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Shockwave therapy and making an informed choice

Before booking shockwave therapy, it helps to know why it's suggested. Here's what the evidence means and how it fits into wider care.

If tendon or heel pain has persisted, you may have been offered shockwave therapy. Before booking a course, you should understand why it is being suggested and how it fits into your wider care.

The decision should begin with an assessment. A treatment name alone does not tell you whether it is right for your symptoms.

Physiotherapy session discussing shockwave therapy

What shockwave therapy is

Extracorporeal shockwave therapy uses a device to deliver acoustic energy through the skin to a selected area. It is used in some settings for persistent tendon and soft tissue conditions.

An appointment should include a discussion of suitability, possible side effects and the expected course of treatment. Ask what improvement the clinician hopes to see and how it will be measured.

What the evidence on shockwave therapy means

Evidence differs between conditions. NICE guidance for Achilles tendinopathy describes efficacy evidence as inconsistent and limited, and recommends special arrangements for clinical governance, consent and audit or research. Its guidance for persistent plantar fasciitis also identifies inconsistent evidence of efficacy and requires special arrangements.

That is different from a promise that the treatment will work. Your clinician should explain the uncertainty as part of consent and discuss reasonable alternatives.

Ask how shockwave therapy fits into the plan

If rehabilitation has been recommended, ask whether it continues alongside treatment and whether any activities need adjusting. You should know who to contact if symptoms change.

Useful questions include what diagnosis is being treated, why shockwave is being considered now and what happens if there is little improvement. You can also ask about the total likely cost and the arrangements for reviewing progress.

A review should consider the activities that matter to you, rather than relying only on whether the treated area feels different immediately after a session.

Suitability needs a proper discussion

Share your medical history and medicines before treatment. Tell the clinician about pregnancy, bleeding conditions, blood-thinning medicines, altered sensation and any significant illness. They should check the relevant guidance for the device and treatment being proposed.

If the diagnosis is uncertain or symptoms have changed, further assessment may be more useful than starting a course of treatment.

Finding out more

Our shockwave therapy page explains the service. If you are considering it for heel pain or Achilles symptoms, contact us to discuss an assessment first. You should have enough information to make a considered decision without pressure to proceed.

Further reading: NICE 1 · NICE 2

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