pain sensitivity, potentially supporting the body’s response to a persistent tendon problem.

When May Shockwave Therapy Be Considered?

Shockwave Therapy is generally considered for persistent symptoms rather than a new or recently developed injury.

It may be discussed when:

• Tendon pain has continued for an extended period
• Symptoms have not improved sufficiently with appropriate rehabilitation
• Pain affects walking, work, exercise or sport
• The problem repeatedly returns when activity is increased
• A structured exercise programme has not produced the expected progress
• Your physiotherapist believes Shockwave Therapy could complement the wider rehabilitation plan

However, experiencing tendon pain does not automatically mean that Shockwave Therapy is the correct treatment. The diagnosis, duration of symptoms, previous rehabilitation and overall health must all be considered.

Conditions That May Be Assessed for Shockwave Therapy

Shockwave Therapy is commonly considered for selected persistent tendon and soft-tissue conditions.

These may include:

• Achilles tendinopathy
• Plantar fasciopathy or persistent plantar heel pain
• Patellar tendinopathy
• Gluteal tendinopathy and greater trochanteric pain syndrome
• Proximal hamstring tendinopathy
• Lateral elbow tendinopathy, often called tennis elbow
• Selected persistent shoulder tendon problems

This list does not mean that every person with one of these conditions will be suitable for treatment. In addition, evidence for Shockwave Therapy differs between conditions and individual responses vary.

A clinical assessment is therefore required before treatment begins.

Persistent Tendon Pain and Tendinopathy

Tendons connect muscles to bones and help transfer force during movement. They are repeatedly loaded during walking, running, lifting, jumping and many everyday activities.

Tendon pain can sometimes develop when the demands placed on a tendon exceed its current ability to tolerate them. This may follow a sudden increase in activity, repeated loading, a change in training or a return to exercise after time away.

Symptoms may include:

• Localised pain around a tendon
• Stiffness after rest or first thing in the morning
• Pain when beginning an activity
• Discomfort during repeated loading
• Reduced confidence with exercise or movement
• Symptoms that return when training intensity increases

Rest alone does not always resolve a persistent tendon problem. Consequently, rehabilitation will often focus on gradually rebuilding the tendon’s ability to tolerate appropriate physical load.

Shockwave Therapy and Exercise Rehabilitation

Shockwave Therapy should not replace progressive exercise and rehabilitation.

Although treatment may help some people manage persistent pain, exercise is usually required to rebuild strength and prepare the affected area for everyday activity, work or sport.

Your wider rehabilitation plan may include:

• Advice about modifying aggravating activities
• Exercises to improve movement and confidence
• Progressive tendon-loading exercises
• Strengthening of the surrounding muscles
• Balance and movement-control exercises
• Gradual increases in walking, running or sporting activity
• Guidance about training volume and recovery

The exercises will depend on the tendon involved, your current physical abilities and the activities you want to resume.

For example, someone with Achilles tendon pain may eventually need a programme that develops calf strength and running tolerance. By comparison, a person with shoulder tendon symptoms may require upper-body strength and progressive lifting exercises.

Your Shockwave Therapy Assessment

Before recommending treatment, your physiotherapist will discuss the problem and how it affects you.

They may ask:

• When the symptoms began
• Whether they developed suddenly or gradually
• Which movements or activities aggravate the problem
• How long the symptoms have been present
• What treatment or rehabilitation you have already completed
• Whether you have had scans, injections or specialist advice
• What medication you currently take
• Whether you have any relevant medical conditions
• Which activities you want to return to

A physical assessment may examine movement, strength, tenderness and your response to loading the affected area.

Depending on the problem, you may be asked to complete movements such as walking, raising an arm, performing a calf raise, squatting or completing another task relevant to your symptoms.

Your physiotherapist will then explain whether Shockwave Therapy appears appropriate and how it would fit into the wider treatment plan.

What Happens During Shockwave Therapy?

The treatment area will be identified before the session begins. A small amount of gel is then applied to the skin to help transmit the acoustic waves from the applicator into the underlying tissue.

The handheld device is positioned over the selected area. Once treatment starts, you will hear a rapid clicking sound and feel repeated tapping against the skin.

Some discomfort is common, particularly when the device passes over a sensitive area. Nevertheless, the intensity can usually be adjusted to a level you can tolerate.

Tell your physiotherapist when the treatment feels excessively uncomfortable. You remain in control, and the settings or position of the applicator can be changed when necessary.

The precise treatment settings, number of pulses and number of appointments will depend on the condition, equipment and clinical protocol being used.

Is Shockwave Therapy Painful?

Shockwave Therapy can feel uncomfortable because it is directed towards a painful or sensitive area. Some people describe the sensation as firm tapping, pulsing or repeated pressure.

The level of discomfort varies between individuals and treatment areas. Your physiotherapist can begin at a manageable setting and make gradual adjustments according to your response.

More intensity does not automatically mean a better result. Treatment should remain purposeful while respecting your comfort and the clinical plan.

What Happens After Treatment?

You may experience temporary soreness around the treated area following a session. Redness, mild swelling, bruising, numbness or altered sensation can also occur.

These reactions are usually temporary. However, contact the clinic when symptoms are severe, unexpected or do not begin to settle.

Your physiotherapist will explain how to manage activity after treatment. Daily movement may remain possible, although strenuous or high-impact activity may need to be modified temporarily.

Continue with the rehabilitation exercises that have been recommended unless your physiotherapist advises otherwise.

Do not stop prescribed medication or change how you take it without first speaking to the appropriate doctor, pharmacist or healthcare professional.

How Many Shockwave Therapy Sessions Will I Need?

The number and spacing of appointments depend on the condition, clinical protocol and your response to treatment.

Shockwave Therapy is commonly delivered as a short course rather than a single isolated treatment. However, Core Physio will explain the proposed schedule after assessing your symptoms and determining whether the treatment is suitable.

Improvement is not always immediate. A response may develop gradually during the weeks following treatment and rehabilitation.

Shockwave Therapy does not work for everyone. Therefore, your progress should be reviewed rather than assuming that completing a fixed number of sessions will automatically resolve the problem.

Possible Side Effects and Risks

Shockwave Therapy is non-invasive, but it can still cause temporary side effects.

Possible reactions include:

• Discomfort during treatment
• Temporary pain or soreness afterwards
• Redness around the treatment area
• Localised swelling
• Bruising
• Temporary numbness or altered sensation
• A short-term increase in existing symptoms

More serious complications, including damage to a tendon or surrounding soft tissue, are uncommon but possible. Your physiotherapist will discuss the relevant risks before treatment and ask for your consent.

When Shockwave Therapy May Not Be Suitable

Shockwave Therapy is not suitable for every person or every condition. A full suitability check must take place before treatment begins.

Tell the clinic before booking or treatment if you:

• Are pregnant or trying to become pregnant
• Are under 18
• Have a blood-clotting or bleeding disorder
• Take anticoagulant or antiplatelet medication
• Have a pacemaker or another powered implanted device
• Have an infection, wound or severe inflammation in the treatment area
• Have cancer or a tumour in or near the proposed treatment area
• Have a fracture, tendon rupture or significant tear near the area
• Have recently received a steroid injection in the same area
• Have reduced sensation or neuropathy around the treatment site
• Have metalwork or a joint replacement near the proposed treatment area
• Are currently taking antibiotics associated with an increased risk of tendon injury
• Have another medical condition that may affect treatment safety

This does not necessarily mean that every item will prevent treatment in every circumstance. However, your physiotherapist must know about it before deciding whether Shockwave Therapy is appropriate.

Never stop anticoagulants, antiplatelet medication or another prescribed medicine solely to receive Shockwave Therapy unless the prescribing clinician has specifically advised you to do so.

Shockwave Therapy for Achilles Tendinopathy

Achilles tendinopathy can cause pain and stiffness around the tendon at the back of the ankle. Symptoms may be particularly noticeable during the first steps after rest, walking uphill, running or repeated calf-loading activity.

Shockwave Therapy may be considered when persistent symptoms have not responded sufficiently to an appropriate period of rehabilitation.

Any treatment should remain combined with progressive calf and lower-limb strengthening. Returning to running or sport will also require a gradual increase in the tendon’s exposure to impact and physical load.

Shockwave Therapy for Plantar Heel Pain

Persistent plantar heel pain can affect walking, standing and exercise. Symptoms are often noticeable during the first steps after rest or following longer periods of weight-bearing.

Shockwave Therapy may form part of the treatment plan when symptoms have remained persistent despite appropriate management.

The wider programme may also consider footwear, activity levels, calf strength and gradual loading of the foot and lower limb.

Shockwave Therapy for Patellar Tendinopathy

Patellar tendinopathy causes pain around the tendon below the kneecap and is often associated with activities involving jumping, running, squatting or rapid changes in load.

Where Shockwave Therapy is considered appropriate, it should complement a progressive strengthening programme.

Later rehabilitation may need to prepare the tendon for jumping, landing, running or the specific demands of your sport.

Shockwave Therapy for Gluteal Tendinopathy

Gluteal tendinopathy and greater trochanteric pain syndrome commonly cause pain around the outside of the hip.

Symptoms may affect walking, stairs, standing on one leg or lying on the affected side. Treatment should consider the activities that compress or load the area alongside hip strength and general movement.

Shockwave Therapy may be considered as part of the wider programme when symptoms remain persistent and an assessment confirms that it is appropriate.

Shockwave Therapy for Elbow Tendon Pain

Persistent lateral elbow pain, often described as tennis elbow, can affect gripping, lifting and repeated arm or wrist movements.

A physiotherapy assessment can consider the activities placing demand on the area and assess the strength and function of the arm.

Where suitable, Shockwave Therapy may be combined with progressive exercise and practical changes to how aggravating activities are managed.

Shockwave Therapy or Physiotherapy?

Shockwave Therapy is one treatment technique that may be used within physiotherapy. The two should not be viewed as competing services.

The physiotherapy assessment establishes whether the treatment is suitable and identifies the rehabilitation work required alongside it.

Shockwave Therapy or Sports Massage?

Shockwave Therapy and Sports Massage are different treatments.

Sports Massage primarily focuses on muscular tension, soft-tissue comfort and recovery. Shockwave Therapy is considered for selected persistent tendon or soft-tissue problems following a clinical assessment.

A physiotherapy appointment is generally the more suitable starting point when you have persistent localised pain, a suspected injury or uncertainty about the cause of your symptoms.

Shockwave Therapy at Core Physio

Core Physio provides Shockwave Therapy following an appropriate physiotherapy assessment. Treatment is available through our London Bridge and East Dulwich clinics.

Our Shockwave Therapy London Bridge service is available for people who live, work or train around London Bridge, Borough, Southwark, Waterloo and surrounding areas.

Shockwave Therapy is also available through our East Dulwich clinic.

Choose your preferred clinic to view service availability, practitioners and online appointment times.

Frequently Asked Questions About Shockwave Therapy

Do I need a physiotherapy assessment first?

Yes. An assessment is required to confirm the likely cause of your symptoms, determine whether Shockwave Therapy is appropriate and plan the rehabilitation that should accompany it.

Does Shockwave Therapy work immediately?

Not necessarily. Some people notice changes during a course of treatment, while others respond gradually over the following weeks. The treatment does not work for everyone, and results cannot be guaranteed.

Is Shockwave Therapy the same as an ultrasound scan?

No. An ultrasound scan is an imaging investigation used to view structures inside the body. Shockwave Therapy is a treatment that delivers acoustic pressure waves to the selected area.

Is Shockwave Therapy electrical?

No. The treatment uses mechanical acoustic waves rather than an electrical current. The device does require power to generate the waves, but electricity is not passed into your body.

Will I need exercises as well?

In most cases, yes. Shockwave Therapy should normally complement an active rehabilitation programme designed to rebuild strength and improve the affected area’s tolerance of movement and physical load.

Can I exercise after Shockwave Therapy?

This depends on the body area, condition and intensity of your usual activity. Your physiotherapist will explain whether training should continue normally or be temporarily modified after treatment.

Can I have Shockwave Therapy after a steroid injection?

A recent steroid injection in the proposed treatment area may mean Shockwave Therapy must be delayed or avoided. Tell your physiotherapist when and where the injection was performed before treatment begins.

Can I have Shockwave Therapy while taking blood-thinning medication?

Anticoagulant or antiplatelet medication can affect whether treatment is appropriate because of the risk of bleeding or bruising. Inform the clinic about all medication before your assessment and do not stop prescribed medication without medical advice.

How many sessions will I require?

The recommended number varies according to the condition and clinical protocol. Your physiotherapist will explain the proposed course after assessing your symptoms and suitability.

What should I wear?

Wear clothing that allows the treatment area to be examined and accessed comfortably. Shorts may be helpful for lower-limb treatment, while a vest or loose top may be useful for the shoulder or arm.

What happens if Shockwave Therapy does not help?

Your physiotherapist can review the diagnosis, rehabilitation programme and response to treatment. Depending on the findings, the next step may involve modifying your exercises, continuing physiotherapy or recommending further medical investigation or specialist advice.

Book a Shockwave Therapy Assessment

Shockwave Therapy may be considered when a persistent tendon or soft-tissue problem has not improved sufficiently with appropriate rehabilitation and activity management.