Concierge musculoskeletal · UK
Extracorporeal shock wave therapy, by a consultant MSK team.
A NICE-aligned, non-invasive option for stubborn tendinopathies, plantar fasciitis and calcific rotator cuff — delivered with the right device, at the right dose, alongside proper rehab.
Why patients choose us
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The right device, focused or radial
Focused (piezo/electromagnetic) reaches deep tendons; radial (pneumatic) treats superficial soft tissue. We match the machine to the diagnosis — not the other way around.
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Consultant-led, NICE-aligned
Delivered by musculoskeletal physios, sports medicine, orthopaedic or podiatry consultants — following NICE Interventional Procedure Guidance with proper consent.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private ESWT costs in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A single ESWT session in our network: £75–£200, home straight away.
| Treatment | Indicative range | Typical duration | Cadence |
|---|---|---|---|
| Single ESWT session (radial or focused) | £75–£200 | 10–15 min | Same visit |
| Course of 3 sessions | £220–£550 | 3 weeks | Weekly |
| Course of 5 sessions | £350–£900 | 5 weeks | Weekly |
| Course of 6 sessions (deep tendon) | £420–£1,100 | 6 weeks | Weekly |
| Initial assessment with ultrasound | £150–£300 | 30–45 min | Same visit |
| Consultant sports medicine review | £200–£400 | 30 min | Same visit |
Prices vary by clinic, by device (focused generally costs more than radial), by whether ultrasound targeting is used, and by whether a consultant physician or MSK physio delivers it. NHS access is limited — some ICBs commission ESWT for specific pathways, most do not. We come back with a firm quote within one working day.
The problem
The right device, the right dose, alongside the right rehab.
ESWT is quietly one of the most inconsistently delivered treatments in the private market — wrong device for the target, too few pulses, no rehab plan alongside. We fix all three before you commit to a course.
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Not sure it is right for you?
For some tendons a graded loading programme alone is enough. We say so before you commit to a course.
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Focused or radial?
Deeper tendons — Achilles, gluteal, calcific cuff — usually want focused. Superficial ones — plantar fascia, tennis elbow — often want radial. We match the device to the diagnosis.
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Want it done properly?
A named clinician, NICE-aligned consent, ultrasound targeting where useful, and a rehab plan that carries on between sessions.
The journey
From enquiry to functional review — what happens, in order.
One clinician from first message to review — including the delayed 6–12 week response window.
Phase 1 · Before your first session
Concierge, off-stage for you
Phase 2 · On the day
10–15 minutes at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us where it hurts
A short, confidential form. What the pain is, how long, what you have already tried — injections, physio, orthotics.
- 02
Before
We come back with a plan
Within one working day: the right device (focused vs radial), the right clinician, the number of sessions likely, an indicative price.
- 03
Before
We arrange the first session
Usually within one to two weeks. Anticoagulants are reviewed with the team. No fasting, no sedation, drive yourself home.
- 04
On the day
Arrival at the clinic
A brief examination, ultrasound if useful, and the point of maximal tenderness is marked. Gel is applied to the skin.
- 05
On the day
The treatment itself
10–15 minutes. Around 2,000–3,000 pulses at an energy flux density of 0.05–0.4 mJ/mm² depending on target. Uncomfortable, not unbearable — most tolerate without anaesthesia.
- 06
On the day
Back to normal, straight away
No dressing, no downtime. A short walk is fine; heavy loading of the treated tendon is paused for 24–48 hours.
- 07
After
Sessions two to six, then review
Weekly sessions, typically 3–6 in total. The functional response is delayed — most people notice change over 6–12 weeks, not immediately.
Typical course: 3–6 weekly sessions. Functional response: 6–12 weeks after the last session.
When it helps
When ESWT is the right step.
The NICE-endorsed indications we see most, plus the newer urology applications where evidence is still developing.
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Plantar fasciitis (heel pain)
NICE IPG311. First-line escalation before steroid injection or surgery for stubborn heel pain over three months.
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Achilles tendinopathy
NICE IPG312. Insertional or mid-portion — often a focused device, delivered alongside eccentric loading.
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Tennis elbow (lateral epicondylitis)
NICE IPG313. Refractory cases where physio and load management have plateaued — a reasonable step before injection.
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Greater trochanteric pain syndrome
NICE IPG376. Gluteal tendinopathy causing lateral hip pain, especially when lying on that side at night.
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Patellar tendinopathy (jumper’s knee)
Chronic tendinopathy at the inferior pole of the patella — common in runners, jumpers and cyclists.
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Rotator cuff calcific tendinopathy
NICE IPG21. Calcium deposits in the shoulder cuff — ESWT can fragment the calcification and reduce pain.
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Delayed or non-union of fractures
NICE IPG279. Selected long-bone non-unions where surgery is not the first choice.
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Chronic pelvic pain (urology) or ED
CP/CPPS and low-intensity ESWT (li-ESWT) for erectile dysfunction — delivered by urology, with NICE assessment ongoing.
Treatment options
ESWT is not one machine, or one protocol.
What each option on the table actually involves — and which fits which problem.
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Focused ESWT (fESWT)
Piezoelectric or electromagnetic generator. Deep penetration — the choice for Achilles, gluteal, patellar and calcific rotator cuff work.
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Radial ESWT (rESWT)
Pneumatic pressure wave, superficial reach. Well-suited to plantar fasciitis, tennis elbow and superficial soft tissue targets.
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Low-intensity ESWT (li-ESWT)
Lower energy protocol used in urology — for erectile dysfunction and chronic pelvic pain / CP/CPPS.
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Cardiac shock wave therapy
A specialist protocol for refractory angina — delivered only in a small number of cardiology centres, pacemaker precautions apply.
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ESWT with ultrasound targeting
The transducer is placed under real-time ultrasound to sit on the exact tendon lesion — useful for deep or hard-to-mark targets.
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ESWT with concurrent loading
Combined with eccentric loading or graded return-to-run — the evidence base is stronger when ESWT is paired with rehab, not used alone.
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ESWT for non-union of fractures
A different protocol, higher energy, targeted at the fracture site — an alternative to revision surgery in selected cases.
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Consultation and diagnosis only
An honest discussion of whether ESWT is the right step, or whether load, injection, or surgery fits better — no obligation to book a course.
Our vetted UK network
A small panel of MSK clinicians, we picked them.
Sports medicine physicians, MSK physios, orthopaedic and podiatry consultants, plus urology for li-ESWT. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinician in our network.
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Consultant sports medicine physicians, MSK physios or urologists — not general practitioners
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Both focused and radial devices available so the right one is chosen
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Ultrasound-guided targeting where the lesion is deep or hard to mark
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Clear NICE-aligned consent — evidence developing, delivered under special arrangements
Safety and recovery
What to expect during and after — honestly.
ESWT is a well-tolerated outpatient treatment. The things worth planning are the transient pain flare, the delayed response window, and the small set of situations where it should not be used.
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It is uncomfortable, briefly
A firm, tapping sensation for 10–15 minutes. Most tolerate without any anaesthesia; a little local anaesthetic cream is an option if you prefer.
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Response is delayed, not instant
ESWT does not switch pain off. Function typically improves over 6–12 weeks after the last session — patience is part of the protocol.
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Transient pain flare is normal
A 24–48 hour flare of the treated tendon is common and expected. Simple analgesia is fine; avoid heavy loading in that window.
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Bruising and reddening
Superficial bruising, transient reddening or a small haematoma can occur — they settle in a few days without treatment.
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Tendon rupture is very rare
With modern focused devices the risk is very low. Rupture has been reported mainly with older non-focused devices, and in tendons weakened by recent steroid injection.
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Not in pregnancy or over malignancy
ESWT is avoided in pregnancy, over malignant tissue in the treatment field, and over active infection or open wound.
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Careful with anticoagulation and pacemakers
Bleeding disorders and anticoagulation need review. Cardiac shock wave near a pacemaker needs specific precautions — the clinician will check.
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Not over lung, bowel or growth plate
Avoided near the lung (pneumothorax risk), over bowel (perforation risk), and over open epiphyses in children.
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Red flags
Sudden severe pain and inability to weight-bear or push off after a session is not normal — call the clinic the same day.
Reading your treatment note
Your ESWT note in four parts. Read the last one first.
Whichever device was used, the note the clinician sends you keeps to the same shape.
A quiet reminder
Musculoskeletal language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and device chosen
Why ESWT was offered — plantar fasciitis, Achilles tendinopathy, calcific rotator cuff — and whether a focused or radial device was used.
- 02 Technique
Energy, pulses and protocol
The energy flux density, number of pulses per session, the total number of sessions planned, and any ultrasound targeting used.
- 03 Findings
Response and side effects noted
How the tendon responded session to session, any pain flare, bruising or reduced tenderness at the point of maximal pain.
- 04 Impression
Next steps and rehab plan
Read this first: what to do between sessions, when to expect improvement, and whether injection, imaging or surgery is the next step if ESWT does not settle it.
Recognised by major UK insurers
Cover for ESWT varies by insurer and by indication — usually funded for NICE-endorsed musculoskeletal indications with clinical justification, self-pay for li-ESWT. We confirm cover before booking.
Frequently asked
Everything we get asked about ESWT.
Quick answers on pain, cost, NICE guidance, alternatives, and how long the response takes.
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What is extracorporeal shock wave therapy (ESWT)?
ESWT is a non-invasive musculoskeletal treatment that delivers focused or radial pressure waves through the skin into a tendon, bone or soft tissue lesion. It is used for stubborn tendinopathies, plantar fasciitis, calcific rotator cuff and selected non-unions of fractures. NICE has issued Interventional Procedure Guidance for several of these indications.
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Does ESWT hurt, and do I need anaesthetic?
It is uncomfortable — a firm, rapid tapping sensation for 10–15 minutes over the tender area. Most people tolerate it without anaesthesia. Some clinicians offer local anaesthetic cream if you prefer; deep intramuscular anaesthesia is generally avoided because it may reduce the treatment’s effect.
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How many sessions of ESWT will I need?
Typically 3–6 sessions, spaced weekly, of around 2,000–3,000 pulses each. Plantar fasciitis and tennis elbow often settle in 3–5 sessions; deeper tendons such as Achilles or gluteal tendinopathy often need the full 6. Response is delayed — most people notice a change over 6–12 weeks after the last session.
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What does private ESWT cost in the UK?
A single session is roughly £75–£200. A course of 3–6 sessions is £220–£1,100 depending on the device (focused costs more than radial), the clinician and whether ultrasound targeting is used. NHS access is limited — some Integrated Care Boards commission ESWT for specific pathways, most do not.
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Which conditions does NICE support ESWT for?
NICE has issued Interventional Procedure Guidance for plantar fasciitis (IPG311), Achilles tendinopathy (IPG312), refractory tennis elbow (IPG313), greater trochanteric pain syndrome (IPG376), calcific rotator cuff tendinopathy (IPG21) and delayed / non-union of fractures (IPG279). Each is delivered under special arrangements for consent — the evidence is developing but reasonable.
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Can ESWT rupture a tendon?
Tendon rupture after ESWT is very rare with modern focused devices. Historical case reports involve older non-focused devices and tendons weakened by recent steroid injection. Your clinician will not treat a tendon that has had a recent steroid injection nearby.
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Who should not have ESWT?
Avoided in pregnancy, over malignant tissue in the treatment field, over active infection or open wound, near the lung (pneumothorax risk) or bowel (perforation risk), and over the growth plates in children. Bleeding disorders, anticoagulation and pacemakers need specific review before treatment.
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Is ESWT better than a steroid injection?
For plantar fasciitis and tennis elbow, the evidence suggests ESWT gives a longer-lasting benefit than a single steroid injection, with less risk of tissue weakening. NICE explicitly positions ESWT as a reasonable step to consider before injection or surgery in refractory cases.
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Consultant assessment for stubborn musculoskeletal pain.
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