A gentle, outpatient treatment for painful joint, tendon and fascia conditions that have not settled with standard treatment — including osteoarthritis, plantar fasciitis, tennis elbow, and Dupuytren’s and Ledderhose disease.
Low dose radiotherapy (LDRT) uses very small doses of radiation to calm inflammation and reduce pain, stiffness and swelling in a range of non-cancerous conditions. In fibrous conditions such as early Dupuytren’s disease, it is used to slow or halt progression of nodules and cords. The doses involved are a small fraction of those used to treat cancer, and treatment itself is painless and takes only a few minutes.
LDRT has been used for decades and is particularly well established in Germany and elsewhere in Europe, where it is supported by national guidelines and randomised trials. Dr Abdul-latif offers it at Mount Vernon Cancer Centre, following the centre’s protocol for radiotherapy of benign conditions, for patients whose symptoms have not responded to conservative management.
Many painful musculoskeletal conditions are driven by persistent, low-grade inflammation in a joint, tendon insertion or band of fascia. At very low doses, radiation does not destroy tissue. Instead, it alters the behaviour of the immune cells responsible for that inflammation, damping down the signals that cause pain and swelling.
In fibroproliferative conditions such as Dupuytren’s and Ledderhose disease, the aim is different: radiotherapy acts on the overactive cells that lay down fibrous tissue, and is used in early disease to slow or stop the growth of nodules and cords before contracture develops.
It is not a first-line treatment. LDRT is considered when standard measures — such as physiotherapy, analgesia, orthotics or injections — have not provided adequate relief, and particularly for people who are unsuitable for surgery or would prefer to avoid it.
Nothing is felt during treatment. Each session takes only a few minutes on the treatment couch, and you can carry on with normal daily activities afterwards.
Only the affected joint, heel, tendon or hand is treated, with careful attention to keeping dose to surrounding tissue to a minimum.
Benefit usually builds over the weeks after treatment rather than immediately, and for many patients it is long-lasting, improving mobility and day-to-day function.
The conditions below are those most commonly treated. Suitability is always assessed individually at consultation, and other benign inflammatory or degenerative musculoskeletal conditions may be considered on a case-by-case basis.
Painful osteoarthritis, particularly of the knee and hip, that has not responded to conservative management. LDRT may reduce pain and stiffness through its anti-inflammatory effect, and can be an option for patients who are unsuitable for, or wish to avoid or delay, joint replacement.
Chronic heel pain from plantar fasciitis, with or without a heel spur, that persists despite rest, stretching, orthotics or injections and limits walking or quality of life. This is one of the best-studied uses of LDRT, with randomised trials showing durable pain relief.
Persistent pain at a tendon insertion — including lateral epicondylitis (tennis elbow) and Achilles tendinopathy — where physiotherapy and other standard treatments have not helped. Treatment is directed at the painful tendon insertion only.
Nodules and cords in the palm of the hand. LDRT is most effective in early-stage disease that is progressing or tender, before significant finger contracture develops, with the aim of slowing or halting progression. It is suited to patients who are unsuitable for surgery or wish to avoid it.
The equivalent condition in the sole of the foot (plantar fibromatosis), where progressive nodules can make walking painful. LDRT is used for symptomatic, progressing nodular disease, following the same approach as for Dupuytren’s disease.
An established preventive treatment for people at high risk of abnormal bone formation around the hip after hip replacement or trauma — for example those who have developed heterotopic ossification before. It is arranged together with the orthopaedic team.
LDRT may be appropriate if you have a confirmed benign condition that is causing ongoing pain or progression, and standard treatments have not given adequate relief. It can be particularly useful where surgery is not advisable, or where you would prefer to avoid or delay an operation.
Because any radiation exposure carries a very small theoretical long-term risk, younger patients are treated only rarely. In line with Mount Vernon’s protocol, patients under 40 are treated only after careful multidisciplinary discussion. As with any radiotherapy, treatment is not given during pregnancy.
Before treatment, X-rays are often requested to confirm the diagnosis and exclude other causes of pain; MRI or ultrasound may occasionally be helpful where the diagnosis is uncertain.
Treatment is delivered entirely as an outpatient. The outline below describes the usual pathway; specifics vary by condition and are discussed in full at consultation.
Review of your symptoms, previous treatments and any imaging, in person or remotely. Discussion of whether LDRT is appropriate, the likely benefit and risks, and the alternatives.
Depending on the site, a short planning appointment and sometimes a CT scan to position you comfortably and reproducibly, and to define the area to be treated.
A short course of brief, painless sessions on a radiotherapy machine. You lie still for a few minutes and can go home, drive or return to work straight afterwards.
Improvement usually builds gradually over the following weeks. A review is arranged after treatment — typically at 6–12 weeks for painful conditions and 3–6 months for Dupuytren’s or Ledderhose disease.
Because the doses are low and only a small area is treated, most people experience few or no side effects. Some notice a temporary increase in pain in the first days or weeks after treatment before improvement begins. With the slightly higher doses used for Dupuytren’s and Ledderhose disease, mild dryness or redness of the skin over the treated area can occur, and usually settles.
The main long-term consideration is a very small theoretical risk of a radiation-induced cancer many years later. This is why careful patient selection matters, why treatment is reserved for symptoms that have not responded to other measures, and why younger patients are treated only rarely. These considerations are discussed openly at consultation so that you can make an informed decision.
Treatment is planned and delivered within a specialist radiotherapy department, using the same quality assurance and dose-minimising techniques that apply to cancer radiotherapy.
Referrals are welcome from GPs, orthopaedic and hand surgeons, rheumatologists, sports and musculoskeletal physicians, podiatrists and physiotherapists. The summary below reflects the Mount Vernon Cancer Centre protocol for radiotherapy of benign conditions, which is based on DEGRO guidance. Final dose and technique are individualised at consultation.
| Condition | Indications | Typical dose fractionation | Review |
|---|---|---|---|
| Osteoarthritis (knee, hip) | Painful OA refractory to conservative management; unsuitable for or declining surgery | 3–6 Gy total in 0.5–1 Gy fractions, 2–3 times weekly | ~3 months |
| Plantar fasciitis | Chronic symptomatic disease refractory to conservative management, affecting mobility or quality of life | 3–6 Gy total in 0.5–1 Gy fractions, 2–3 times weekly | 6–12 weeks |
| Dupuytren’s disease | Early-stage progressive or tender nodular disease; unsuitable for or wishing to avoid surgery | 30 Gy in 10 fractions, as 2 courses of 15 Gy in 5 fractions, 6–12 weeks apart | 3–6 months |
| Ledderhose disease | Progressive symptomatic nodular disease; pain affecting walking | 30 Gy in 10 fractions, as 2 courses of 15 Gy in 5 fractions, 6–12 weeks apart | 3–6 months |
| Heterotopic ossification (hip) | High-risk patients undergoing hip arthroplasty; previous HO | Single fraction 7–8 Gy, pre-operatively or within 72 hours post-operatively | Orthopaedic team |
| Other painful enthesopathies (e.g. lateral epicondylitis, Achilles tendinopathy) | Refractory symptoms; assessed on a case-by-case basis | Low-dose regimen individualised at consultation | 6–12 weeks |
Please include relevant history, previous treatments and any imaging with the referral. Plain radiographs are recommended where appropriate to exclude alternative pathology. Patients under 40 are considered only after multidisciplinary discussion.
It uses the same equipment and the same careful planning, but the doses are much lower and the aim is different: to calm inflammation or slow fibrous tissue growth, not to destroy a tumour. Having LDRT does not mean you have cancer.
No. You will not feel anything during treatment, which takes only a few minutes per session. You can drive and carry on with normal activities afterwards.
Improvement usually develops gradually over several weeks after the course finishes, rather than immediately. Some people notice a brief flare in pain before it improves. Your response is assessed at a review appointment after treatment.
For painful conditions such as osteoarthritis, plantar fasciitis and tendinopathy, typically around six short sessions given two or three times a week. For Dupuytren’s and Ledderhose disease, two short courses of five daily treatments, separated by 6–12 weeks. Prevention of heterotopic ossification requires a single treatment.
Referrals are welcome from your GP or specialist, and you are also welcome to make an enquiry directly for a consultation. Please bring or send details of previous treatments and any X-rays or scans.
Many patients are self-funding, and some insurers may cover treatment subject to pre-authorisation. Please contact the secretary, and check with your insurer before treatment starts.
Selected guidelines and trials underpinning the Mount Vernon protocol for radiotherapy of benign conditions.
Ott OJ, Niewald M, Weitmann HD et al. Strahlentherapie und Onkologie, 2015
Seegenschmiedt MH, Micke O, Niewald M et al. Strahlentherapie und Onkologie, 2015
Niewald M, Seegenschmiedt MH, Micke O et al. International Journal of Radiation Oncology, Biology, Physics, 2012
Betz N, Ott OJ, Adamietz B et al. Strahlentherapie und Onkologie, 2010
Muecke R, Seegenschmiedt MH, Heyd R et al. Strahlentherapie und Onkologie, 2010
Ott OJ, Hertel S, Gaipl US et al. Strahlentherapie und Onkologie, 2012
If you have a long-standing painful joint, heel or tendon condition, or early Dupuytren’s or Ledderhose disease, and would like to know whether low dose radiotherapy could help, please get in touch. Consultations are available at Mount Vernon Cancer Centre, at The Clementine Churchill Hospital in Harrow, and by video or telephone; treatment is delivered at Mount Vernon.
Secretary: 020 3826 2182 · amy.bignell1@nhs.net
New patient consultation £250 · Follow-up £150 · Self-pay and all major insurers accepted