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Shockwave therapy

Shockwave therapy is mainly used for treating soft tissue problems, especially tendon injuries, and inflammation of tissues lying deep under the skin (fasciitis).

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What is shockwave therapy?

Shockwave therapy uses high energy sound waves, which pass through the skin to the affected area, increasing the blood flow to help accelerate the healing process.

Shockwave therapy, also called extracorporeal shockwave therapy (ESWT), is a treatment usually offered when symptoms have not responded to other treatments, such as physiotherapy, modifying daily activities, pain relief, and steroid injections.

A course of treatment normally requires one treatment session each week and treatment sessions should not be more than 2 weeks apart. The number of sessions will depend on the underlying problem and the progress made with treatment. Shockwave therapy is best used as part of a rehabilitation programme, including advice on activities and exercises, and other interventions that may be needed such as medicines for pain relief.

The National Institute for Health and Care Excellence (NICE) recommends that there are no major safety concerns but the evidence whether shockwave therapy is an effective treatment is limited in quality and quantity, and therefore does not recommend it as an evidence based therapy to be used as a routine treatment. Therefore the potential benefits of shockwave therapy need to be carefully considered for each person before treatment begins.

Although shockwave therapy is generally safe, it should be avoided for some people including those who:

  • Are pregnant, or trying to conceive.

  • Have received a steroid injection into the area to be treated within the previous 12 weeks.

  • Have any increased risk of bleeding (haemorrhage), such as haemophilia.

  • Have a heart pacemaker, any other heart device, or any unstable heart condition.

  • Have a fracture, tumour or infection at the site of treatment.

  • Currently have a thrombosis.

  • Have epilepsy.

  • Are taking certain type of antibiotics called fluoroquinolone antibiotics eg, ciprofloxacin.

  • Have fragile bones, eg, osteogenesis Imperfecta.

  • Have increased sensitivity or decreased sensation over the area to be treated.

What is shockwave therapy used for?

Shockwave therapy can be effective for a wide range of problems, such as:

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Is shockwave therapy painful?

Each shockwave treatment takes around 10 minutes. A gel is applied to the skin over the area to be treated, and the shockwave therapy will then be delivered through a handheld probe. When the therapy is happening, you may feel a little discomfort, but it is not painful.

Shockwave therapy side-effects

Potential side effects at the treated area include:

  • Bruising.

  • Pain.

  • Local swelling.

  • Skin reddening.

  • Numbness or altered sensation.

These side effects should resolve within a week after the treatment. There is also a small risk of tendon rupture (such as rupture of the Achilles tendon) or ligament rupture and damage to the soft tissue.

Further reading and references

  • Extracorporeal shockwave therapy for Achilles tendinopathy; NICE Interventional Procedure Guidance, December 2016
  • Wang CJ; Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012 Mar 20;7:11. doi: 10.1186/1749-799X-7-11.
  • Burton I; Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review. Sports Med Health Sci. 2021 Nov 11;4(1):8-17. doi: 10.1016/j.smhs.2021.11.002. eCollection 2022 Mar.
  • Al-Siyabi Z, Karam M, Al-Hajri E, et al; Extracorporeal Shockwave Therapy Versus Ultrasound Therapy for Plantar Fasciitis: A Systematic Review and Meta-Analysis. Cureus. 2022 Jan 2;14(1):e20871. doi: 10.7759/cureus.20871. eCollection 2022 Jan.
  • Smallcomb M, Khandare S, Vidt ME, et al; Therapeutic Ultrasound and Shockwave Therapy for Tendinopathy: A Narrative Review. Am J Phys Med Rehabil. 2022 Aug 1;101(8):801-807. doi: 10.1097/PHM.0000000000001894. Epub 2021 Oct 4.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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