Can shockwave therapy or other advanced treatments help stubborn tendonitis?
Shockwave therapy and other advanced interventions are frequently used in the United Kingdom to treat stubborn tendonitis that has not responded to standard physiotherapy and rest. When a tendon injury becomes chronic, the tissue can enter a state of failed healing where the inflammatory process has stalled, leaving the tendon weakened and persistently painful. Advanced treatments aim to re-stimulate the body’s natural healing response or mechanically break down disorganized tissue. These options are typically considered secondary treatments within the NHS and are often provided by specialized musculoskeletal (MSK) or sports medicine clinics.
What We’ll Discuss in This Article
- How Extracorporeal Shockwave Therapy (ESWT) stimulates tendon repair.
- The role of Platelet-Rich Plasma (PRP) injections in chronic healing.
- Understanding tendon stripping (hydrodissection) for localized relief.
- High-volume injections and their use in specific tendon types.
- The clinical criteria for accessing advanced treatments in the UK.
- NHS-aligned expectations for recovery following specialized therapy.
How Extracorporeal Shockwave Therapy (ESWT) works
Shockwave therapy involves passing high-energy sound waves through the skin to the site of the injured tendon. These waves create a mechanical stimulus that causes microscopic trauma to the tissues, which in turn triggers the body to increase blood flow and release healing growth factors to the area. For many patients with chronic Achilles tendonitis or plantar fasciitis, ESWT is a non-invasive alternative to surgery. According to NHS information on shockwave therapy, the procedure usually involves three to five sessions spaced a week apart. While it can be briefly uncomfortable, it is a highly effective way to “re-start” the healing process in a stubborn tendon.
Platelet-Rich Plasma (PRP) injections
PRP therapy involves taking a small sample of the patient’s own blood, concentrating the platelets in a centrifuge, and then injecting this “rich” plasma back into the site of the tendonitis. Platelets are the cells in our blood that contain growth factors essential for tissue repair. By delivering a concentrated dose of these factors directly to the damaged tendon fibers, PRP aims to accelerate the remodeling of the tissue. In the UK, NICE clinical standards for tendinopathy suggest that PRP is most useful for specific conditions like lateral epicondylitis (tennis elbow) where other injections have failed, although its availability on the NHS varies by region.
Tendon stripping and hydrodissection
For tendons that are being irritated by nearby nerves or adhesions, a procedure called hydrodissection or “tendon stripping” may be used. This involves injecting a large volume of saline or local anaesthetic between the tendon and its surrounding sheath or nearby nerves. The pressure of the fluid physically separates the tissues, breaking down small adhesions and reducing the mechanical friction that causes pain. This is a common treatment for stubborn Achilles tendonitis and is often performed under ultrasound guidance to ensure the fluid is placed precisely where the irritation is occurring.
High-volume injections (HVI)
A high-volume injection is a specialized technique often used for chronic tendonitis in the shoulder or the Achilles. It involves injecting a larger amount of fluid (usually a mix of saline, local anaesthetic, and sometimes a low-dose steroid) into the space around the tendon. The goal is to stretch the tendon sheath and disrupt the small, abnormal blood vessels and nerves that can grow into a degenerated tendon and cause persistent pain. Many UK specialists recommend HVI as an intermediate step before considering surgery, as it can provide significant relief for those who have found little success with standard corticosteroid injections.
When are advanced treatments recommended?
Advanced treatments are typically only recommended after a patient has completed at least three to six months of “high-quality” conservative management. This must include a structured loading program, such as eccentric exercises, which are the gold standard for tendon rehabilitation. If the pain remains severe enough to prevent daily activities or sleep despite these efforts, a GP may refer the patient to an MSK specialist or a sports medicine doctor. In the UK, the choice of treatment depends on the specific tendon involved, the findings of diagnostic imaging like an ultrasound or MRI, and the patient’s overall health and functional goals.
Expectations and the road to recovery
It is important to remember that advanced treatments like shockwave therapy are not “magic bullets” and must still be combined with rehabilitation. The goal of these treatments is to create a more favorable environment for healing, but the patient must still perform the necessary exercises to strengthen the tendon and its supporting muscles. Most patients begin to see a gradual improvement in their symptoms over a period of six to twelve weeks following the completion of their advanced therapy sessions. Consistency with post-treatment advice, such as avoiding high-impact activities immediately after a shockwave session, is essential for achieving the best long-term outcome.
Conclusion
Shockwave therapy and other advanced treatments like PRP or high-volume injections provide valuable options for managing stubborn tendonitis that has failed to settle with standard care. By using mechanical or biological stimuli to promote tissue repair, these interventions can often help patients avoid more invasive surgery. While these treatments are specialized and may not be available in every local NHS trust, they represent an important secondary phase of care for chronic musculoskeletal conditions. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Does shockwave therapy hurt?
The treatment can feel like a deep, repetitive tapping or thumping sensation; most people find it tolerable, and the clinician can adjust the intensity if it becomes too uncomfortable.
How many PRP injections will I need?
The standard protocol often involves one to three injections, depending on the severity of the tendon damage and the clinician’s recommendation.
Can I drive home after a high-volume injection?
It is usually recommended that you have someone else drive you, as the local anaesthetic can make the limb feel temporarily weak or numb.
Is shockwave therapy available on the NHS?
Availability varies, but many NHS trusts provide shockwave therapy for chronic conditions like plantar fasciitis and Achilles tendonitis through their physiotherapy departments.
Will I be sore after advanced treatments?
t is common to feel a “dull ache” or increased stiffness for twenty four to forty eight hours after shockwave or HVI as the body reacts to the stimulus.
Can these treatments fix a complete tendon tear?
No, advanced treatments like ESWT or PRP are designed for chronic inflammation and degeneration (tendinosis) rather than for repairing a complete structural rupture.
Why haven’t I been offered these treatments yet?
In the UK, you must usually demonstrate that you have completed a full course of physiotherapy and activity modification before these specialized options are considered.
Authority Snapshot
This article provides an overview of specialized secondary care options for persistent soft tissue injuries within the UK healthcare framework. It has been written by the MyPatientAdvice Medical Writing/Research Team and reviewed by Dr. Rebecca Fernandez to ensure clinical accuracy. The information presented is strictly aligned with the latest NHS and NICE protocols for the management of chronic musculoskeletal conditions.
