I've just seen rather a disturbing image.
A shockwave wand being wafted over a back like a magic incense stick, alongside a neat explanation of how it treats tendon pain.
It hammered a thought I've been trying to ignore.
Every era of physio finds a machine to worship.
In the 90s it was the mystical bleep of ultrasound. Today it's the rhythmic thwack of shockwave. Different kit. Same behaviour.
Hear me out.
This isn't about the technology. There's some evidence for some things and it has a place. I don't blame the companies either. They're doing exactly what they should: build, test, educate and sell.
The drift happens with us.
The second a patient walks in asking for shockwave by name, we stop leading. It feels premium. Looks high-end. Low risk. Kapow. So we wheel it out, plug in, select body part, gel on, off we go.
And quietly the model flips. Passive treatment leads. Thinking becomes a distant second.
Before long we're not using it where it's indicated. We're using it where it's asked for or where we've run out of ideas.
That's the shift: from clinical reasoning to commercial convenience.
For chronic tendons that have genuinely failed a proper loading programme, it's a brilliant adjunct. But that's it. An adjunct. A sequence, not a shortcut. You can't zap a tendon into submission. They don't need a miracle. They need load, applied well, over time.
The problem isn't the tool. It's what happens when the tool becomes the plan.
If your clinical reasoning is driven by what the patient asks for rather than what they need, you're not running a clinic.
You're running a spa for sore body parts. Just with slightly better marketing.