Chronic pain from tendon injuries, heel pain, or shoulder problems can linger for months, sometimes years, even with rest and traditional care. For many Americans dealing with these conditions, extracorporeal shockwave therapy (ESWT) has gained attention as a non-invasive option that may help restart the body’s healing process. So what does the shockwave therapy evidence actually tell us?
Key Takeaways
- Shockwave therapy (ESWT) uses acoustic waves, not electrical currents, to target injured tissue non-invasively.
- Plantar fasciitis has the strongest evidence, with success rates of 34% to 88% across clinical studies.
- Calcific shoulder tendinitis also shows favorable outcomes in clinical research.
- A typical course involves 3 to 6 sessions, with full results developing 8 to 12 weeks after the final session.
- Side effects are generally minor and temporary.
What Is Shockwave Therapy?
Shockwave therapy is a non-invasive treatment that uses high-energy sound waves (acoustic waves) to target injured tissue. A handheld device sends these waves through the skin to a specific area where healing has stalled. Depending on the device, those pressure waves can penetrate 6 centimeters or more, reaching deep muscle, tendon, and bone tissue that surface-level treatments cannot.
One common misconception is that the “shock” in shockwave refers to electricity. Not the case. The waves are purely mechanical, similar to sound pulses, not electrical currents. Sessions typically take about 10 to 30 minutes, depending on the size of the area being treated.
Two Types of Shockwave Therapy
Clinicians generally use one of two types based on the condition being treated:
- Radial shockwave therapy (RSWT): Sends pressure waves outward across a broad, shallow area. Most commonly used in outpatient settings for soft tissue conditions.
- Focused shockwave therapy (FSWT): Delivers energy to a deeper, more precise point. Often used for bone-related conditions or dense calcium deposits.
How Does Shockwave Therapy Work?
Shockwave therapy works through a process called mechanotransduction, where mechanical energy is converted into biological signals at the cellular level. The sound waves create a controlled micro-stress in tissues where healing has stalled, prompting the body to restart its natural repair cycle.
What Happens in the Body During Treatment
Here is what researchers believe may occur when shockwaves reach injured tissue:
- New blood vessel growth (neovascularization): The waves may stimulate new blood vessel formation, potentially improving oxygen and nutrient delivery to the affected area.
- Growth factor release: Mechanical stress could trigger the release of proteins that support tissue repair, including factors that activate fibroblasts (cells that heal connective tissue).
- Breakdown of calcium deposits: For conditions like calcific tendinitis, the acoustic energy may help break apart calcium buildup in tendons.
- Pain signal modulation: Shockwaves could overwhelm local nerve endings and may reduce levels of Substance P, a chemical linked to chronic pain signaling.
- Inflammation modulation: For conditions where the body is stuck in a prolonged inflammatory state, the therapy may help reduce chronic inflammation, creating conditions more favorable for tissue repair.
Which Conditions May Benefit from Shockwave Therapy?
Growing evidence for shockwave therapy suggests potential benefit across several chronic musculoskeletal conditions, particularly those that have resisted other treatments.
Plantar Fasciitis (Heel Pain)
Plantar fasciitis is one of the most studied conditions for shockwave therapy. Clinical studies report success rates ranging from 34% to 88%, depending on the protocol and study design. Shockwave may help break down calcifications that form in chronic cases and restart the healing process. A 2023 systematic review found high-quality evidence that ESWT may have a large effect on both pain and function for plantar fasciitis that has not responded to conventional care.
Calcific Shoulder Tendinitis
When calcium deposits form within the rotator cuff tendons, they can cause significant pain and limit shoulder movement. A meta-analysis found that shockwave therapy reduced the size of calcium deposits, with changes visible on imaging. Reported success rates vary widely, from 30% to 97%, depending on how success is defined and the protocol used.
Achilles Tendinopathy
Achilles tendon pain, common among runners and active individuals, often becomes chronic. Two 2023 systematic reviews found the overall evidence for ESWT and Achilles tendinopathy to be inconclusive, with some comparisons showing a placebo outperforming ESWT for functional improvement.
Tennis Elbow (Lateral Epicondylitis)
The scientific evidence that shockwave therapy works for tennis elbow is mixed. While some studies report up to 80% pain reduction, other high-quality trials have found limited benefit compared to placebo.
Patellar Tendinopathy (Jumper’s Knee)
Athletes who jump frequently may develop chronic knee tendon pain. A 2023 review noted that ESWT may help with pain compared to conservative treatment alone, though the evidence base still needs more high-quality studies.
Bursitis and Myofascial Pain
Inflamed bursa sacs in the shoulder and hip, as well as chronic muscle and fascia pain, may also respond to shockwave therapy. Both are newer applications with clinical research still developing, though early results are promising when combined with physical therapy.
What Does a Typical Treatment Session Look Like?
A standard course of shockwave therapy usually involves 3 to 6 sessions, spaced one to two weeks apart. Sessions generally take 10 to 30 minutes and follow the same steps:
- Locating the area: A clinician identifies the exact point of maximum tenderness.
- Applying gel: A water-based gel goes on the skin to help transmit the sound waves.
- Delivering the treatment: The handheld device presses against the skin and delivers a series of rapid pulses. Most patients describe a strong tapping or pulsating sensation.
- Adjusting intensity: Clinicians can increase or decrease the energy level based on comfort.
Most people can return to normal activities right after treatment, with no downtime required. High-impact exercise should be avoided for about 48 hours. Anti-inflammatory medications like ibuprofen are typically discouraged before and after treatment, since NSAIDs could interfere with the therapy’s controlled inflammatory response.
Safety and Side Effects
Shockwave therapy is generally considered safe when performed by a qualified provider, with a strong safety profile confirmed across clinical studies.
Common side effects that may occur include:
- Temporary redness or swelling at the treatment site
- Mild soreness or bruising
- Short-term numbness in the area
Serious complications are rare. However, shockwave therapy is generally not recommended for individuals with blood-clotting disorders, active infections in the treatment area, or during pregnancy.
Who May Not Be a Good Fit
Shockwave therapy works best for chronic soft tissue injuries that have been diagnosed and have not responded to conservative treatment. Certain situations call for a different approach:
- Acute injuries. If you were injured recently, rest and physical therapy may be more appropriate first.
- Severe or complete tears. Fully ruptured tendons or ligaments may need surgical repair before considering shockwave.
- Very early-stage conditions. If conservative treatment has not been tried yet, shockwave may not be the right first step.
Results vary from person to person. Some see dramatic improvement, others see modest change, and a smaller number see little benefit.
When Can You Expect Results?
Patience matters with shockwave therapy. Many patients notice improvement after 2 to 4 sessions, but the full healing response can take 8 to 12 weeks to develop after the final session. The waves trigger the healing cascade, but actual tissue remodeling takes time.
Conclusion
The growing body of shockwave therapy evidence points to a non-invasive option that may support healing for certain chronic musculoskeletal conditions. Unlike treatments that only manage pain temporarily, shockwave therapy aims to address the underlying tissue damage, encouraging your body to rebuild rather than just mask discomfort.
Getting the right diagnosis before starting treatment matters. A comprehensive evaluation, including imaging to confirm the injury and rule out conditions that shockwave cannot treat, is the foundation of effective treatment.
At Rocky Mountain Regenerative Medicine in Boulder, Colorado, shockwave therapy is combined with advanced diagnostics and personalized care planning. RMRM providers assess your specific injury and develop a customized treatment plan. Combined with options like stem cell therapy, peptide therapy, exosome therapy, and hyperbaric oxygen therapy, the goal is to help your body heal from within. Through the Annual Membership Program, patients receive personalized, ongoing care tailored to their needs.
Ready to learn more? Contact RMRM or book an appointment to explore whether shockwave therapy may be a good fit for you.
Disclaimer: The content in this article is for educational and informational purposes only. Nothing here should be considered medical advice. Always consult with a qualified healthcare professional before starting any treatment. Individual results may vary.
