Extracorporeal shockwave therapy (ESWT) at Manchester Institute of Health & Performance (MIHP)

What is extracorporeal shockwave therapy?

Extracorporeal shockwave therapy (ESWT) is a non-surgical treatment that uses pulses of energy directed into injured tissues. These shockwaves travel through the skin to the damaged tendon or muscle and help improve blood flow, prompting cells to regenerate and heal.

What conditions can shockwave therapy treat?

• Plantar fasciitis: Heel pain from a thickened band of tissue under the foot.
• Achilles tendinopathy: Pain at the back of the heel involving the Achilles tendon.
• Tennis elbow: Pain on the outer side of the elbow from tendon overuse.
• Golfer’s elbow: Pain on the inner side of the elbow (another form of tendonitis).
• Patellar tendinopathy: Pain at the front of the knee around the patellar tendon.
• Rotator cuff tendon problems: Shoulder tendon pain (often from tendonitis or calcifications).
• Greater trochanteric pain syndrome: Pain on the outer side of the hip, often called bursitis.

What are the benefits of shockwave therapy?

• Non-invasive: No surgical cuts or needles are needed, and you stay awake during the procedure.
• No anaesthesia or medication: Unlike an operation, there is usually no need for general anaesthetic, and no drugs are injected.
• Outpatient and quick: Each treatment only takes about 15-20 minutes, and you can return home straight away. Recovery time is minimal.
• Promotes natural healing: Shockwaves jump-start the body’s own repair process by boosting blood flow and cell regeneration in the injured area.
• Proven effectiveness: Many people experience significant improvement. For the large majority of people, they will find successful relief from their symptoms after ESWT.

How long do the benefits of shockwave therapy last?

Many people’s symptoms will have significant relief after treatment, especially if they keep up with recommended exercises and care, although the effects can vary. The majority of patients have long-term improvement for many months (or even years), while others may see their symptoms gradually return and choose to repeat the therapy later.

Is extracorporeal shockwave therapy (ESWT) right for me?

• You have chronic tendon pain (often in the foot, ankle, knee, elbow or shoulder) that has lasted for months and has not improved with other treatments.
• You have already tried conservative treatments (such as physiotherapy, exercises, rest, orthotics, or painkillers) and still have significant pain.
• Your doctor or therapist has confirmed the diagnosis (often using an ultrasound or MRI scan beforehand).
• ESWT is not used if you are pregnant, have a pacemaker, have an active infection in the area, or are on strong blood thinners.

What happens during extracorporeal shockwave therapy?

Your consultant will locate the source of your pain and apply a gel-like substance on your skin. A probe is pressed on to the affected area, and the machine delivers quick pulses (shockwaves) into the tissue. You will feel a series of tapping or tingling sensations. It may be uncomfortable but should not be overly painful. Each session lasts about 15 to 20 minutes with no anaesthetic or sedation needed during the treatment.

Most people will need two to three treatments for their recovery, but may need up to 6 sessions if they are treating a recurring issue.

Preparing for ESWT therapy

You will first meet with a consultant to review your medical history and symptoms. They may order an ultrasound or MRI scan to confirm the problem before treatment.

Wear loose, comfortable clothing so the area can be accessed easily. Do not apply any creams or lotions on the area that is to be treated on the day of your procedure.

You may be advised to avoid anti-inflammatory drugs (like ibuprofen) just before and after treatment, since these can reduce the therapy’s effectiveness. Simple painkillers such as paracetamol are usually fine to take if needed.

No special fasting is required, and since no anaesthesia is used, you can drive yourself to and from the appointment. The healthcare team will give you any additional advice (for example, about what to avoid immediately after the treatment).

Recovery from shockwave therapy

• Immediately after: You can go home right away because this is an outpatient procedure. There is no need for a hospital stay or extended recovery time.
• First few days: The treated area may feel sore, and you might see some redness or swelling. This often feels similar to having a minor bruise, and it usually improves within a few days. Mild pain or stiffness is common, but you can use paracetamol to relieve any discomfort. You should avoid anti-inflammatory medication such as Ibuprofen, as this may interfere with your healing response.

You will be able to return to light activities and walking immediately, but avoid heavy exercise or strain on the treated area for about 2-3 days. You will be given gentle exercises and stretches to follow by your healthcare team.

Some people feel relief right away, while others only notice change after several weeks. Your healthcare team will typically schedule a check-up 6-8 weeks after your treatment to see how your symptoms have improved.

What are the risks of extracorporeal shockwave therapy?

Possible side effects following ESWT

• Local discomfort: It’s normal to feel some tenderness or achiness in the treated area for a day or two.
• Redness or bruising: The skin over the treatment site may turn red, swell slightly, or bruise, similar to having mild trauma.
• Numbness or tingling: A few people experience temporary numbness or a tingling sensation in the area after treatment.
• Inflammatory response: Sometimes pain can briefly increase as part of the natural healing reaction, but this usually subsides quickly.

Alternatives to extracorporeal shockwave therapy

• Physiotherapy and exercise: A tailored exercise program (stretching, strengthening, and other techniques) is often tried first for tendon pain.
• Medications and supports: Pain relief, along with rest, ice, or orthotic supports (shoe inserts, braces) can help reduce symptoms.
• Injections: Corticosteroid shots or other injections (e.g. platelet-rich plasma) into the tendon area can reduce inflammation in some cases.
• Other therapies: Therapies such as ultrasound or laser treatment may be offered by as alternative pain-relief methods.
• Surgery: If conservative treatments fail, surgical options (such as releasing or repairing a tendon) may be considered.

How much does extracorporeal shockwave therapy (ESWT) cost?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.