The words used on this site, defined plainly. Most of them are either names for a specific tendon problem or names for the way a trial was run, and both matter, because the second decides how much to believe about the first.
Also known as: ESWT, Shockwave therapy.
A treatment in which acoustic pressure pulses are delivered through the skin into a painful tendon, heel or bone. Extracorporeal simply means outside the body. In the United Kingdom it is used as a second-line option for musculoskeletal problems that have not settled with loading rehabilitation.
Source: www.nice.org.uk
A problem that has not responded to the treatment normally tried first. The word appears in the title of every piece of NICE guidance on shockwave, and it is the single most useful filter for deciding whether the treatment applies to you. A tendon that has hurt for six weeks is not yet refractory.
Source: www.nice.org.uk
Also known as: RSWT, Radial pressure wave.
A machine type in which a projectile strikes an applicator on the skin and the wave spreads outward, losing energy within a couple of centimetres. Common in physiotherapy and podiatry clinics on cost grounds, and appropriate where the target is shallow, such as the heel or the outer elbow.
Also known as: FSWT.
A machine type that converges the pressure wave at a chosen depth, which can be several centimetres into the tissue. It is what the positive calcific shoulder studies used. A result obtained with a focused device does not automatically transfer to a radial one applied to the same area.
Also known as: Placebo arm.
A trial group given a convincing imitation of the treatment with the active element switched off. It matters enormously here, because tendon pain responds strongly to expectation. A study without a sham arm cannot separate the machine from the attention, the reassurance and the passage of time.
Source: www.nhs.uk
Also known as: RCT.
A study in which participants are allocated by chance to the treatment or to a comparison group. Randomisation is what stops the healthier patients ending up in the treated arm. For shockwave, randomised trials consistently report smaller benefits than uncontrolled case series do.
Source: www.nhs.uk
A structured attempt to find and combine every study on a question. Useful, and easy to misread on this topic, because reviews often pool radial and focused machines, several different tendons, and a range of energy settings, which produces an average that describes nobody in particular.
Source: www.nhs.uk
A number expressing how large a difference a treatment made, separately from whether the difference was statistically significant. A small effect size on a large trial can be real and still be too small for a patient to notice, which is a fair description of several shockwave results.
Also known as: MCID.
The smallest change in a pain or function score that a patient would actually regard as worthwhile. It is the right yardstick for reading a trial. A statistically significant improvement that falls below this threshold has not helped anybody, whatever the paper concludes.
How a condition behaves if nothing is done. Tennis elbow and plantar fasciitis both improve on their own in most people over a year or more, so a treatment started late collects credit for time. It is the main reason uncontrolled results in this field look better than they are.
Source: www.nhs.uk
Persistent tendon pain with disorganised tissue on imaging and little of the inflammation the older name implied. It is a failure of the tendon to adapt to the load placed on it, which is why load, correctly dosed, is the treatment that most reliably reverses it.
Source: www.nhs.uk
Also known as: Plantar heel pain, Plantar fasciopathy.
Degenerative change in the thick band of tissue along the sole, giving pain under the heel that is worst on the first steps of the morning. Most cases settle within a year with loading and footwear changes. The refractory minority is the group shockwave trials recruited.
Source: www.nhs.uk
Pain and thickening two to six centimetres above the heel bone. It responds well to a structured eccentric loading programme, which remains the first treatment and outperforms most alternatives, so shockwave here is an addition rather than a substitute.
Source: www.nhs.uk
Pain at the point where the Achilles meets the heel bone. It tolerates the standard eccentric programme badly, because the movement compresses the tendon against bone, and it is the harder of the two Achilles presentations to settle.
Source: www.nhs.uk
Also known as: Tennis elbow, Lateral epicondylitis.
Pain on the outside of the elbow where the wrist extensor tendons attach, provoked by gripping and lifting. It usually has nothing to do with tennis. A corticosteroid injection relieves it faster and leaves worse outcomes at one year, which is the comparison worth having.
Source: www.nhs.uk
Also known as: Jumper's knee.
Load-related pain at the lower edge of the kneecap, most common in jumping sports. It is the one knee problem with a genuine shockwave literature, though the trials are small and the results modest. Knee pain in general is not a shockwave target.
Source: www.nhs.uk
A calcium deposit inside a shoulder tendon, often intensely painful and visible on ultrasound or X-ray. It is the shoulder condition with the strongest shockwave evidence, and the positive studies used focused machines at higher energy levels rather than radial ones.
Source: www.nice.org.uk
Also known as: Frozen shoulder.
Thickening and contraction of the shoulder joint capsule, running a long course through pain, stiffness and gradual recovery. It is frequently confused with calcific tendinopathy and needs imaging to separate them, because the two treatment paths diverge completely.
Source: www.nhs.uk
Also known as: Gluteal tendinopathy.
Pain over the bony point on the outside of the hip, usually from tendinopathy of the gluteal tendons rather than from a bursa. It is the fourth musculoskeletal use NICE has assessed for shockwave, and it is provoked by lying on that side and by crossing the legs.
Source: www.nice.org.uk
Exercise that loads a muscle and tendon while it lengthens, such as lowering slowly onto a step. It is the best-evidenced treatment for midportion Achilles tendinopathy and the reason every serious shockwave protocol runs a loading programme alongside the sessions.
Source: www.csp.org.uk
Also known as: MSK.
Relating to muscles, tendons, ligaments, joints and bone. It is the scope of this entire site. Shockwave technology has applications elsewhere in medicine, and none of them is described anywhere here.
Source: www.nhs.uk
Also known as: Health and Care Professions Council.
The statutory regulator for physiotherapists, podiatrists and several other professions in the United Kingdom. Its register is public and searchable by name, which is the check worth doing before you let anyone treat you, whether or not you arrived through this site.
Source: www.hcpc-uk.org
The UNTIL group service that takes an enquiry and books it in with a clinician at one of the four clubs. It is operated by the same group that runs this site, and no payment passes per enquiry.