Shockwave Therapy

What Is Shockwave Therapy?

Extracorporeal shockwave therapy, usually shortened to ESWT or simply shockwave, is a treatment that uses acoustic pressure waves delivered through the skin to a targeted area of tissue. Far from being a novelty gadget, shockwave has a well-established place in the treatment of certain chronic tendon and soft tissue conditions, particularly those that have become persistent and haven't responded fully to more conservative approaches such as rest, exercise and manual therapy alone. At JW Physio Clinic in Loughton, shockwave therapy is delivered by our HCPC-registered physiotherapists as part of a wider, carefully considered treatment plan, rather than as a standalone quick fix.

The underlying idea is that the mechanical energy delivered by the shockwave stimulates a local biological response in the treated tissue. This is thought to encourage blood flow, trigger the body's own repair processes, and help break the cycle of chronic, poorly-healing tissue that characterises many stubborn tendon problems. It's a treatment that works with the body's healing mechanisms rather than replacing them, which is why it's typically used alongside — not instead of — an appropriate exercise and load management programme.

How Shockwave Therapy Works

During treatment, a handheld applicator delivers a series of pressure pulses through a small amount of gel applied to the skin, directed at the specific area of tenderness or dysfunction identified during your assessment. The pulses create a controlled mechanical stimulus within the tissue, which is believed to help disrupt long-standing, poorly-organised scar tissue, stimulate new blood vessel formation, and encourage the tendon or soft tissue to move from a stalled, chronic state back toward active healing. It's this mechanical stimulation of tissue healing — rather than any electrical, thermal or chemical mechanism — that defines shockwave therapy and gives it its name.

Conditions Shockwave Therapy Treats Well

Shockwave therapy has a well-recognised role in the treatment of a number of persistent musculoskeletal conditions, particularly where symptoms have been present for some time and haven't fully resolved with other treatment. Conditions we commonly treat with shockwave at JW Physio Clinic include:

• Plantar fasciitis — persistent heel and arch pain, one of the most common and well-supported uses of shockwave therapy.
• Achilles tendinopathy — chronic pain and stiffness affecting the Achilles tendon, whether mid-portion or at its attachment to the heel bone.
• Tennis elbow (lateral epicondylalgia) and golfer's elbow (medial epicondylalgia) — persistent pain around the elbow linked to tendon overload, often from repetitive gripping or racquet sports.
• Calcific shoulder tendinopathy — shoulder pain associated with calcium deposits within the rotator cuff tendons, which can respond well to shockwave in appropriate cases.
• Patellar tendinopathy ("jumper's knee") — persistent pain at the front of the knee, common in sports involving jumping and rapid changes of direction.

Shockwave tends to be considered when a tendon problem has become chronic — typically present for many weeks or months — rather than as a first-line treatment for a very recent, acute injury, where other approaches are usually more appropriate initially.

What a Shockwave Session Feels Like

Sessions are carried out in clinic and don't require any anaesthetic or downtime. You'll be positioned comfortably with the treatment area exposed, a small amount of gel applied to the skin, and the applicator moved over the specific tender area while pulses are delivered. Most people describe the sensation as a rhythmic tapping or thudding, which can feel uncomfortable — particularly directly over the most sensitive point — but is generally well tolerated. Your physiotherapist will start at a lower intensity and adjust based on your feedback, aiming for a level that's noticeable and therapeutic without being unbearable. Any discomfort during the session typically eases quickly afterwards, though it's common to feel some mild soreness in the treated area for a day or so following each session, similar to how a deep tissue massage might feel.

How Many Sessions Are Typically Needed

Shockwave therapy is generally delivered as a short course of sessions spaced roughly a week apart, rather than as a single one-off treatment, since the biological response it aims to stimulate tends to build cumulatively over a course rather than resolving everything in a single visit. Exactly how many sessions are appropriate depends on the specific condition, how long you've had symptoms, and how your tissue responds as treatment progresses. Rather than quote a fixed number of sessions that may not reflect your individual case, your physiotherapist will discuss a realistic, evidence-informed plan with you following your assessment, and will review your progress as the course goes on, adjusting the plan if needed.

Who Shockwave Therapy Isn't Suitable For

While shockwave is a safe treatment for the majority of appropriate patients, it isn't suitable for everyone, and a proper clinical assessment is essential before starting. General contraindications include pregnancy, the presence of a cardiac pacemaker or other implanted electronic device, blood clotting disorders or use of certain blood-thinning medication, treatment directly over certain major nerves or blood vessels, treatment over an area of known or suspected malignancy, and active infection in the area to be treated. This list isn't exhaustive, and your individual medical history will always be reviewed carefully during assessment to confirm whether shockwave is an appropriate and safe option for you. If it isn't suitable, we'll discuss alternative treatment approaches that are better suited to your situation.

Combining Shockwave With Other Treatment

Shockwave therapy is rarely used in isolation. It tends to work best as one part of a broader treatment plan that also includes an appropriate, progressive loading or strengthening programme for the affected tendon, manual therapy to address any related stiffness or muscle tension, advice on managing training load or day-to-day activity to avoid ongoing aggravation, and footwear or biomechanical advice where relevant, particularly for lower limb conditions such as plantar fasciitis or Achilles tendinopathy. Your physiotherapist will explain exactly how shockwave fits into your individual plan, and why the other elements of treatment matter just as much as the shockwave sessions themselves in achieving a lasting result.

What to Expect Between and After Sessions

Between sessions, you'll usually be given a specific home exercise programme to continue, along with guidance on activity levels — some conditions benefit from continued gentle loading throughout a course of shockwave, while others need a period of relative rest from aggravating activities. It's common for symptoms to fluctuate during a course of treatment, and a temporary increase in discomfort in the day or two after a session doesn't necessarily mean treatment isn't working; your physiotherapist will help you understand what's a normal response and what would be worth flagging. Meaningful improvement in long-standing tendon conditions tends to build gradually over the course of several weeks, rather than appearing immediately after a single session, so a degree of patience and consistency with the accompanying exercise programme makes a real difference to the overall outcome.

Preparing for Your Shockwave Assessment

Before starting shockwave therapy, you'll have a thorough assessment to confirm the diagnosis, review your medical history for any contraindications, and discuss whether shockwave is a suitable and worthwhile option for your specific condition. It helps to bring details of any previous treatment you've tried for the condition, including physiotherapy, injections or medication, along with any relevant scan reports, so we have as complete a picture as possible when planning your treatment.

Getting Started

If you've been dealing with a stubborn tendon problem — whether that's heel pain that hasn't settled, a persistent case of tennis elbow, or ongoing Achilles or knee pain that's limiting your activity — book an assessment with our team to discuss whether shockwave therapy could be a helpful part of your treatment plan. We'll give you an honest opinion on whether it's likely to help your specific condition, alongside the other treatment options available.

Why Chronic Tendon Problems Often Need More Than Rest

It's a common misconception that a stubborn tendon problem simply needs more time and more rest to resolve. In reality, many long-standing tendinopathies enter a state where the normal healing process has effectively stalled — the tissue remains disorganised, with poor blood supply and an accumulation of degenerative change, rather than progressing through the usual stages of repair. Simply waiting for this kind of tissue to heal on its own, or resting completely and hoping symptoms fade, often doesn't work, and can sometimes allow the underlying tissue changes to become further entrenched. Shockwave therapy is specifically aimed at this kind of stalled, chronic presentation, providing a fresh mechanical stimulus intended to help kick-start the healing process back into gear, in combination with the loading and strengthening work that remains essential to long-term recovery.

What Makes a Good Candidate for Shockwave Therapy

Not every tendon problem is best treated with shockwave, and a proper assessment helps identify who is likely to benefit most. Generally, shockwave tends to be most appropriate for people with a clear, well-localised area of chronic tendon pain that has been present for a reasonable length of time — often many weeks or months — and that hasn't fully resolved with an appropriate trial of exercise-based rehabilitation and activity modification. It's typically less appropriate as a first-line treatment for a very recent, acute injury, where the tissue is still in an early, active inflammatory stage and other approaches are usually more suitable initially. Your physiotherapist will explain where your particular presentation sits on this spectrum, and why shockwave has or hasn't been recommended for your specific case.

Setting Realistic Expectations

Because shockwave therapy is often sought out after other treatments haven't fully resolved a stubborn problem, it's important to set realistic expectations from the outset. Shockwave can be a genuinely effective tool for the right condition, but it isn't a guaranteed cure, and outcomes vary between individuals depending on factors such as how long symptoms have been present, the severity of the underlying tissue changes, and how consistently the accompanying exercise programme is followed. We aim to be honest about likely outcomes based on your specific presentation, rather than overstating what shockwave alone can achieve, so that you can make an informed decision about whether to proceed and can approach the course of treatment with a clear, realistic understanding of what to expect.

Aftercare Following Each Session

After each shockwave session, we'll give you clear guidance on what activity level is sensible in the following days, which varies depending on the condition being treated and how it's responding to your course of treatment so far. Some conditions benefit from continuing gentle, controlled loading of the tendon between sessions, as this is thought to support the healing response the shockwave is aiming to stimulate, while others need a short period of relative rest immediately after treatment before resuming normal activity. Simple measures such as staying well hydrated, avoiding particularly aggressive stretching of a freshly treated area on the day of your session, and keeping up with any prescribed home exercises all help support the overall effectiveness of your course. If you notice anything that feels significantly different from the mild, expected soreness described above — for example, sharp new pain, marked swelling, or symptoms spreading beyond the treated area — it's worth contacting us so we can review and adjust your plan if needed.

Frequently Asked Questions