Menu
Book

Shockwave therapy questions & evidence

Sound waves delivered through the skin to tendon and heel pain that has not settled with rest. The questions patients ask first, then what the studies show.

Reviewed by Elias Nghaywe, DPT, MScUpdated 24 October 20266 min read5 studies

Elias Nghaywe smiling at his desk in a Dr. Phyx t-shirt

Your questions, answered

What patients ask us most about shockwave therapy, in plain words.

What is shockwave therapy?

A device sends short, strong pressure waves through a gel on your skin into the painful tissue. These are sound waves, not electricity. It is used mainly for long-standing tendon and heel pain that has not improved with rest.

What does it treat?

The best-studied uses are heel pain (plantar fasciitis), calcium deposits in the shoulder tendons, Achilles and kneecap tendon pain, pain on the outside of the hip, and tennis elbow. It is meant for problems that have lasted for months.

Does it hurt?

For most people it feels uncomfortable rather than painful, and we adjust the intensity to what you can tolerate. The area can feel sore or look a little red for a day or two.

How many sessions will I need?

Usually three to five sessions, about a week apart. Improvement often continues over the following weeks, because the aim is to restart the tissue's own healing response.

Can I work and train afterwards?

Yes, you can carry on with normal daily activity. We may ask you to avoid heavy or painful loading of that area for about two days.

Why combine it with exercise?

Shockwave reduces pain, and tendons get stronger with the right loading. Used together, they give better results than either one alone, as the research below shows.

What the research shows

Key findings from systematic reviews, randomised trials and major studies indexed on PubMed. Numbers link to the full references below.

Chronic heel pain

Randomised trial · 245 patients

Three sessions of radial shockwave reduced heel pain scores by 72%, compared with 45% for placebo, at 12 weeks. 61% of patients were classed as a success, compared with 42%, and the advantage was even more pronounced at 12 months.[1]

Heel pain across 11 trials

Meta-analysis · 11 trials

Across 11 high-quality randomised trials, shockwave reduced morning heel pain, and moderate- and high-intensity treatment improved function.[2]

Long-lasting results with the right dose

Meta-analysis · placebo-controlled

Medium-energy shockwave achieved better success rates than placebo at 3, 6 and 12 months, and reduced pain.[3]

Calcium deposits in the shoulder

Randomised trial

In people with calcific shoulder tendinitis, radial shockwave reduced pain and improved shoulder function within 4 weeks, with the benefit maintained at 6 months. The calcium deposits disappeared completely in 86.6% of treated patients, with no adverse effects reported.[4]

Better together: Achilles tendon

Randomised trial · 68 patients

Adding shockwave to a tendon-loading exercise programme gave better results than exercise alone at 4 months: 82% of patients were completely recovered or much improved, compared with 56%, and pain fell from 7 to 2 out of 10.[5]

How we use it at Dr. Phyx

We consider shockwave when tendon or heel pain has lasted for months. First we assess what is overloading the tissue, then we combine shockwave with a loading programme and hands-on work to treat the cause, not only the pain.

A typical course is a few short sessions combined with exercises you do at home, adjusted as you improve.

Always by a qualified specialist, after a full assessment, because your health comes first.

When we are careful

Shockwave is not used in these situations. We check them at your assessment:

  • Pregnancy
  • Blood thinners or a bleeding disorder
  • Infection, a tumour or an open wound in the area
  • Over growth plates in children and teenagers
  • Directly over the lungs, major nerves or blood vessels
  • Within a few weeks after a steroid injection in the same area

Is your heel or tendon pain a fit for shockwave?

Send us a message on WhatsApp. We will tell you honestly whether it suits your case, and book a first assessment if it does.

Ask on WhatsApp

References

  1. Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008;36(11):2100-2109. PubMed · doi:10.1177/0363546508324176
  2. Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil. 2013;92(7):606-620. PubMed · doi:10.1097/PHM.0b013e31828cd42b
  3. Wang YC, Chen SJ, Huang PJ, et al. Efficacy of different energy levels used in focused and radial extracorporeal shockwave therapy in the treatment of plantar fasciitis: a meta-analysis of randomized placebo-controlled trials. J Clin Med. 2019;8(9):1497. PubMed · doi:10.3390/jcm8091497
  4. Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86(5):672-682. PubMed · doi:10.1093/ptj/86.5.672
  5. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463-470. PubMed · doi:10.1177/0363546508326983

This article is general information reviewed by a physiotherapist. It is not a diagnosis or a personal treatment plan.