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Extracorporeal Shockwave Therapy (ESWT)

  1. What is Shockwave Therapy?
  2. How does ESWT work?
  3. Is ESWT safe?
  4. Are there any reasons why I can’t have ESWT?
  5. What musculoskeletal conditions can be treated with ESWT and when should I have it?
  6. What does the process involve?
  7. What does it feel like and when will I get better?
  8. 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;

  1. 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.
  2. 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.

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.

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.