Shockwave Therapy (ESWT)

Extracorporeal Shockwave Therapy is a clinically validated, non-invasive treatment for chronic tendon and soft tissue conditions, including Achilles tendinopathy, patellar tendinopathy, plantar fasciitis, gluteal tendinopathy and calcific shoulder tendinopathy. A handheld applicator delivers targeted acoustic (mechanical, not electrical) waves through the skin into the affected tissue.

Radial shockwave spreads pressure waves outward across a broader region and suits most tendinopathies. Focused shockwave converges energy at a precise depth and is better for calcific deposits, bone stress injuries and highly localised pathology. We select the mode based on your assessment findings.

The treatment works on several levels at once: it reduces pain sensitivity by lowering Substance P concentration and nociceptor excitability, stimulates new blood vessel formation in poorly vascularised tendon tissue, activates tenocytes to synthesise new collagen and remodel degenerated tissue, mechanically disrupts calcium deposits, and supports bone remodelling in delayed-healing bone stress injuries.

Most courses run to three to six sessions spaced roughly a week apart, with each shockwave application taking 10 to 15 minutes inside a longer appointment that also covers reassessment and exercise progression. Pain relief often begins within the first two or three sessions, which is exactly what allows the rehabilitation loading to be done properly. It is recommended by NICE for several specific conditions, and the evidence is consistent that ESWT plus progressive loading outperforms either alone, which is why we never prescribe it in isolation.

Shockwave changes tissue biology; measurement tells us whether it is working. Diagnostic ultrasound lets us confirm the diagnosis, locate the pathology and any calcific deposit, and choose the right applicator, energy level and treatment depth rather than treating a general area.

Handheld dynamometry quantifies the strength of the affected muscle-tendon unit against the other side, so progress is tracked as measured change rather than self-reported comfort. ForceDecks force-plate testing adds jump, hop and landing data, showing how the tendon tolerates rapid load and elastic demand, which is the capacity that actually determines return to running and sport.

Taken together, these give clear discharge criteria: symptoms settled, strength deficits closed, and force-plate asymmetries resolved.