There are several absolute contraindications to shockwave therapy and several relative ones.

Below are lists of the contraindications and their reasons why:

For a PDF to use as a template before treatment see below:

Absolute:

• Lungs. Treatments must not be performed across any of the surface area of the lungs or in areas where the shockwave would be directed towards the lungs. This includes the heart, the thoracic spine and associated muscles, the sternum, the bulk of the pectorails muscles, the scapula, and the apex of the lungs under the upper fibres of trapezius.

• Eyes. The fragile and delicate tissue of the eye could be adversely affected by shockwave.

• Brain. The destructive forces seen at transitions could damage and destroy brain matter.

• Major blood vessels. Both the major blood vessels in the neck and thigh should be avoided to prevent damage and potential catastrophic bleeding.

• Major nerves. Superficial major nerves like the brachial plexus, ulna/radial nerve should not be treated directly (treatment around these areas is acceptable just not directly to the nerve).

• Open wounds/post surgical wounds with or without stabilisation (glue, stitches, steristrips). Shockwave damages tissues and local circulation. This could lead to degradation of the wound, further bleeding and delayed healing.

• Implanted devices or hormones. Both the positive and negative waves could potentially damage implanted devices e.g. nerve stimulators causing unwanted effects and equipment failure. Implanted hormones could be rapidly released by shockwave application to them.

• Epiphysis. Open growth plates could potentially be damaged by shockwave either by using settings that create more growth and close them too quickly or by using settings that delay growth.

Relative:

• Genitals. Normally treatment round the genitals should be excluded, however recent research in erectile dysfunction has now made this a relative not absolute contraindication.

• Pregnancy. This is an absolute contraindication for treatment to the stomach. This is even true for cellulite treatment where there is no negative test for pregnancy (as even low dose shockwave can affect a foetus), however, treatment to the ankle in pregnancy would be acceptable.

• Clotting disorders/anti-coagulants. As shockwave can (at high pressure or frequency) cause bleeding, patients in this group should be treated with caution.

• Joint replacements. Certain settings have been used to loosen previously implanted joints ready for a new implant. Obviously if this is not the desired outcome then shockwave is contraindicated. However, other settings can encourage bone growth around implanted joints but once again if this is not the desired outcome then it is contraindicated.

• Infection. As shockwave can increase cell production this may not be a positive effect where there is infection, although encouraging the growth of healthy tissue also occurs so there could be potential uses for shockwave in addressing cysts. Research continues.

• Cancer. As per infection shockwave to cancerous tissue could encourage cell growth but may also destroy the tissue which could be beneficial. Research is on going.

• Corticosteroid injection. There is evidence to suggest that as steroid injections weaken an area further immediate treatment with shockwave could cause more damage. Generally people recommend waiting one month before application