- What is Shockwave Therapy?
- How does ESWT work?
- Is ESWT safe?
- Are there any reasons why I can’t have ESWT?
- What musculoskeletal conditions can be treated with ESWT and when should I have it?
- What does the process involve?
- What does it feel like and when will I get better?
- What happens after the treatment?
What is Shockwave Therapy?
Shockwave Therapy, sometimes known as Extracorporeal Shockwave Therapy (ESWT), is a technology that uses shockwaves to treat conditions of the musculoskeletal system. Extracorporeal means that the shocks are delivered from outside the body (i.e., through the skin). Some shockwave therapies are delivered via an intracorporeal method (i.e., from inside the body) like in the treatment of kidney stones. Musculoskeletal conditions are usually treated with an extracorporeal approach.
Extracorporeal shockwaves can be created in one of 2 ways;
- Radial Pressure Waves. Radial waves are low density pulses of energy generated by compressed air which converts into acoustic energy. Radial shockwave delivers most of its energy at the contact point (skin) and progressively reduces as soundwaves pass into the tissue. Penetration can be modified by frequency and transmitter type. Radial pressure waves have a superficial spread and a slow impulse.
- Focused shockwaves. Focused waves can penetrate deeper into the tissues and provide all their power at the designated depth. Focused shockwaves are generated electromagnetically through a cylindrical coil creating opposing magnetic fields when current is applied. This causes a submerged membrane to move and generate a pressure wave in the surrounding fluid medium. These propagate through the medium without any loss in energy with a small focal zone. At the site of actual wave generation, the amount of energy dispersed is minimal making this treatment form of shockwave delivery more precise. This also limits damage to the skin and underlying soft tissues.
Be sure to check with your clinician what form of shockwave is being used, as the treatment, experience and eventual outcome may differ.
At LBSM, we only use focused shockwave as it provides:
- A more effective and precise delivery of shockwave
- Greater versatility for use and conditions treated
- Better outcomes
- Better patient experience
- Fewer side effects (such as skin irritation and breakdown)
How does ESWT work?
The shockwaves are precisely delivered to the inflamed or injured tissue aiming to reduce pain and promote healing. Shockwave may aid tissue healing by the following mechanisms:
- Improving blood flow to the shocked area
- Stimulate cells to release chemicals that promote growth and healing (in soft tissue and bone)
- Increasing cell metabolism
- Release tension and tightness in musculoskeletal structures
Is ESWT safe?
Yes. There is no evidence to suggest that delivering shockwaves is harmful to the tissues of the body. There is no radiation involved.
Are there any reasons why I can’t have ESWT?
Any contraindications to ESWT will be discussed with you by your doctor before your shockwave treatment course begins. Treatment is not advised if you:
- Are pregnant
- Are taking antiplatelet medication (such as aspirin or clopidogrel) or anticoagulants (for example warfarin or rivaroxaban)
- Are diagnosed with epilepsy
- Have a blood clotting disorder
- Have been diagnosed with bone cancer
- Have a cardiac pacemaker or other cardiac device
- Have an infection in the treatment area
What musculoskeletal conditions can be treated with ESWT and when should I have it?
Shockwave therapy is a very useful, versatile and non-invasive treatment adjunct. Like any intervention, it should always be part of a wider rehabilitation and lifestyle plan. Your clinician may decide to use ESWT earlier or later in your treatment plan, depending on your symptoms and/or progress. Common types of injuries treated by shockwave include:
- Tendon inflammation (tendinitis)
- Ligament sprains
- Muscle injury
- Muscle and fascial tightness
- Bone injury and stress fracture
- Nerve injury and entrapment
What does the process involve?
As the shockwaves are usually focused on a precise area of inflammation, it is good practice to “mark out” the target area with an ultrasound scan prior to treatment. This allows the clinician to better understand the location and depth of penetration required for the shockwaves.
The treatment area is exposed, and a conducting jelly applied. The shockwaves are then delivered using a handheld device. The treatment usually lasts roughly 10 minutes, with a set number of shockwaves delivered at a set intensity and frequency.
A full shockwave treatment course can range anywhere from 3-10 sessions, depending on what is being treated and the severity of injury. Sessions are usually 1-2 weeks apart.
Please note: As part of your shockwave therapy session, a diagnostic ultrasound may be carried out and billed separately.
This improves the accuracy of the shockwave therapy, achieving the best possible outcome by;
- Visualising the affected area in detail, helping confirm the exact location and extent of the problem (such as tendon damage or inflammation).
- Guiding the shockwave therapy more precisely, so clinicians can target the treatment to the right spot and avoid surrounding healthy tissue.
- Monitoring progress over time, by comparing the ultrasound images before, during, or after a course of treatment.
What does it feel like and when will I get better?
You are made to feel comfortable during the session and it is common for patients to be lying down. The shockwave machine makes a gentle “tapping noise” (please note, radial shockwave is much louder and more forceful). The sensation can feel strange and a little painful at first. Often by the end of the session the tissues have adapted, and the shockwaves feel much more comfortable. It is possible to adjust the intensity of the shockwaves to your pain threshold to make sure the procedure is not too uncomfortable. Often patients say the treated area feels less “painful” or “stiff” after each treatment. Sometimes the positive effects are not felt until a few treatments have been conducted.
What happens after the treatment?
After each ESWT session, it is important not to take any anti-inflammatory medication or to ice the treated area. This is to prevent any “dampening down” of the shockwave effect on tissues. You will be given advice around rest and activity after each session and told when the next session will be. Usually there is minimal delay in returning to sport and normal activity after each session.
Please feel free to contact the LBSM team if you have any further questions around your shockwave treatment.
Shockwave Therapy – Common Complications and UK Nationally Quoted Rates
| Category | Side Effect / Consideration | Typical Frequency | Description / Notes |
| Common side effects | Pain during treatment or increased pain shortly after | ~5–18% | Some patients experience discomfort during the procedure or a temporary increase in pain afterwards. This usually settles within a few hours to a few days. |
| Local skin redness (erythema) | ~4–12% | Mild redness at the treatment site is relatively common and typically resolves within hours or a few days. | |
| Local swelling or bruising (ecchymosis / petechiae) | ~1–10% | Temporary swelling or small bruises can occur due to the mechanical effect of the treatment on tissues. These usually settle quickly without treatment. | |
| Temporary numbness, tingling, or altered sensation | Uncommon | Occasionally caused by temporary local nerve irritation. Symptoms typically resolve spontaneously. | |
| Less common side effects | Headache, dizziness, or feeling generally unwell | Rare | Reported occasionally in studies but typically short-lived and self-limiting. |
| Superficial skin irritation or minor infection | Very rare | Most often associated with treatments where local anaesthetic or injections are used. | |
| Rare but more serious complications | Tendon or ligament rupture | Very rare | A small number of cases have been reported in the literature. Risk may be influenced by underlying tendon degeneration or high-energy treatment protocols. |
| Deep tissue injury, osteonecrosis, or stress-type fractures | Extremely rare | Only isolated case reports exist. These complications are considered highly uncommon. | |
| Important precautions | Pregnancy | — | Shockwave therapy is generally avoided during pregnancy. |
| Bleeding or clotting disorders / anticoagulant medication | — | May increase the risk of bruising or bleeding at the treatment site. | |
| Infection or malignancy at the treatment site | — | Treatment is generally contraindicated in these situations. | |
| Recent steroid injection at the treatment site | — | Timing of treatment may need adjustment due to potential effects on tissue healing. | |
| What patients should discuss with their clinician | Treatment protocol | — | Ask what device will be used (focused or radial), the energy level, and the number of sessions planned. |
| Expected side effects | — | Clinicians should explain the typical side effects they see in their own practice and how they are managed. | |
| When to seek medical advice after treatment | Severe or worsening pain | — | Unusual or severe pain should be assessed by the treating clinician. |
| Increasing swelling, redness, warmth, fever or discharge | — | These may suggest infection and require prompt medical review. | |
| Sudden loss of function or new neurological symptoms | — | Contact the clinic or NHS services promptly if these occur. |
References:
- NICE HTG200 – Extracorporeal shockwave therapy for refractory plantar fasciitis.
- NHS patient information (Guy’s & St Thomas’) –Extracorporeal shockwave therapy (patient leaflet / side effects).
- NICE IPG571 – Extracorporeal shockwave therapy for Achilles tendinopathy: benefits and risks.
