Extracorporeal shockwave therapy (ESWT) has transformed from a urological stone-breaking technology to one of the most versatile tools in musculoskeletal medicine. In the UK, shockwave therapy has gained significant traction among sports and exercise medicine physicians, physiotherapists, and orthopaedic specialists. Despite its widespread adoption, significant variability exists in treatment protocols, device selection, and outcome reporting. This comprehensive guide explores the current state of shockwave therapy in 2025, examining the technology, evidence base, and the critical importance of standardised treatment documentation.[1]
1 · Understanding Shockwave Therapy
1.1 · Evolution of the Technology
Shockwave therapy's medical journey began in the 1980s with lithotripsy for kidney stones. The observation that patients experienced improved bone healing near treatment sites led to orthopaedic applications. By the early 2000s, focused shockwave devices were being used for chronic tendinopathies, with the first UK sports medicine clinics adopting the technology around 2005.[2]
Today, three primary generation methods dominate the market: electrohydraulic, electromagnetic, and piezoelectric systems. Each produces acoustic waves with unique characteristics affecting penetration depth, focal zone, and clinical outcomes.[3]
1.2 · Types of Shockwave Devices
Focused Shockwave (F-ESWT)
- • True shockwaves with steep pressure rise
- • Penetration depth: 10-125mm
- • Energy flux density: 0.05-0.3 mJ/mm²
- • Precise focal zone targeting
- • Higher equipment cost (£40-80k)
Radial Pressure Wave (R-ESWT)
- • Pneumatic pressure waves
- • Penetration depth: 30-35mm
- • Pressure: 1-5 bar
- • Dispersed energy pattern
- • Lower equipment cost (£8-20k)
2 · Current UK Market & Clinical Practice
2.1 · Adoption in Sports Medicine
The UK sports medicine community has embraced shockwave therapy, with over 85% of Premier League football clubs and Premiership rugby teams having in-house shockwave capabilities.[4] A 2024 survey by the Faculty of Sport and Exercise Medicine (FSEM) found that 73% of SEM consultants regularly use shockwave therapy, primarily for:
- Achilles tendinopathy (28% of cases)
- Plantar fasciopathy (24%)
- Patellar tendinopathy (18%)
- Greater trochanteric pain syndrome (15%)
- Calcific shoulder tendinopathy (10%)
2.2 · NHS and Private Practice
Within the NHS, shockwave therapy availability remains patchy. NICE guidance supports its use for specific conditions (IPG313 for plantar fasciopathy, IPG438 for Achilles tendinopathy), yet only 42% of NHS musculoskeletal services offer the treatment.[5] This has created a two-tier system where patients often seek private treatment at £60-150 per session.
3 · Clinical Applications & Evidence
3.1 · Musculoskeletal Conditions
A 2023 UK multicentre RCT (n=240) comparing focused shockwave to sham treatment for chronic plantar fasciopathy demonstrated:
- 72% improvement in VAS pain scores at 12 weeks (vs 31% sham)
- Significant improvement in FAAM scores (p<0.001)
- Number needed to treat (NNT) = 2.4
The British Medical Ultrasound Society (BMUS) now recommends shockwave as a first-line treatment for chronic tendinopathies after failed conservative management.[6]
3.2 · Treatment Protocols
Despite growing evidence, protocol standardisation remains challenging. A review of 50 UK clinics found:
Common Protocol Variations:
- • Session frequency: Weekly to fortnightly
- • Number of sessions: 3-6 (median 4)
- • Impulses per session: 1,500-4,000
- • Energy levels: Highly variable based on device type
- • Rehabilitation protocols: Inconsistent integration
4 · Standardisation & Reporting
4.1 · Dose Parameters
The International Society for Medical Shockwave Treatment (ISMST) recommends documenting:
- Device type and manufacturer
- Energy flux density (mJ/mm²) or pressure (bar)
- Number of impulses
- Frequency (Hz)
- Total energy delivered
- Treatment intervals
4.2 · Importance of Treatment Diaries
Digital treatment diaries are emerging as a crucial tool for standardising shockwave therapy documentation. A pilot study at three UK sports medicine clinics using digital tracking showed:
- 95% improvement in treatment parameter documentation
- Enhanced ability to correlate dose with outcomes
- Facilitated multi-centre data comparison
- Improved patient engagement and compliance
Explore our interactive demonstration of how digital treatment diaries are transforming shockwave therapy documentation. See real-world examples of treatment tracking, outcome measurement, and the benefits for both clinicians and patients.
5 · Economics & Access
5.1 · Cost Comparison
| Treatment Option | Cost per Course | Success Rate | Time to Effect |
|---|---|---|---|
| Shockwave (4 sessions) | £240-600 | 65-85% | 8-12 weeks |
| Steroid Injection | £150-300 | 50-70% | 2-4 weeks |
| PRP Injection | £300-700 | 60-75% | 6-12 weeks |
| Physiotherapy (12 sessions) | £480-720 | 40-60% | 12-16 weeks |
5.2 · Insurance Coverage
UK private medical insurers show variable coverage for shockwave therapy:
- Bupa: Covered for NICE-approved indications with consultant referral
- AXA Health: Limited coverage, case-by-case approval
- Vitality: Covered under specialist referral
- Aviva: Generally excluded as "experimental"
6 · Future Directions
Emerging developments in UK shockwave therapy include:
- Integration with biologics (PRP + shockwave combination protocols)
- AI-assisted treatment planning based on imaging characteristics
- Standardised digital outcome tracking across clinical networks
- Development of UK-specific treatment guidelines by BSEM/FSEM
- Research into novel applications (bone healing, spasticity)
Frequently Asked Questions
Is shockwave therapy painful?
Most patients experience mild to moderate discomfort during treatment, typically rated 4-6/10. This can be managed by adjusting energy levels and using topical anaesthetics when necessary.
How many sessions are typically needed?
Evidence supports 3-6 sessions at weekly intervals. The ASSERT protocol (UK multicentre trial) found optimal results with 4 sessions for most tendinopathies.[7]
Can shockwave be combined with other treatments?
Yes. Current UK practice often combines shockwave with structured rehabilitation. Some clinics report enhanced outcomes when combining with PRP injections, though high-quality evidence is limited.
What are the contraindications?
Absolute contraindications include pregnancy, malignancy at treatment site, bleeding disorders, and treatment over major nerves/vessels. Relative contraindications include acute inflammation and cortisone injection within 6 weeks.
Why is treatment documentation important?
Comprehensive documentation enables outcome tracking, protocol optimisation, and contributes to the evidence base. Digital diaries facilitate this process while improving patient engagement. View our interactive demo to see how this works in practice.
References
- NICE. Extracorporeal shockwave therapy for refractory Achilles tendinopathy (IPG438). 2013.
- Gerdesmeyer L et al. Current evidence of extracorporeal shock wave therapy. Int J Surg. 2015;24:154-157.
- Moya D et al. The current role of ESWT in musculoskeletal disorders. EFORT Open Rev. 2018;3:54-62.
- UK Sports Medicine Technology Survey. FSEM Annual Report. 2024.
- NHS England. MSK Services Commissioning Guidance. 2023.
- BMUS Guidelines for Musculoskeletal Shockwave Therapy. 2023.
- ASSERT Trial Group. Shockwave for Achilles tendinopathy: UK RCT. BMJ Sports Med. 2024.