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Musculoskeletal medicine · UK

Shockwave therapy - a non-surgical route through stubborn tendinopathy.

Extracorporeal shockwave therapy (ESWT) delivers acoustic pressure waves through the skin into stubborn tendon and bone conditions - plantar fasciitis, Achilles and patellar tendinopathy, tennis elbow, greater trochanteric pain, calcific shoulder. Recommended by NICE for several MSK indications, and delivered without needles or downtime.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private Shockwave Therapy (MSK / Extracorporeal) costs in the UK.

Ranges across our MSK network. Focused shockwave with ultrasound guidance sits at the top; radial shockwave in a physiotherapy clinic at the base.

In short

A private shockwave course (3–6 sessions): £450–£1,200.

Procedure Indicative range
MSK consultation with ultrasound £220–£380
MRI (targeted, one region) £350–£550
Radial shockwave - single session £90–£180
Focused shockwave - single session £150–£280
Course of 3 sessions (radial) £300–£500
Course of 5 sessions (focused, US-guided) £700–£1,200
Combined shockwave + loading physio bundle £850–£1,600

Prices vary by hospital, by consultant, and by the complexity of your case.

The problem

A middle route between injection cortisone and surgery.

Chronic tendinopathy is a huge gap in UK MSK care - too far along for physio alone, too early for surgery. Shockwave sits in the middle when it is used properly.

  • Cortisone weakens tendons

    Repeated cortisone injections into tendons weaken them and increase rupture risk. Shockwave offers a non-injection route for stubborn tendinopathy.

  • Loading physio does most of the work

    The evidence for shockwave is strongest when combined with a proper loading programme. Passive shockwave alone underperforms.

  • The right device for the tissue

    Focused shockwave for calcific rotator cuff, deep tendinopathy and bone. Radial for superficial tendon and enthesis.

When it helps

When Shockwave Therapy (MSK / Extracorporeal) is the right step.

The situations where shockwave is a NICE-endorsed option, and the flags that mean a different route.

  • Plantar fasciopathy

    Chronic heel pain over 3 months despite orthoses, calf stretching and loading - one of the strongest indications for shockwave.

  • Achilles tendinopathy

    Mid-portion and insertional Achilles pain after failed loading physio. Focused shockwave with continued eccentric loading.

  • Patellar tendinopathy (jumper’s knee)

    Anterior knee pain at the inferior pole of the patella in loading athletes. Radial or focused shockwave alongside slow heavy resistance training.

  • Calcific rotator-cuff tendinopathy

    A defined calcium deposit in the supraspinatus tendon with pain - focused shockwave is a NICE-recommended non-surgical option.

  • Greater trochanteric pain (gluteal tendinopathy)

    Chronic lateral hip pain from gluteus medius or minimus tendinopathy - radial shockwave with hip strengthening.

  • Tennis and golfer’s elbow

    Lateral or medial elbow enthesopathy after failed physio. Radial shockwave sessions weekly.

  • Selected bone applications

    Delayed union and non-union of long-bone fractures, and selected stress fractures - under orthopaedic supervision.

  • Red flag: full-thickness tear or infection

    Shockwave is contraindicated over an acute full-thickness tendon tear, active infection, tumour, or over children’s growth plates. Imaging first.

Device options

Focused, radial, and how they compare.

  • Focused ESWT (fESWT)

    Higher-energy focused pulses delivered to a defined depth. Best for deep tissue targets - calcific rotator cuff, insertional Achilles, deep hip tendinopathy - and bone applications.

  • Radial ESWT (RSWT)

    Lower-energy radial pulses that spread from the applicator. Best for superficial tendinopathy and enthesopathy - plantar fascia, tennis elbow, patellar tendon, gluteal tendons.

  • Ultrasound-guided delivery

    Real-time ultrasound to locate the pathology accurately. Standard for deep and calcific targets, and where anatomy makes surface landmarks unreliable.

  • Combined with loading physiotherapy

    A structured, progressive loading programme in parallel with the shockwave course. The combination is the evidence-based unit.

  • Shockwave for delayed union

    Focused shockwave through a fracture site with delayed healing - an orthopaedic indication with a growing evidence base.

  • Shockwave for calcaneal spurs

    A NICE-recommended option for chronic plantar heel pain with a calcaneal spur - the shockwave targets the fasciopathy, not the spur itself.

  • Repeat courses

    A second course is offered if the first delivered partial benefit but not full resolution. A third is uncommon.

  • Not for erectile dysfunction

    Li-ESWT for ED is a separate application with a different evidence base and delivery - see the dedicated ED shockwave page.

Safety and recovery

What to expect afterwards - honestly.

Shockwave is a well-tolerated clinic procedure. The risks worth planning are selecting the right pathology, the right device, and combining with a proper loading programme.

  • A clinic-based, non-invasive procedure

    No injections, no anaesthetic, no downtime. Sessions are 10–20 minutes; you can drive home and go back to work.

  • Discomfort during and after

    Sessions are uncomfortable - the machine can be dialled down for tolerance. Mild soreness for 24–72 hours after each session is normal.

  • Bruising and skin reaction

    Small bruises and skin redness are common. Larger haematomas are uncommon and settle in 1–2 weeks.

  • Symptoms can flare before they settle

  • Rare tendon rupture

    A very rare complication when applied to an already-damaged tendon at high energy. Selection and imaging first mitigate the risk.

  • Not for full-thickness tears, infection or tumour

    Shockwave is contraindicated over these - imaging first is the reason.

  • Not for children over growth plates

    The evidence in skeletally immature patients is limited; shockwave over open physes is avoided.

  • Avoid NSAIDs during the course

    Anti-inflammatories dampen the healing response shockwave induces. Stop 3 days before and for the course; use paracetamol for symptom control.

  • Red flags after a session

    Sudden severe pain, an audible pop or loss of function suggests tendon injury - same-day MSK or A&E, not a routine follow-up.

Reading your report

Your shockwave record in four parts. Read the last one first.

Every shockwave session is logged with device settings and delivered pulses. The record you receive after the course keeps to the same shape.

A UK consultant reviewing notes with a patient - Shockwave Therapy (MSK / Extracorporeal)

A quiet reminder

Medical language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Diagnosis and imaging basis

    Which tendon or bone was treated, what the ultrasound or MRI showed, and the clinical selection reasoning.

  2. 02 Technique

    Device, energy and delivered pulses

    Focused or radial, energy flux density, frequency, number of pulses per session, guidance method.

  3. 03 Findings

    Response across the course

    Session-by-session tolerance, pain scores and functional measures - the objective record of how you responded.

  4. 04 Plan

    Loading physio and 3-month endpoint

    Read this first: the continuing physiotherapy programme, the review dates, and when to consider a repeat course or a different route.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Several UK insurers cover shockwave therapy for NICE-recommended MSK indications when medically indicated and delivered by a recognised MSK clinic.

Frequently asked

Everything we get asked about Shockwave Therapy (MSK / Extracorporeal).

Quick answers on evidence, cost, painfulness and NHS access.

  • What does the evidence say?

    NICE has issued interventional procedures guidance supporting shockwave for plantar fasciopathy, calcific rotator-cuff tendinopathy and refractory Achilles and patellar tendinopathy. Guidance is more cautious for tennis elbow and gluteal tendinopathy. Systematic reviews consistently favour shockwave over sham for these indications when combined with loading.

  • How many sessions will I need?

    A standard course is three to six sessions at weekly intervals, delivered over 3–6 weeks. Benefit builds and peaks around three months after the last session. A second course is offered to responders who did not reach full resolution.

  • Does it hurt?

    The session is uncomfortable - energy is dialled to the highest tolerable level for the pathology. Most people describe it as bearable rather than painful, and mild soreness for 24–72 hours afterwards is expected. The machine settings are adjustable if you cannot tolerate the standard energy.

  • Is it available on the NHS?

    Yes, but variably. Some NHS musculoskeletal services offer shockwave for NICE-approved indications; others do not commission it and refer to physiotherapy or steroid injection first. Private access is faster and more predictable for a properly structured course.

  • How much does shockwave cost privately in the UK?

    A full course of 3–6 sessions runs roughly £450–£1,200 depending on the device (focused vs radial), the operator (MSK doctor vs physiotherapist) and imaging guidance.

  • Can shockwave replace surgery?

    For calcific rotator-cuff, plantar fasciopathy and mid-portion Achilles tendinopathy it very often does. For structural failure - full-thickness tears, advanced insertional Achilles change with bone spurs - surgery is still the answer, and shockwave is not.

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