Birmingham Physiocare Ltd

Shockwave therapy is not appropriate for every tendon condition, and our physiotherapist will be precise about where the evidence supports its use. These are the conditions where Birmingham Physiocare consistently achieves strong clinical results and where the research evidence specifically supports the treatment.

• Plantar Fasciitis: The strongest evidence base of any shockwave application. High-quality evidence from multiple systematic reviews confirms a large effect on pain and function, with the 2025 meta-analysis in Foot and Ankle Surgery confirming ESWT produces results comparable or superior to competing modalities. Three sessions at weekly intervals, each delivering 1800 impulses at appropriate energy parameters, is the most widely used evidence-based protocol, though your physiotherapist will adjust this based on MSK Ultrasound findings confirming fascial thickness and pathology extent.
• Calcific Tendinopathy Of The Rotator Cuff: High-quality evidence confirms ESWT produces a large effect on pain and function for calcific shoulder tendinopathy, with FDA approval specifically covering this indication. Shockwave disrupts calcific deposits mechanically while simultaneously stimulating the surrounding tendon tissue, an effect impossible to achieve through injection or exercise alone.
• Midportion Achilles Tendinopathy: Consistent evidence from four RCTs confirms ESWT is effective for midportion Achilles tendinopathy, reducing pain and improving function. The best available evidence suggests combination with eccentric exercise produces superior outcomes to shockwave alone, which is why exercise rehabilitation is always integrated alongside treatment at Birmingham Physiocare.
• Lateral Epicondylitis: FDA approval for lateral epicondylitis, with systematic review evidence confirming ESWT outperformed physiotherapy alone for pain, disability scores and grip strength in a direct comparative trial.
• Patellar Tendinopathy: Low to moderate evidence, communicated honestly, supports ESWT as a useful intervention where conservative loading programmes have not achieved adequate resolution, with the evidence base acknowledging the absence of a practical clinical guideline for this specific condition.
• Gluteal Tendinopathy: Chronic greater trochanteric pain driven by gluteal tendinopathy, frequently the genuine diagnosis behind lateral hip pain misattributed to arthritis without MSK Ultrasound confirmation, responds to the same neovascularisation and tissue regeneration mechanism that underpins shockwave in other chronic tendinopathies.

Manual therapy operates through two parallel mechanisms that 2025 systematic review evidence has confirmed act in combination direct biomechanical correction of joint position and tissue length, alongside neurophysiological modulation of pain processing at the spinal cord and brainstem level. The selected technique depends entirely on which mechanism your presentation requires.

• Mechanical Back Pain and Facet Joint Dysfunction: Graded oscillatory mobilisation at the specific lumbar or thoracic segment identified through palpation and movement testing, restoring accessory joint glide and interrupting the guarding response that perpetuates stiffness. Where active patient-engaged correction produces superior central pain modulation, Mulligan SNAG technique is selected over passive Maitland grades.
• Cervicogenic Headache and Upper Cervical Dysfunction: Sustained Natural Apophyseal Glides applied specifically at C1 through C3, the segments responsible for the majority of cervicogenic headache presentations. The technique directly addresses the source joint dysfunction rather than managing the referred headache symptom.
• Sciatica and Radicular Leg Pain: Neurodynamic mobilisation techniques including sliders and tensioners applied to the affected nerve root and its surrounding interface, reducing mechanosensitivity and restoring the nerve’s capacity to glide freely through adjacent tissue during normal movement.
• Frozen Shoulder and Adhesive Capsulitis: Staged mobilisation matched precisely to the freezing, frozen and thawing phases of the condition, since applying aggressive technique during the acutely irritable freezing phase actively worsens the presentation, while insufficient intensity during the frozen phase fails to progress capsular extensibility.
• Hip and Knee Osteoarthritis: Combined Maitland and Mulligan mobilisation reduces pain, improves range of movement and restores strength more effectively than either approach used in isolation, with current evidence confirming manual therapy combined with supervised exercise as the most effective conservative pathway for osteoarthritic joints.
• Chronic Ankle Instability: Mobilisation With Movement combined with corrective taping addresses the biomechanically altered fibular position frequently underlying recurrent ankle sprain, a mechanism distinct from simple ligament laxity and one that standard strengthening programmes alone do not resolve.
• Post-Surgical Joint Stiffness: Graded mobilisation working within consultant-defined protocols to manage scar tissue adhesion and restore accessory joint movement following orthopaedic procedures, coordinated with exercise rehabilitation as tissue healing progresses.