Extra corporeal shockwave therapy (ECSWT) is a relatively new means of treating some tendon, ligament and bone conditions. During treatment a focused acoustic pressure wave is directed at the area of injury. It is particularly useful for the treatment of proximal suspensory desmititis (PSD) and ‘kissing spines’ where the supraspinous ligament is affected. Treatment provides short term pain relief and a long term improvement in healing.