Extracorporeal Shockwave Therapy (ESWT) patient information document 

What is ESWT? 

• Extracorporeal shockwave therapy (ESWT) is a non-invasive form of treatment that can be used to treat a wide variety of painful conditions.
• ESWT works by delivering high energy soundwaves into the tissue through the skin via a hand held probe.
• Research has shown that these shockwaves delivered into injured tissue can provide pain relief as well as stimulating increased blood flow and stem cell activity which can encourage a healing response in many tissues

Why should I have ESWT?

• Shockwave is indicated in a number of conditions but is known to be particularly effective in helping stubborn conditions like plantar fasciitis and chronic tendon pain.
• Generally shockwave is indicated when other treatments have failed or it may be used alongside more traditional methods of Physiotherapy.
• ESWT is 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 ESWT may provide pain relief in up to 70-80% of cases.

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 is not usually problematic and normally 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 there any reasons why I can’t have ESWT? 

There are relatively few contraindications to the radial shockwave which we use here at Physio Effect. ESWT is contraindicated 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 prosthesis in the area requiring treatment  
• You have a blood clotting disorder  
• You are under 18  
• 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.
• Research and evidence has shown that most injuries require a minimum of 3 sessions, which is why treatment is sold as a block of 3.
• We advise booking weekly sessions for your course to ensure optimal timing. A maximum of 10 days between treatments is acceptable.

• It is important that you do not take non-steroidal anti-inflammatory (NSAIDs) medication for 2 weeks prior to your 1st session and over the duration of your treatment as this may interfere with treatment effectiveness.
• If you are unsure if you take NSAIDs then it is best to clarify with your Doctor or pharmacist.

• Please wear comfortable and loose clothing so we may easily access the body part to be treated.
• Please read and be familiar with the above mentioned precautions and contraindications and if you are unsure whether this treatment is appropriate for you please call us first or discuss it with us during your assessment.

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 and demonstrate 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 allows 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.
• Please do not take 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.