The words that appear on a private shockwave quote, defined plainly. Much of this vocabulary is engineering rather than medicine, and two clinics can describe the same machine in language that makes them sound like different treatments.
Also known as: ESWT, Shockwave therapy.
A non-invasive treatment in which a handheld device passes acoustic shockwaves through the skin to the tissue underneath. "Extracorporeal" simply means the energy is generated outside the body. NICE describes the mechanism by which it might affect a tendinopathy as not known, which is an unusual and useful thing for a regulator to say out loud.
Source: www.nice.org.uk
Also known as: RSWT, Unfocused shockwave, Radial pressure wave.
The unfocused form, generated pneumatically by firing a projectile at an applicator head held against the skin. The energy spreads outward from the contact point and is strongest at the surface. It is the commoner machine in a physiotherapy room, and it is the one most private clinics mean when they advertise shockwave without qualifying it.
Source: www.nice.org.uk
Also known as: FSWT.
The form generated electrohydraulically, electromagnetically or piezoelectrically, and converged on a point at a chosen depth below the skin. It can reach deeper structures than a radial device and can be aimed with ultrasound guidance. It is the more expensive machine, and a quote that names it is describing different equipment rather than a premium tier of the same thing.
Source: www.nice.org.uk
Also known as: EFD.
The measure of how much acoustic energy is delivered per unit area, written in millijoules per square millimetre. NICE draws the line at 0.12 mJ/mm2: above it counts as high energy and can be painful enough that a local anaesthetic is offered, below it counts as low energy and can be repeated without one. Ask which side of that line your course sits on.
Source: www.nice.org.uk
Also known as: Shots, Impulses.
The count of individual shockwaves delivered in one session, usually quoted in the low thousands per treated area. It is the unit clinics use to describe dose, alongside the pressure in bar and the frequency in hertz. A quote that gives a session length but no pulse count is describing how long you will be in the room rather than what you will receive.
Also known as: Tendonitis, Tendinitis.
Persistent pain and loss of function in a tendon, with structural change in the tissue rather than the short-lived inflammation the older word tendonitis implies. It is the umbrella diagnosis behind most musculoskeletal shockwave referrals, and it responds primarily to graded loading over months rather than to any passive treatment.
Source: www.nhs.uk
A problem that has not settled with the treatments normally tried first. The word appears in the title of most of the NICE guidance on this treatment, and its presence there is the point: the guidance describes shockwave for a condition that has already failed conservative care, not for a tendon that started hurting last month.
Source: www.nice.org.uk
Also known as: Plantar fasciopathy, Plantar heel pain.
Degeneration of the plantar fascia causing pain under the heel, usually worst on the first steps of the morning. NICE lists rest, ice, analgesia, anti-inflammatories, orthotics, physiotherapy, eccentric loading and corticosteroid injection as the conservative treatments that come before shockwave is considered.
Source: www.nice.org.uk
Persistent pain and thickening in the Achilles tendon, either at the mid-portion or at its insertion on the heel bone. The two behave differently and respond differently, and a clinician who has not distinguished between them has not yet assessed you properly. NICE holds separate guidance on shockwave for this condition.
Source: www.nice.org.uk
Also known as: Lateral epicondylalgia, Lateral epicondylitis.
Pain over the outside of the elbow where the wrist extensor tendons attach, provoked by gripping and lifting. Most cases settle over twelve to eighteen months with load management whether or not anything is done to them, which is the reason the evidence for adding a treatment is so hard to read.
Source: www.nice.org.uk
Also known as: GTPS, Gluteal tendinopathy.
Pain over the bony point on the outside of the hip, often worse lying on that side at night. It was long described as bursitis and is now understood mainly as a tendinopathy of the gluteal tendons. NICE rates the evidence for shockwave here as limited in both quality and quantity.
Source: www.nice.org.uk
Also known as: Calcific tendinitis.
A tendinopathy in which calcium deposits form within the tendon, most often in the rotator cuff of the shoulder. It is one of the presentations most frequently offered shockwave privately. A deposit is visible on imaging, so this is one of the few shockwave indications where a scan before and after gives an objective comparison.
Also known as: Progressive loading, Eccentric loading.
A structured programme of gradually increasing exercise that puts controlled force through the injured tendon. It is the treatment with the strongest evidence base for tendinopathy and it is slow, unglamorous and mostly unsupervised. Shockwave is studied as something added alongside it, never as a replacement for it.
Source: www.nhs.uk
Something offered after the first approach has been tried properly and has not worked. Shockwave is a second-line treatment for musculoskeletal pain in every piece of NICE guidance that covers it. Being offered it at a first appointment, before any loading programme has been attempted, is worth questioning.
Source: www.nice.org.uk
Also known as: HTG, Interventional procedures guidance, IPG.
The NICE programme that assesses procedures and devices. Guidance previously numbered IPG was renumbered HTG when the interventional procedures, diagnostics and medical technologies programmes were combined, with the content unchanged. A clinic citing an IPG number is not out of date, it is citing the earlier reference for the same document.
Source: www.nice.org.uk
The status NICE gives a procedure whose safety looks acceptable but whose efficacy evidence is inconsistent. It requires that clinical governance leads are informed, that the patient is given clear written information about the uncertainty, and that outcomes are audited. Every piece of NICE guidance on musculoskeletal shockwave carries it.
Source: www.nice.org.uk
Also known as: Harley Street Medical Area, The Harley Street area.
The cluster of private hospitals, clinics and consulting rooms across Marylebone, centred on Harley Street and largely held under one freeholder, the Howard de Walden Estate. Records show around 20 doctors in the area in 1860 and more than 3,000 people working in it today. The name describes a district, not an accreditation.
Source: www.hdwe.co.uk
Also known as: Sessional room hire, Room rental.
The arrangement under which a great many practitioners in the district work: a room booked by the session or the half-day in a building run by somebody else. It is entirely legitimate and it is the reason a smart address tells you about the building rather than about the person in it. Ask who is treating you and who holds the indemnity.
Also known as: Health and Care Professions Council.
The statutory regulator for physiotherapists, podiatrists and thirteen other professions in the United Kingdom. Its register is public and free to search by name. Delivering shockwave is not itself a protected act, so checking the register of whoever proposes to treat you is the practical safeguard rather than a formality.
Source: www.hcpc-uk.org
Paying for private treatment directly rather than through an insurer or the NHS. Most shockwave in this district is self-pay, because insurers frequently exclude it or fund it only against a named diagnosis and a documented failure of conservative care. It is worth asking your insurer before the first session rather than after the third.
Also known as: ESWL, Extracorporeal shockwave lithotripsy.
A hospital urology procedure that uses shockwaves to break up kidney stones. It shares the physics and the word shockwave with the musculoskeletal treatment described on this site and it is otherwise unrelated. This site covers musculoskeletal shockwave only. Kidney stones are treated in a urology department, not a physiotherapy room.
Source: www.nhs.uk