Shockwave Therapy: Could It Help Your Persistent Tendon or Heel Pain?
If you've been struggling with persistent heel pain, tennis elbow or a tendon problem that just doesn't seem to improve, you may have heard of shockwave therapy.
At Exmoor Osteopathy & Sports Injury Clinic in Minehead, we offer radial shockwave therapy as a non-invasive treatment option for certain musculoskeletal conditions. It can be particularly useful when symptoms have persisted despite rest, exercise or other treatments.
But what exactly is shockwave therapy, how does it work, and could it help you?
What is shockwave therapy?
Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses acoustic pressure waves to stimulate biological responses in targeted tissues.
At Exmoor Osteopathy, we use radial shockwave therapy, which delivers pressure waves through a handheld applicator placed against the skin. The waves spread through the tissues from the treatment point, providing mechanical stimulation to the affected area.
The science behind shockwave therapy
Shockwave therapy works by delivering mechanical pressure waves into the affected tissues. These waves stimulate cellular responses through a process known as mechanotransduction, in which mechanical forces are converted into biochemical signals.
Research suggests that shockwave therapy may influence several biological processes:
Cellular signalling: Mechanical stimulation can influence how cells respond to their local environment, including processes involved in tissue maintenance and remodelling.
Pain modulation: Shockwave therapy may affect peripheral pain sensitivity and pain-signalling pathways, helping to reduce symptoms.
Blood vessel formation: Research suggests it can influence signalling pathways involved in angiogenesis, the formation of new blood vessels.
Tissue remodelling: Mechanical stimulation may influence cellular activity and the turnover of components within the extracellular matrix, which provides structural support to tissues.
These processes may help reduce pain and improve function in certain musculoskeletal conditions. The relative contribution of each mechanism depends on the tissue, condition and treatment protocol, and not every proposed mechanism has been definitively established in clinical practice.
Shockwave therapy is particularly relevant to some persistent tendon problems, where changes in tendon structure and function can contribute to pain and reduced tolerance to loading. Treatment is commonly combined with an appropriate rehabilitation programme to help restore the tissues' capacity to cope with everyday activities and exercise.
What conditions can shockwave therapy help?
Shockwave therapy is used for several musculoskeletal conditions, particularly persistent problems affecting tendons and the tissues around joints. Its suitability depends on the specific diagnosis and your individual circumstances.
1. Plantar fasciitis and persistent heel pain
Plantar fasciitis, often referred to as plantar heel pain, is one of the best-known applications of shockwave therapy.
The plantar fascia is a strong band of connective tissue running along the sole of the foot, helping to support the arch and distribute forces during walking and running. Repeated loading can contribute to pain and changes in the tissue.
Common symptoms include:
Pain under the heel, particularly with the first steps in the morning.
Discomfort after sitting or resting.
Pain after prolonged standing or walking.
Difficulty walking, exercising or participating in sport.
When symptoms persist, shockwave therapy may help reduce pain and improve function. It can be considered alongside appropriate footwear, activity modification and progressive exercises.
2. Achilles tendinopathy
The Achilles tendon connects the calf muscles to the heel bone and experiences substantial forces during walking, running and jumping.
Achilles tendinopathy can cause pain, stiffness and reduced tolerance for physical activity. Symptoms may occur in the middle portion of the tendon or where it attaches to the heel bone.
Treatment depends on the location and nature of the problem. Progressive calf strengthening and tendon loading are important components of rehabilitation. Shockwave therapy may be considered in selected cases, but it is not routinely appropriate for every person with Achilles pain.
3. Tennis elbow
Tennis elbow, also known as lateral elbow tendinopathy, causes pain around the outside of the elbow. It is associated with the tendons involved in extending the wrist and fingers.
You may notice pain when gripping, lifting, carrying shopping, using tools or performing repetitive tasks. Despite its name, tennis elbow can affect people who have never played tennis.
Shockwave therapy may be considered when symptoms persist. An assessment helps determine whether the symptoms are consistent with tennis elbow and whether shockwave therapy is an appropriate part of your treatment plan.
4. Greater trochanteric pain syndrome (GTPS)
Greater trochanteric pain syndrome commonly causes pain over the outside of the hip. It is frequently associated with the gluteal tendons and surrounding tissues.
Symptoms can include pain when lying on the affected side, climbing stairs, walking uphill or standing on one leg.
Shockwave therapy may be considered for selected people with persistent symptoms. Managing activities that aggravate the hip and progressively strengthening the gluteal muscles are also important aspects of treatment.
5. Calcific shoulder tendinopathy
Calcific shoulder tendinopathy occurs when calcium deposits develop within a tendon of the rotator cuff. This can cause shoulder pain and restrict movement, particularly when lifting the arm.
Shockwave therapy is one treatment option that may be considered for selected patients. Suitability depends on the nature of the calcium deposit, symptoms and clinical assessment.
Other shoulder conditions can cause similar symptoms, so establishing the likely diagnosis is important before choosing treatment.
What does NICE say about shockwave therapy?
The National Institute for Health and Care Excellence (NICE) publishes guidance on medical procedures, including shockwave therapy for several musculoskeletal conditions.
Its guidance covers conditions such as plantar fasciitis, tennis elbow, greater trochanteric pain syndrome and calcific shoulder tendinopathy. The recommendations vary between conditions, reflecting differences in the evidence and the requirements for safe and appropriate use.
NICE guidance provides an important reference point when considering shockwave therapy. However, it is not a blanket recommendation for every type of tendon pain.
At Exmoor Osteopathy, we consider the diagnosis, your symptoms, previous treatment and individual circumstances when deciding whether radial shockwave therapy may be appropriate.
What happens during a shockwave therapy appointment?
Your appointment begins with a discussion of your symptoms, medical history and previous treatment. Your practitioner will assess the affected area and consider whether shockwave therapy is suitable.
If treatment is appropriate, the process generally involves:
Preparing the area: A small amount of coupling gel is applied to the skin to help transmit the pressure waves.
Applying the treatment: A handheld applicator is moved over the target area, delivering a series of controlled pulses.
Adjusting the intensity: The treatment settings are adapted to the area being treated and your tolerance.
Planning your recovery: Your practitioner discusses activity, exercises and how to manage the affected area between appointments.
The treatment itself usually takes only a few minutes, although your appointment will allow time for assessment and advice.
Does shockwave therapy hurt?
You may feel discomfort during treatment, particularly when the applicator is placed over a sensitive area. Most people describe the sensation as a series of rapid taps or pulses.
The intensity can be adjusted to help keep treatment tolerable. You should tell your practitioner if the discomfort is excessive.
Temporary soreness, redness or mild swelling can occur afterwards. Your practitioner will explain what to expect and advise you on managing any short-term reactions.
How many shockwave therapy sessions will I need?
The number of sessions depends on the condition being treated, how long you've had symptoms and how you respond to treatment.
A course commonly involves several appointments, often spaced about a week apart, although the schedule varies. Your practitioner will explain the proposed course and review your progress rather than assuming everyone needs the same number of sessions.
Improvement may be gradual rather than immediate. The aim is to help reduce pain, improve function and support a return towards your usual activities.
Is shockwave therapy enough on its own?
Shockwave therapy can be a useful part of treatment, but it is not usually the whole solution.
For many tendon-related conditions, appropriate exercise and progressive loading are central to recovery. Tendons and muscles need to build their capacity to cope with the demands placed on them.
Depending on your condition, your treatment plan may include:
Advice on modifying aggravating activities without unnecessarily avoiding movement.
Exercises to improve strength and load tolerance.
Guidance on gradually returning to walking, work, sport or other activities.
Review of your symptoms and progress.
Combining shockwave therapy with an appropriate rehabilitation programme helps address both symptoms and the physical demands you need to manage.
Is shockwave therapy suitable for everyone?
No. Shockwave therapy is not appropriate for every condition or every patient.
Your practitioner will review your medical history and check for factors that may affect suitability.
These may include pregnancy, certain blood-clotting disorders, anticoagulant medication, active infection or cancer in the treatment area, and other relevant medical circumstances. Precautions depend on the treatment site, equipment and individual situation.
Shockwave therapy should not be applied indiscriminately to unexplained pain. An assessment is important to identify the likely cause of your symptoms and determine whether further investigation or a different treatment approach is needed.
Could shockwave therapy help you?
If persistent heel, elbow, hip or tendon pain is affecting your daily life, shockwave therapy may be worth discussing with a suitably qualified practitioner.
At Exmoor Osteopathy & Sports Injury Clinic in Minehead, we offer radial shockwave therapy and can assess your symptoms to help determine whether it is an appropriate option. We'll explain the available treatments and discuss how shockwave therapy might fit alongside exercise, rehabilitation and other aspects of your care.
Any questions? Click here to get in touch with our team - we’re always happy to help.
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