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Extracorporeal shock wave therapy (ESWT) - Ideal Number of sessions?

Hi everyone,

First of all, here’s a little background:

I have a small Haglunds deformity in my left foot and I’ve been suffering with pain for over 10 years. My Specialist said that Extracorporeal Shock Wave therapy (ESWT) can help my problem if there is swelling of the Achilles tendon. Furthermore, Shockwave is more for soft tissue / tendon problems but often the pain associated with a Haglunds is coming from the Achilles tendon.

Anyway, in December 2017, I paid £400 for 3 sessions (each lasting about 3 minutes) over a 3 week period. I can tell you that the Shockwave treatment definitely works... I haven't felt this good in years. After saying that, I do feel short changed because I paid for 3 treatments so that appears to be the end. I feel sad as I do feel there is room for improvement.

I’m quite upset as the Specialist’s website promoting the treatment says 'usually' 3 or 4 sessions are provided to people with my condition. In my opinion using the term ‘usually’ implies that there are cases that warrant more or even less treatment. It appears that because 3 sessions were agreed at the outset, that’s where it ends.

My question is, given my improving trend over the 3 sessions should I insist on another one or two sessions as part of the original treatment or should I wait to see if my condition further improves? My specialist says that it can take up to 12 months to get the full benefit of the original treatment.

Kindest regards,

Mike Ptycia

6 months ago

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Cliff Eaton
Cliff Eaton

Dear Michael Firstly apologies for tardy response but I’ve been travelling The object of shockwave is to ‘reboot’ a stalled healing cascade. After 3-4 treatments you should feel a significant improvement. However more is NOT necessarily better. The fact that you have felt significant improvement shows that shockwave has influenced the ‘reboot’ of your heeling. Now you must be a patient patient! The influence that shockwave has had at a cellular level an continue from 2 to 12 weeks. I usually ask to review a patient after 6 weeks after the third treatment. Only if the symptoms haven’t resolved at this juncture do I prescribe more shockwave I hope that helps and that your symptoms are indeed resolving Cliff

Cliff Eaton
Cliff Eaton

Dear Michael Firstly apologies for tardy response but I’ve been travelling The object of shockwave is to ‘reboot’ a stalled healing cascade. After 3-4 treatments you should feel a significant improvement. However more is NOT necessarily better. The fact that you have felt significant improvement shows that shockwave has influenced the ‘reboot’ of your heeling. Now you must be a patient patient! The influence that shockwave has had at a cellular level an continue from 2 to 12 weeks. I usually ask to review a patient after 6 weeks after the third treatment. Only if the symptoms haven’t resolved at this juncture do I prescribe more shockwave I hope that helps and that your symptoms are indeed resolving Cliff

michael361
michael361

Thanks for the replies.

Based on the initial X-Ray, my specialist recommended a course of 3 Shockwave sessions. My pain and mobility has significantly improved and I confirmed this in my last appointment. No further examinations have taken place since my original consultation.

I am most definitely improving so I'm now just a little unsure how to approach this. Although I've paid my £400 and my Shockwave treatment has ended he has kindly given me an open appointment to see him again within 6 months.

Prof Oscar Ronzio
Prof Oscar Ronzio

Hi everyone. I totally agree with Tim. I think that in your patology your PT should recomend to do other ultrasound or Rx as control to see what happened with the Haglunds after the 3 treatments. But remember that we treat patients, not images. The effect of ESWT in the tendon should continue for months, this is truth. In our algorithm of tendinopathies, if the patient improves, we continue the treatment Best, Oscar

Last updated 6 months ago

Prof Tim Watson
Prof Tim Watson

Mike. Thanks for your query. I can't say from clinical experience of treating this condition with Shockwave, but 'normally' 3 - 5 sessions, typically at weekly intervals would be about right for these kind of problems. Some people DO need more - the 3-5 session range is based on the research evidence (which is where I get involved). The problem is that only the person treating you is really in a position to judge your improvement and to make a clinical judgement with regards what is most likely to work best. Not sure that you can 'insist' on more treatment, but it is certainly a conversation that you might want to have with the therapist / clinician treating you

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