Shockwave Therapy

What is Shockwave Therapy?

Extracorporeal Shockwave Therapy (ESWT) uses high-energy acoustic waves to stimulate healing in damaged tissues. It’s been used in medicine since the 1980s and has strong research evidence for treating chronic tendon problems.

Think of it as kickstarting your body’s natural repair mechanisms. The shockwave energy creates controlled microtrauma at the tissue level, triggering increased blood flow, new vessel formation, and collagen remodelling. Your tendons essentially get a wake-up call to start healing properly.

I offer shockwave therapy at my Chester clinic for anyone dealing with stubborn tendon issues that haven’t responded to standard physiotherapy approaches.

How Does It Work?

Shockwave works through several mechanisms:

The science behind it is solid. The shockwave pulses create mechanical stress at the cellular level, which activates growth factors and stem cells. This initiates a healing cascade that can reverse chronic degenerative changes in tendon tissue.

What Conditions Respond Best?

Shockwave therapy has the best evidence for chronic tendon problems - conditions that have been there for at least three months and haven’t responded well to other conservative treatments. Here’s what I treat most commonly across Merseyside and Cheshire:

Plantar Fasciitis

This is probably the condition with the strongest evidence for shockwave therapy. If you’ve got that classic sharp heel pain first thing in the morning, or pain under your heel after standing for long periods, you likely know how frustrating plantar fasciitis can be.

The plantar fascia is a thick band of tissue running along the bottom of your foot. When it gets overloaded, it develops painful degenerative changes. Stretching helps, orthotics can help, but sometimes these stubborn cases need something more.

Research shows shockwave therapy has success rates of 70-80% for plantar fasciitis. NICE (National Institute for Health and Care Excellence) guidelines support its use. I see excellent results with it, particularly for people who’ve been limping around for months trying everything else.

If you’re looking for effective plantar fasciitis treatment in Liverpool, Chester, or Queensferry, shockwave is worth considering - especially if you’ve already tried insoles, stretching, and rest without much improvement.

Achilles Tendinopathy

The Achilles tendon is notorious for being slow to heal. It has poor blood supply, carries massive loads (up to 12 times your body weight when running), and tends to develop chronic degenerative changes rather than true inflammation.

There are two main types:

Mid-portion Achilles tendinopathy - Pain and thickening 2-6cm above where the tendon attaches to the heel bone. Common in runners across Merseyside, particularly those who’ve ramped up mileage too quickly.

Insertional Achilles tendinopathy - Pain right at the heel bone attachment, often with a bony lump. This one’s particularly stubborn and sometimes involves calcification.

Achilles tendinopathy responds well to loading exercises (heavy slow resistance training), but combining exercise with shockwave often accelerates recovery. The shockwave helps remodel the degenerative tissue while the exercise rebuilds strength and capacity.

I treat a lot of runners, triathletes, and football players with Achilles problems. It’s one of those injuries that can drag on for months if not managed properly.

Tennis Elbow and Golfer’s Elbow

Despite the names, you don’t need to play tennis or golf to get these conditions. I see them in office workers, tradespeople, gym-goers, anyone who does repetitive gripping or wrist movements.

Tennis elbow (lateral epicondylitis) - Pain on the outside of the elbow, made worse by gripping, lifting, or extending the wrist.

Golfer’s elbow (medial epicondylitis) - Pain on the inside of the elbow, aggravated by flexing the wrist or gripping.

Both are tendinopathies of the forearm muscles where they attach to the elbow. Like other tendon problems, they’re degenerative rather than inflammatory, which is why anti-inflammatories often don’t help much.

Shockwave therapy for tennis elbow has good research support. It works better than cortisone injections for long-term outcomes, and unlike cortisone, there’s no risk of weakening the tendon. I typically combine shockwave with specific exercises to address the underlying strength and capacity issues.

Other Conditions Shockwave Can Help

Patellar tendinopathy (jumper’s knee) - Pain at the front of the knee, just below the kneecap. Common in basketball players, volleyball players, and anyone who does a lot of jumping.

Calcific shoulder tendinopathy - Calcium deposits in the rotator cuff tendons causing severe shoulder pain. Shockwave can break down these deposits without needing surgery.

Greater trochanteric pain syndrome - Pain on the outside of the hip, often mistakenly called “hip bursitis”. Usually involves tendon problems of the gluteal muscles rather than true bursitis.

What Does the Science Say?

I’m evidence-based in my approach, so let’s talk research. Shockwave therapy isn’t some fringe treatment - it’s recommended by NICE and has been extensively studied.

For plantar fasciitis, systematic reviews show success rates of 70-80%, significantly better than placebo treatments. Studies comparing shockwave to cortisone injections show shockwave produces better long-term outcomes, even though cortisone gives quicker initial relief.

For Achilles tendinopathy, research demonstrates that shockwave combined with eccentric exercises produces better results than exercises alone. The shockwave appears to enhance the tendon’s response to loading.

Tennis elbow studies show shockwave outperforms wait-and-see approaches, and produces more durable results than cortisone. A 2021 systematic review found moderate to strong evidence supporting shockwave for lateral epicondylitis.

The quality of evidence varies between conditions, but for the main ones I treat - plantar fasciitis, Achilles tendinopathy, tennis elbow - the research is solid. These aren’t marginal gains either. We’re talking clinically meaningful improvements in pain and function.

Shockwave vs. Other Treatments

Let me put shockwave in context compared to other options you might have tried or been offered.

Shockwave vs. Cortisone Injections

Cortisone gives faster pain relief - usually within a few days. But it’s temporary. The injection suppresses inflammation and pain without addressing the underlying tendon degeneration. Most people find the effects wear off after a few weeks or months.

There’s also growing evidence that repeated cortisone injections can weaken tendons and potentially increase rupture risk, particularly in the Achilles. Not great if you’re trying to get back to running.

Shockwave takes longer to work - you’re looking at 6-12 weeks typically - but it stimulates actual tissue healing and remodelling. The results tend to be more durable because you’re fixing the problem rather than masking it.

If you’ve had cortisone before and it’s worn off, shockwave is often the next logical step before considering surgery.

Shockwave vs. Surgery

Surgery is invasive, requires recovery time, and comes with surgical risks. For most chronic tendon problems, it should be a last resort after conservative treatments have failed.

Shockwave is non-invasive. No anaesthetic, no incisions, no surgical recovery. You can drive yourself home and get on with your day. The most you’ll deal with is some soreness at the treatment site.

Success rates for shockwave often rival surgical outcomes for conditions like plantar fasciitis, without the risks and downtime. Always worth trying shockwave first if you’re being told you might need an operation.

Shockwave vs. Exercise Alone

Exercise therapy - specifically progressive loading exercises - is the foundation of tendon rehabilitation. Heavy slow resistance training for Achilles, eccentric wrist exercises for tennis elbow, calf raises for plantar fasciitis. This stuff works.

But sometimes tendons are so irritable or degenerative that exercise alone isn’t enough, or progress is painfully slow. That’s where shockwave comes in.

The research suggests shockwave plus exercise produces better outcomes than either alone. The shockwave helps remodel the degenerative tissue, making it more responsive to loading. The exercise rebuilds strength and capacity.

I don’t use shockwave instead of exercise. I use it alongside exercise to accelerate and enhance the response.

Is It Painful?

Let’s be honest - shockwave treatment is uncomfortable. I’m not going to tell you it’s pleasant. The higher the energy level, the more uncomfortable it is, and you need adequate energy to get results.

Most people describe it as a deep, achy sensation with some sharp moments depending on the area being treated. Bony areas like the heel or elbow tend to be more sensitive than fleshy areas.

The good news is that it’s manageable discomfort, not unbearable pain. I adjust the intensity based on your feedback, and the treatment only lasts 15-20 minutes. You can absolutely tolerate it for that duration.

Some areas become less sensitive as treatment progresses. The first session is often the most uncomfortable.

If you’re particularly worried about pain tolerance, we can start at lower energy levels and build up, though this may require more sessions to achieve the same result.

How Many Sessions Do I Need?

Research shows optimal results with 3-6 sessions, typically spaced 1 week apart. I recommend starting with a 3-session package and reassessing before deciding whether to continue.

Some people respond brilliantly to 3 sessions. Others need the full 6 to get maximum benefit. It depends on the condition, how long you’ve had it, and how your tissues respond.

The sessions need to be spaced at least a week apart to allow the healing response to develop between treatments. More frequent sessions don’t speed up results.

Results typically become apparent 6-12 weeks after completing treatment. This delayed response can be frustrating, but it reflects the time needed for genuine tissue remodelling. You’re not getting a temporary pain-blocking effect - you’re stimulating actual structural changes in the tendon.

Aftercare Guidance

What you do after treatment matters. Here’s what I tell everyone:

First 48 hours:

• Some increased discomfort or aching is normal and actually indicates the treatment is working. It shouldn’t be severe though.
• You might see some redness or mild swelling at the treatment site. This settles quickly.

First 24 hours:

• Avoid heavy loading or high-impact activities on the treated area. No sprinting, heavy lifting, or intense sports.
• Gentle activity is absolutely fine - walking, swimming, cycling at easy pace.

After 24 hours:

• Gradually return to normal activities as comfort allows
• Continue with any exercises I’ve prescribed - shockwave enhances exercise response
• Stay active - complete rest isn’t necessary or beneficial

Some people feel immediately better after treatment. Don’t be fooled. The real healing process takes weeks. Others feel temporarily worse before improving. Both responses are normal.

Initial Assessment Required

I always do an assessment before starting shockwave therapy. This isn’t just box-ticking - I need to confirm that shockwave is actually appropriate for your condition.

Not everyone needs shockwave. Sometimes there’s a simpler solution - maybe your technique needs adjusting, maybe you need different exercises, maybe there’s a biomechanical issue we can address. I’m not going to sell you shockwave if it’s not the right tool for the job.

The assessment also lets me rule out contraindications. Shockwave isn’t suitable if you’re pregnant, have blood clotting disorders, take certain medications, have active infections, or have tumours in the area. There are also some conditions that can mimic tendinopathy but won’t respond to shockwave.

I’ll take a proper history, examine the area, and explain exactly what shockwave involves, what you should expect, and what the evidence shows for your specific condition. You’ll leave with a clear plan, whether that includes shockwave or not.

The assessment costs £75. If you proceed with treatment the same day, we’ll start your first shockwave session right after the assessment.

Available in Chester

I offer shockwave therapy at my clinic on Silver Road in Chester. Whether you’re based in Chester or anywhere across Cheshire, you can access the same evidence-based treatment.

Booking is straightforward — book online or get in touch via WhatsApp.

Pricing Packages

Sessions	Price	Per Session
1 session	£75	£75
3 sessions	£200	£67
6 sessions	£375	£62.50

Important: Shockwave requires an initial assessment (£75) before your first treatment to confirm it’s appropriate for your condition.

If you decide to proceed with treatment on the same day as your assessment, we’ll start your first session immediately and that counts as session one of whichever package you choose.

The packages represent better value because chronic tendon problems almost always need multiple sessions. One session rarely does the job. If you’re unsure, start with the 3-session package and we’ll review progress before deciding whether you need more.