NHS Lancashire and South Cumbria Integrated Care Board regularly reviews clinical evidence of effectiveness for various treatments. We are currently reviewing evidence for extracorporeal shockwave therapy (ESWT), platelet-rich plasma (PRP) and autologous blood injections as treatment for Achilles tendinopathy, refractory elbow tendinopathy (tennis elbow) and plantar fasciitis.
Read the current policy on our website.
The revised policy proposes that these interventions would not be routinely commissioned for the conditions mentioned, reflecting the current evidence base and the need to prioritise NHS resources towards treatments with clearer demonstrated clinical benefit.
Proposed policy:
1. Autologous blood, platelet rich plasma injections or extracorporeal shockwave therapy are not routinely commissioned for Achilles tendinopathy.
2. Autologous blood, platelet rich plasma injections or extracorporeal shockwave therapy are not routinely commissioned for refractory tennis elbow.
3. Autologous blood, platelet rich plasma injections or extracorporeal shockwave therapy are not routinely commissioned for plantar fasciitis
NB: this does not affect access to standard conservative treatments such as physiotherapy, exercise programmes or other routinely available Musculoskeletal services.
Extracorporeal shockwave therapy
Extracorporeal shockwave therapy (ESWT) is a procedure where shockwaves are passed through the skin to the injured part of the body using a special device. The shockwaves are audible, low energy sound waves, which increase blood flow to the injured area.
Multiple evaluations and reviews of the effectiveness of ESWT for lateral elbow pain, plantar fasciitis, and Achilles tendinopathy have found little or inconclusive evidence of effectiveness in treating these conditions.
Platelet-rich plasma and autologous blood injections
Platelet-rich plasma (PRP) is created by taking the patient’s blood and spinning it in a centrifuge, separating blood platelets which produce growth factors. PRP is re-injected into the affected tendon. Growth factors may start the healing process and reduce pain and swelling.
In autologous blood injection, whole blood is taken from the patient and re-injected around the affected tendon. Growth factors may start the healing process and reduce pain and swelling.
Reviews of PRP and autologous blood injection as treatment for musculoskeletal soft tissue injuries such as elbow tendinopathy, Achilles tendinopathy and plantar fasciitis found that there is currently insufficient compelling evidence to support it.
Why is the policy needed?
To manage inappropriate referral and procedure activity in line with evidence-based best practice.
Summary of proposed policy changes:
Evidence reviews identified inconsistent data which does not support shockwave therapy, platelet‑rich plasma, and autologous blood injections as effective treatments for Achilles tendinopathy, plantar fasciitis, and lateral epicondylitis. The proposed policy recommends that none of these interventions are routinely commissioned for these conditions.
The proposed policy brings Lancashire and South Cumbria ICB into line with Cheshire and Merseyside ICB, who do not routinely commission ESWT for these conditions. Aligning with neighbouring ICBs gives a consistent, evidence‑based approach across the North West region.
This survey will close on Friday 21st August 5pm.