The exact mechanism by which ESWT works is not known, but it is postulated that the shockwaves interact with the tissue and cause microtrauma, resulting in a pro-inflammatory response by the body. This is characterised by new blood vessel formation and increased blood supply to the treatment area, thus allowing for accelerated healing.

There are two forms of shockwave: focused and radial. These forms differ in physical characteristics and their method of production. Focused shockwaves affect a small, precisely defined area, travel deeper and carry higher energy; whereas radial shockwaves affect a larger, more diffuse area, do not travel as deeply and carry less energy.

Focused shockwaves are employed in the treatment of bone disorders (eg. non-union fractures) or soft tissue calcifications, and require precise imaging, anesthesia and close supervision.

Radial shockwaves are used in the treatment of soft tissue injuries such as tendon related conditions, and promote tissue healing. These conditions include plantar fasciitis, patellar tendinitis (jumper’s knee), tennis/golf elbow and shoulder tendinitis.

Extensive research has been conducted to assess the efficacy of ESWT and while most have shown favorable outcomes, some have shown no benefit over placebo treatment.

ESWT has been shown to be a good non-invasive treatment option for orthopaedic conditions, and is an alternative worth undertaking for many patients who wish to avoid invasive treatments such as steroid injections or surgery.

Contraindications to ESWT include:

• Bleeding disorders or if taking anti-coagulation medications
• Infection in the treatment area
• Malignant disease in or near the treatment area
• Prosthetic device in the treatment area
• Pregnancy

ESWT is not known to cause any significant adverse effects. However, potential complications are pain and hypersensitivity at the site of treatment, which usually resolve very quickly.

A hand-held probe is placed over the area of greatest tenderness and the shockwaves are delivered over a duration of approximately 20 minutes. Occasionally, mild transient discomfort may be felt at the treatment site, thus if necessary, topical local anaesthetic cream may be applied prior to treatment.

Patients usually require 5 to 6 weekly sessions and overall, the healing response takes 6 to 8 weeks. Between treatments, patients are able to perform their usual daily activities.