Someone with six months of heel pain is usually offered a cortisone injection, and it usually works — for a while. Understanding why the relief fades, and what the alternative actually does, is worth ten minutes.
What cortisone does
Cortisone is a powerful anti-inflammatory. In a genuinely inflamed structure it can be excellent, and for short-term relief of severe pain it is often the fastest thing available.
The complication is that most chronic tendon problems are not primarily inflammatory. They are degenerative and load-related — the tendon has been asked to do more than it has capacity for, over months. An anti-inflammatory does not address that, which is why the pain commonly returns, and why repeated injections into a tendon are not recommended.
What shockwave does instead
Shockwave therapy delivers acoustic pressure waves into the tissue. Rather than suppressing a response, it provokes one: increased blood flow, and stimulation of the body’s own repair processes in tissue that had settled into a stalemate.
It is non-invasive, it takes five to fifteen minutes per area, and it does not require any recovery downtime. Most people notice a change after the first session, with more substantial improvement after three to five and optimal results over six to eight weeks.
Where the evidence is strongest
- Plantar heel pain
- Achilles tendinopathy
- Gluteal tendinopathy
- Calcific tendinopathy of the shoulder
- Tennis elbow and golfer’s elbow
The part that neither of them does
Neither injection nor shockwave builds capacity. Both open a window; loading is what closes it. A tendon that has been given shockwave and then rested will feel better and fail again on the first hard week.
That is why shockwave here comes with a rehabilitation program rather than instead of one, and why we would rather do the loading without shockwave than shockwave without the loading.
Who should not have it
It is not suitable during pregnancy, with active cancer, on blood thinners such as warfarin, within six weeks of a corticosteroid injection into that area, or in acute inflammation or infection. Your physiotherapist screens for all of these — and that six-week window after cortisone is the one people most often do not know about.
What it costs
Shockwave is charged as an add-on to the consultation fee. The current amount is on the pricing page, alongside everything else, so you can work it out before you book.
Forge West End is at Unit 4, 249 Montague Road, West End. Book online or call 07 3844 0686 — we are open from 6am Monday to Friday.