Diary of a shockwave patient: does it hurt & does it work?

by Vivien Eden

I love running, but it doesn’t love me back. In 2014 I did the Windsor Half Marathon. My French family had come over to take part and we ran it together in glorious sunshine – it was tough, but amazing. Afterwards, I slacked off on running, but on Boxing Day that year, I felt like escaping the family for a bit (we’ve all been there!) and went for a lengthy run. That’s when it started, a bruised achy feeling in my left heel. I thought I’d bashed my foot on a stone and figured it would sort itself out. It didn’t, and so I saw a sports massage therapist who’d always managed to cure my aches and pains in the past. His best guess was that it was bruised. Feet take a while to improve, give it time and so I waited.

But the bruised feeling didn’t subside. Walking aggravated it and I was soon in pain whenever I stood. Exercising became difficult. I decided to see a podiatrist and chose Daleen at The Arch Clinic. She gave me a biometric assessment which revealed I was hyper-mobile. She recommended orthotics to keep me aligned so that my heel… could heal. Every waking moment, I wore trainers with my orthotics: it was goodbye to my beloved Converse, flip flops and high heels. The pain became more manageable, but it hadn’t gone. Over the next year, I tried different orthotics physiotherapy, acupuncture and osteopathy. I stretched, I rolled my foot with rolling pins, iced bottles, golf balls, spikey balls but I couldn’t get the stubborn injury to go.

An MRI revealed a thickened plantar fascia with a small tear in it, so a steroid injection was recommended – I had it on my birthday nearly 3 years after the pain started. It wasn’t the miracle cure I was hoping for. So having exhausted all options, I gave up and waited.

Something happened over the next four years – my foot got a lot better. It almost felt normal. After a period of stability, I tentatively downloaded the Couch25K app and proceeded to follow its gentle walking/jogging regime (with orthotics). My foot felt great so I surmised that I could do a bit more; I had some serious time to make up after all. I’d always fancied giving hockey a go and had longingly watched my daughter play for several years. So, as lockdown eased, I signed up. It’s certainly harder to learn a new sport when you’re in your 40s, but it was so much fun. A few months into my new hockey hobby, I felt a niggle in my foot. I was wearing my orthotics in my trainers so figured I’d be alright. I played a match – my foot felt OK. The next day… I could have cried. The cursed thing was back.

I didn’t hang about this time I threw everything at it: stretching, physio, acupuncture, an MRI, ultrasounds, consultations with an orthopaedic surgeon…it was being stubborn though. Finally, a new suggestion came – shockwave therapy. Shockwave is billed as the last non-invasive option when you’ve tried everything else, and I really had. As luck would have it The Arch Clinic had recently acquired a shockwave machine and so I booked in for five sessions on consecutive weeks with Hugo. You can get away with three, but for chronic conditions you need a couple more.

I was both excited to try something new and feeling trepidation because I’d heard it was a bit ‘painful’. So let me tell you how the sessions went and, importantly, what they felt like.

Session 1)

A very tall, masked Hugo led me up to the upstairs treatment room. A swanky white machine, with a nozzle attached, stood next to the couch. Hugo explained the procedure: identify the exact spot that hurts (as it turns out, by pressing on it surprisingly forcefully “yep, it definitely hurts there…”), apply gel as if you were having an ultrasound, put the machine’s nozzle over the area for a minute or two. During this time the machine would apply a rapid succession of shocks caused by a pellet on the end of nozzle being repeatedly fired via compressed air. For some reason, I had thought it would be a type of laser blasting out and so this was more mechanical than I was expecting. I asked about the pain level and I believe the phrase Hugo used was ‘a bit unpleasant’. I was encouraged to speak out if it got too much as the level of intensity could be changed at any point.

I was asked if I was ready. Tentatively replying “yes” in a small voice, I felt the weight of something metallic pressing into my heel. Buttons were pressed on the machine, it hummed and whirred. There was a second or two delay before anything happened and then…

“How’s that?” asked Hugo

“Ow, Hugo, Ow!”

“OK, I’ll turn it down a bit.”

It felt like a little imp had a hammer and was repeatedly and relentlessly bashing it into my heel several times a second. I felt the little shocks resonating inside my ankle bones and more than anything Hugo’s vice like grip on my foot – probably so I didn’t run off. Yes, I think I’d call that unpleasant, but it was magnified by the fact it was the first treatment and the whole sensation was like nothing I could have imagined.

It didn’t last long, but it was a very intense couple of minutes.

We then had to treat an area on the side of my foot, which is anatomically a more delicate area, so Hugo put the machine into something like “anaesthetic mode” before slowly ramping up the level. That wasn’t too bad.

I hobbled out of the clinic which probably wasn’t the best advert for them. My foot was tender for a few days, but was back to its normal level of bruised achy heel pain by the time the next session was due.

Session 2)

I decided to take a couple of paracetamols before turning up this week. Hugo had made it clear that anti-inflammatories were a no-no as they would undo what the shockwave therapy was trying to do i.e. provoke the body into self-healing the injury. But paracetamol was fine – so why wouldn’t you?

Well, they definitely took the edge off. Hardly any writhing on the couch this week and I recall saying to Hugo that “that wasn’t half as bad.” I felt quite smug and my foot only felt pummelled for about 48 hours, I could operate pretty normally after that.

Session 3)

Again, paracetamol was my friend. This session wasn’t horrific at all. The sound of the machine probably bothered me the most this week. It does make a very loud and disconcerting bang, bang bang… sound. Again, when I was leaving, I said something like “that was absolutely fine,” which was probably a bit of a mistake.

Session 4)

With last week’s words still in Hugo’s head I was told that we’d be ramping up the shockwave machine this week. The idea is to have the patient at the maximum level that they can handle as the more intensity (I’ll say ‘pain’) the more effective it is. I was clearly expected to handle more.

The pellet really felt like it was boring into my flesh this time, although it never left a mark, or any redness. I took some big slow breaths to stay calm – even though it was a bit tricky with my mask on – but I kept telling myself, it’s just for a couple of minutes, then it’ll all be over… and it was.

Session 5)

Despite having done a Pilates class in the morning, my shoulders had worked their way up to my ears during this final session. Hugo went all out with the machine on level 2.6! The machine goes up to level 4. Perhaps that’s a new Arch Clinic challenge, or a very stupid drinking game – who can make it to level 4? NOT me. When the treatment ended, I jumped off the couch in euphoria as I now got 6 weeks off for my body to do the full healing process.

Post treatment

So now I wait. I have felt the pain in my foot subsiding a little week on week. It flared up hugely after each session, which is kind of the point of shockwave, but by day 5 after each treatment I found a lot of relief. And a little more so each week. So, in essence, shockwave is painful, but it should never be too much for a patient to handle. If it fixes a long-standing injury, 2 minutes of unpleasantness once a week shouldn’t put you off.

It’s not just for feet either. Shoulders, ankles and elbows are all candidates for shockwave and, since you don’t need to weight bear on them, I think it would be easier to live with the tenderness immediately after the treatment. To find out if shockwave might help your condition, please get in touch with Hugo and the team. They are fully trained, know their stuff. They won’t tell you it’s right for you if it’s not.