Treatments will be offered by Jonathan, one of our two osteopaths. He has
been interested in sports injuries and tendon problems for many years –
frequently struggling with them. He started to use shockwave treatment after
treating a female trapeze artist with severe acute medial epicondylitis (
Golfer’s Elbow ) in 2018. Normal acupuncture, soft tissue techniques,
mobilisation ( osteopathic ), rest, ice and anti-inflammatories had improved
the condition by maybe 10-20% over 5 weeks. He had given up and was
going to suggest a steroid injection when a colleague recommended trying
shockwave therapy. Two weeks and three treatments later, the trapeze artist
was training and performing again – 100% better. Obviously, not all people are
going to have such an amazing result so quickly as that but it was enough to
make Jonathan realise that he needed to be able to offer this modality in his
Firstly… is the shock electric?
No, the “shock” is NOT an electric shock. It is a PERCUSSIVE shock,
generated by a metal projectile shooting up and down a special handpiece,
the shock being transferred to the body tissues via an applicator head. The
shock can be made electro-magnetically or pneumatically ( using a
specialised compressor unit ). The machine used in Oakwell is the latter.
Press on the below link to see the same shockwave machine being used
used. Graphics explain the working mechanism as well as treatment
conditions being listed.
Why use shockwave therapy ?
Shockwave therapy is an increasingly popular means of treating many types
of musculoskeletal injuries – especially tendon problems. The evidence
behind shockwave as a treatment modality is very positive and steadily
increasing. The UK government agency NICE – who decide whether
treatments / drugs are effective – have said that it is effective for many
types of tendon / muscle strain. Conditions listed below.
Shockwave is particularly good for chronic problems that have not responded
to other procedures e.g physiotherapy, acupuncture, steroid injections AND is
useful for those people wanting to avoid injections and or surgery. Unlike
injections or the use of ice and anti-inflammatories, where rest is essential (
typically 2 days to 2 weeks ), training / exercise can often continue the
following day. This is why shockwave is increasingly used as a
preventative modality especially by those really pushing themselves e.g
marathon runners, Triatheletes, professional sports people.
Other advantages are that it is non-invasive so no risk of infection and there
is also no risk of tendon rupture which can rarely happen with recurrent
Shockwave is being used in many hospital physiotherapy departments and
also Orthopaedic hospitals : Birmingham Orthopaedic Hospital uses Storz
Medical equipment. Storz have just made a contract to supply over 100
BMI Hospitals with their Shockwave units. They also provide
machines to over 10 Premier Football physiotherapy departments. Jonathan
uses a Storz Masterpuls 50 ( MP50 ) in his treatments.
Conditions well suited to Shockwave therapy
Shoulder tendonitis *** / calcified tendinopathy *** / capsular strain
Peri articular shoulder pain ( trigger points )
Lateral epicondylitis ( tennis elbow ) ***
Medial epicondylitis ( golfer’s elbow ) ***
Cervical syndrome ( upper back pain / trigger points )
Thoracic dorsalgia ( mid back pain / trigger points )
Trigger point lumbago ( lower back pain )
Gluteal / Trochanteric ( hip ) pain syndrome / tendonitis ***
Quadriceps / hamstring / adductor trigger points
Quadricep / patella tendonitis ***
Calf muscle shortening / repetitive or chronic cramp problem
Tibial stress syndrome
Achilles tendonitis* Plantar fasciitis*
*** denotes N.I.C.E recommended
How does Shockwave therapy work?
To put it simply, it turns a tendon or muscle injury from a chronic situation into
an an acute situation i.e allowing / promoting the healing
process. It does this in several ways. The shocks cause:
1/ some re-vasculisation to the affected area ( increases blood flow ).
2/ stimulation of cells to produce more Substance P ( a pain and growth
mediator ) which reduces pain.
3/ interference with the “inflammation cascade” to reduce chemicals that
4/ interference ( and consequent reduction ) with the pain signals that travel
along nerves from the affected area to the brain. This is known as the “Pain
Gate” Theory. An easy way to describe this is to remember the last time you
caught a finger in a door or stubbed your toe: the initial pain is often very high
but when the affected body part is rubbed or squeezed, the pain
subsides significantly and quickly. Behold… the Pain Gate Theory in action.
There is no guarantee that the problem will not return if underlying causative
factors are not corrected. This is why it works so well with an osteopath who
will be looking out for these biomechanical problems.
What can I expect during a treatment?
A treatment will consist of 2000 – 3000 shocks. With shallow tendon problems
e.g to the elbow and knee, the percussive shocks are 12 -15 times a second.
Deeper hip treatments will be at 8-10 times a second. A small amount of gel
will be applied to the area being treated, this causes the shocks to be more
effective / penetrate more deeply.
Some soft tissue work ( functional massage ) and mobilisation of adjacent
joints will also occur. Tendon problems usually occur because the muscle was
too tight as well as being overused. Biomechanical problems of any other
related joints will be addressed: this is very important to try and ensure that
the condition does not reoccur in the future.
Does it hurt?
Some levels of minor discomfort are common – if it is too sore the power level
is simply turned down. Research has shown that shockwave works best if the
treatment levels are taken up to what can be tolerated. This
seems to provoke a better healing response.
Some mild bruising / swelling / tenderness / redness is common which
generally settles down with 36-48 hours. Cold packing or paracetamol is
advised for this. Taking ibuprofen or any other type of anti-inflammatory
medication will interfere in the provoked healing process.
How many treatments will I need?
Acute and recently chronic problems ( 1 – 12 months ) usually react well to 3
treatments. Very chronic conditions / problems ( 2-3 years plus ) often need 5
When can I expect any pain reduction?
This varies from patient to patient and with the severity of the symptoms.
For the lucky ones some pain reduction may occur after the first treatment.
Most improvements are noticed after the second and third treatments.
Research has shown that optimum recovery time is between 6-12 weeks
after a group of 3-4 treatments.
NICE has provided research evidence showing that 75-80% of patients ( with
tendinopathies ) report significant improvements / recovery even 18 months
after shockwave therapy, in contrast to only 20% of those who have had
steroid injections. This is why the therapy is being offered more regularly at
Orthopaedic hospitals before surgery – the last resort – is contemplated
Some effort is also needed from yourself!
For certain tendinopathies ( especially the achilles ) a fuller recovery / faster
return to functionality depends of the person carrying out regular stretching
exercises for a few months. The stretches are very specific and are called
ECCENTRIC – simply put, the muscle being contracted WHILST being
stretched. This will all be explained very clearly. The stretching
consists of three sets of !5. It takes 5-7 minutes ( per leg ) and should be
done twice a day.
Can Shockwave therapy be used alongside osteopathy?
Absolutely. A full osteopathic assessment will be made in all consultations.
Any obvious spinal / joint adjustments needed will be offered / advised
during the consult. Postural and exercise advice will also be given.
If anyone having an osteopathic consultation or treatment is thought to be
suitable for Shockwave therapy, it will be offered. This would incur a
additional cost of £20 per treatment.
What is the success rate for Shockwave therapy?
Documented international research show an overall improvement rate of 77%
of chronic ( tendon ) conditions that have not responded to other types of
treatment. It is important to highlight that this means that here is a 23%
chance of no or only slight improvement. Maximum benefit has been shown
to occur 8-12 weeks after the first treatment so sometimes patience is
needed to let the body tissues do their work.
A review 12 weeks after the final treatment is recommended – this is following
the guidelines used by many UK Orthopaedic Surgeons. If symptoms persist
at this stage, alternative treatment / surgery would be discussed.
1/ If pregnant
2/ Any blood clotting disorders ( including thrombosis )
3/ Oral anti-coagulants being taken
4/ Steroid injection in the previous 6 weeks
5/ If a pacemaker being used
6/ Tumours local to affected area
7/ Infection / skin abrasion at the treatment site
8/ If under 18yrs old ( except for Osgood-Schlatter disease
9/ Treatment over any air filled areas such as the lungs or guts also not
They are a German company ( now based in Switzerland ) and have been
making medical equipment since 1946. All products are designed and made
to very strict standards in their Swiss factory. They have been making
shockwave products since 1987.
Cost of treatments
Consultation ( includes treatment ) 45 minutes £80
Follow up treatments ( 30 mins ) £60
Block booking of consultation and 2 treatments £180
Block booking of 4 treatments £216
Trial SW treatment during osteopathy £60
Please note, above costings are for one area / problem being treated. A
second area adds £15 / Three areas adds £25 ( per treatment ) NICE
recommends a minimum of three treatments. All hospital orthopaedic
and physiotherapy units follow this procedure.