Shockwave

Extracorporeal Shockwave Therapy (ESWT)

What is ESWT?

ESWT is a procedure that uses high energy non-electrical, sound waves which are passed through the skin to the injured body part via a handheld probe. These “shockwaves” help to increase blood flow to the affected area and stimulate an effective healing response.

Why should I have ESWT?

Shockwave is particularly effective in helping stubborn conditions, like plantar fasciitis and chronic tendon pain, which may not have responded to other forms of treatment. ESWT is also non-invasive and deemed to be safe and effective for many conditions by the National Institute for Health and Care Excellence (NICE). Studies have shown that ECSWT may provide pain relief in up to 70-80% of cases.

How does Shockwave Therapy Work ?

Applied through a hand piece attached to an external compressor, a shockwave is an intense, short energy wave generated by a projectile which strikes a fixed applicator at very high speed. Traveling faster than the speed of sound, shockwaves are delivered to targeted tissue through the skin. The waves target damaged tissue and encourage the physiological effects that lead to tissue healing and regeneration.

There are two key phases within the application of a radial shockwave; a compression phase which creates sheer stress in the damaged tissue and a depression/tensile phase that creates cavitation bubbles within the tissue that generate healing.

Shockwave Therapy is particularly effective for the following injuries:

• Tendinopathies
• Shoulder Tendonitis
• Frozen Shoulder
• Tennis Elbow
• Patella Tendinitis
• Achilles Tendinitis
• Plantar Fasciitis
• Lateral Hip Pain/Greater Trochanter pain syndrome
• Golfers Elbow
• Osgood Schlatter’s Disease
• Shin Splints (medial tibial stress syndrome)

Are there any risks or side effects?

Some patients find shockwave treatment to be uncomfortable, but most are able to tolerate it well. The treatment can be tailored to your individual response and adjusted accordingly. Some discomfort, redness or bruising may develop after treatment, but this usually subsides after a few days. There is a small risk of tendon rupture or damage to the soft tissues following shockwave treatment, but the risk is extremely small and the potential benefit far outweighs any risk.

Are any reasons why I can’t have ESWT?

There are relatively few contraindications to the radial shockwave, if;

• You are pregnant.
• You are being treated for cancer.
• You have an infection or wound at the treatment site.
• You have had a steroid injection in the previous 6 weeks.

ESWT may not be appropriate, or used with caution if;

• You have metal pins, plates or prothesis in the area requiring treatment.
• You have a blood clotting disorder.
• You are taking anticoagulant medication.
• You have had a serious tissue rupture at the injury site previously.
• Loss of sensation at the site of injury.

How can I prepare for my treatment?

ESWT works best when sessions are delivered approximately 1 week apart. Most injuries require a minimum of 3 sessions. We would ask that you are available for 3 weeks in a row or for 3 sessions spaced over a month. It is important that you do not take non-steroidal anti-inflammatory (NSAIDs) medication for 2 weeks prior to your 1st session as this may interfere with treatment effectiveness. We need access to the skin of the injured body part so please ensure you are wearing loose fitting clothing to facilitate this.

What happens during an ESWT session?

• Your treatment will be carried out by a member of the physiotherapy team.
• If it is your first time in the clinic, or if it is the first time seeing us with a new injury, we will take a detailed injury and medical history. This will allow us to make sure you are suitable for ESWT and to plan your treatment most effectively.
• Over the course of treatment, your physiotherapist will discuss important injury management strategies like rehab exercise and activity modification.
• ESWT is delivered via a hand held probe touching the skin over the injured body part.
• Ultrasound gel will be placed on the skin first, which allow the shockwaves to be transmitted more easily.
• The treatment lasts between 5 and 10 minutes.
• Treatment is a little noisy and it can be uncomfortable, although the intensity can be adjusted if this gets too much.

What happens after a session and treatment?

• After a session is over you can leave the clinic straight away.
• If discomfort persists then taking regular pain relief, like paracetamol, is ok but do not take any NSAIDs, such as Ibuprofen, as this may interfere with the treatment effect.
• You will be able to drive straight after treatment and can continue with normal day to day activities like work and light exercise. However, it is advisable to avoid strenuous or high impact exercise for 48 hours after a session. After this you may resume your normal activities and rehabilitation regime but it is recommended that you do not increase load etc over the period of treatment.
• Follow up sessions will be booked at your convenience and the response to treatment will be monitored.
• Once you have reached the end of a treatment block a discussion will be had about the next course of action.
• Further ESWT can be planned if needed or you may be asked to follow up with the clinician that referred you.

Dr Ehab Georgy

CONSULTANT PHYSIOTHERAPIST & CLINICAL LEAD

Graduating in 2000, Ehab has been working as a specialist neuro-musculoskeletal physiotherapist for over 23 years. He has worked and conducted research in a number of prestigious and internationally renowned hospitals, universities and institutions in the UK, Ireland, Belgium and Egypt. His main areas of specialties are complex neurological diseases, pain management and movement disorders ... Read more