new physiotherapy techniques and approaches

Shockwave Therapy: Level 1+ Evidence for Multiple Conditions

Extracorporeal shockwave therapy (ESWT) has established itself as a treatment with the highest level of clinical evidence. Research published in Frontiers in Medicine (2024) confirms Level 1+ evidence for calcific shoulder tendinopathy, lateral epicondylitis (tennis elbow), greater trochanteric pain syndrome, and plantar fasciitis. Studies report success rates between 62% and 83% for delayed bone healing.

At CK Physio, we use focused shockwave technology rather than radial shockwave. Focused shockwave delivers greater precision and can reach deeper tissue structures with more accuracy. This matters for conditions like Achilles tendinopathy or chronic shoulder pain where the problem lies beneath the surface.

Blood Flow Restriction Training: A Maturing Rehabilitation Tool

Blood flow restriction (BFR) training has emerged with moderate-to-high quality evidence supporting its clinical applications. A 2024 meta-analysis published in Frontiers in Physiology demonstrated that low-load BFR training is significantly superior to low-load training alone for muscle strength and hypertrophy, with an effect size of 0.52—considered meaningful in clinical terms.

This technique is particularly valuable for patients who cannot tolerate heavy loads. If you are recovering from ACL reconstruction, managing knee osteoarthritis, or working to prevent muscle loss as you age, BFR training may offer benefits that traditional rehabilitation cannot match.

What the evidence shows: BFR training uses cuff pressures at 40-80% limb occlusion with loads of just 20-40% of your maximum. Importantly, research confirms it does not increase blood clotting risk and may actually promote healthy circulation. CK Physio's Chartered Physiotherapists can assess whether BFR is appropriate for your specific situation.

Dry Needling: Most Effective as Part of Combined Treatment

Current evidence supports dry needling for myofascial trigger points, with deep needling showing superiority over superficial approaches for spine-related pain. However, the research is clear: long-term effects at 6-12 months remain statistically non-significant when dry needling is used alone.

The technique is most effective when combined with stretching (achieving a large effect size of -1.73) and as an adjunct to exercise and manual therapy. This aligns with CK Physio's philosophy of combining multiple evidence-based approaches rather than relying on any single treatment modality.

Therapeutic Ultrasound: Limited Evidence for Most Conditions

The evidence for therapeutic ultrasound continues to show limited effectiveness. A 2024 systematic review found only small benefits for knee osteoarthritis (9.6% improvement on pain scales) whilst finding it ineffective for shoulder disorders. The 2025 Rotator Cuff Tendinopathy Clinical Practice Guideline explicitly states therapeutic ultrasound is not recommended due to lack of benefit.

This is not to say ultrasound has no place in physiotherapy—it may help certain individuals in specific circumstances. However, as evidence-based practitioners, CK Physio prioritises treatments with stronger research support whilst being transparent about the limitations of any intervention.

What This Means for Your Treatment

Manual therapy provides quicker short-term pain relief compared to exercise alone, but shows less effectiveness for long-term outcomes. The evidence is clear: integration with active exercise is now considered essential, not optional. At CK Physio, we combine skilled manual techniques with personalised exercise programmes to maximise both immediate relief and lasting results.

NICE Guidelines Prioritise Exercise-First Approaches

Three key NICE guidelines now shape UK physiotherapy practice:

• NG59 (Low Back Pain): Recommends group exercise programmes as first-line; manual therapy only as part of a treatment package
• NG193 (Chronic Pain): Recommends supervised exercise programmes; advises against opioids, NSAIDs, or paracetamol for chronic primary pain
• NG226 (Osteoarthritis): Therapeutic exercise should be offered to all people with OA; promotes self-referral to physiotherapy

HCPC Standards Updated

The HCPC Standards of Proficiency (revised September 2023) shifted from passive "understanding" to active "demonstration" of competence, with expanded focus on equality, diversity and inclusion, enhanced digital skills requirements, and stronger leadership expectations. The Standards of Conduct (September 2024) clarified communication responsibilities and strengthened duty of candour requirements.

First Contact Practitioners Expanding Access

NHS England's First Contact Practitioner programme now means you may be able to see a physiotherapist directly for musculoskeletal problems without first seeing your GP. Data shows 86.4% of patients are managed within primary care through this route, with significantly lower opioid prescribing compared to GP-led pathways.

What is the most effective physiotherapy treatment for chronic pain?

Research shows active exercise-based treatments produce better long-term results than passive treatments for chronic pain. NICE guidelines recommend supervised exercise programmes as first-line treatment, ideally combined with pain neuroscience education. At CK Physio, we create personalised active rehabilitation programmes tailored to your specific condition.

Is shockwave therapy painful?

Shockwave therapy may cause mild discomfort during treatment, but most patients tolerate it well. The sensation is often described as a tapping or clicking feeling. Results typically appear 3-12 weeks post-treatment, with benefits lasting up to two years. CK Physio offers focused shockwave therapy, which provides greater precision than radial alternatives.

What conditions can be treated with blood flow restriction training?

Blood flow restriction training is effective for ACL reconstruction rehabilitation, knee osteoarthritis management, and preventing muscle loss in older adults. It allows patients who cannot tolerate heavy loads to achieve meaningful strength gains using lighter weights. CK Physio's Chartered Physiotherapists can assess whether BFR training is suitable for your recovery.

How has physiotherapy changed in 2025?

The biggest shift is from passive treatments to active rehabilitation. Research now confirms that exercise-first approaches produce better outcomes than passive interventions alone. There is also growing integration of technology, including telehealth options and AI-assisted rehabilitation tools. CK Physio embraces these evidence-based advances whilst maintaining personalised, hands-on care.

Should I see a physiotherapist or chiropractor for back pain?

Physiotherapy is recommended by NICE as a first-line treatment for back pain. Chartered Physiotherapists use evidence-based exercise programmes and manual therapy as part of a comprehensive treatment plan. The key difference is physiotherapy's emphasis on active rehabilitation and patient education to prevent recurrence. Book an assessment at CK Physio to discuss your options.

Ready to Start Your Recovery?

Our Chartered Physiotherapists in Hanwell and Ealing are ready to create your personalised treatment plan based on the latest evidence.