TL;DR
Extracorporeal shockwave therapy (ESWT) sends acoustic pressure waves into painful tissue to trigger the body’s healing response. It is used for long-lasting tendon and soft tissue pain that has not improved with rest and exercise.
- The strongest evidence is for plantar fasciitis, calcific shoulder tendinitis and tennis elbow.
- Sessions take about 10 to 20 minutes, with no needles, anesthesia or downtime.
- Most courses are 3 to 6 sessions, about a week apart.
- Improvement usually builds over several weeks after the course.
What is shockwave therapy?
Shockwave therapy is a non-invasive treatment that uses acoustic waves, not electricity, delivered through the skin by a handheld device. “Extracorporeal” means the waves are created outside the body. There are two main types: focused shockwave, which reaches deeper tissue, and radial pressure wave therapy, which spreads more widely near the surface.
How does shockwave therapy work?
The pressure waves are thought to:
- Stimulate new blood vessel growth in the treated tissue
- Trigger a healing response in tendons that have stalled
- Help break down calcium deposits
- Calm pain signals in the area
What conditions does shockwave therapy treat?
- Plantar fasciitis and heel pain. See shockwave therapy for plantar fasciitis.
- Calcific tendinitis of the shoulder
- Tennis elbow and golfer’s elbow
- Achilles tendinopathy
- Patellar tendinopathy (jumper’s knee)
- Outer hip pain (greater trochanteric pain syndrome)
- Some cases of delayed bone healing
It is usually considered after at least a few months of other care, such as exercise and physical therapy.
What does the evidence say?
Large randomized trials have shown that focused shockwave therapy reduces heel pain in chronic plantar fasciitis more than placebo, and reduces pain and calcium deposits in calcific shoulder tendinitis. Evidence for other tendon problems is promising but more mixed. Shockwave is most effective alongside a strengthening program.
What does a session feel like?
- A gel is applied and the device is placed on the painful area.
- You feel tapping or pulsing that can be uncomfortable but is usually tolerable. The intensity can be adjusted.
- A session takes about 10 to 20 minutes.
- You can usually walk out and return to normal activity, avoiding heavy strain on the area for a day or two.
- Mild soreness or redness for a day or two is common.
Who should not have shockwave therapy?
It is usually avoided:
- During pregnancy
- Over a cancer or an active infection
- In people with bleeding disorders or on some blood thinners
- Over open growth plates in children
- Directly over the lungs, major nerves or blood vessels
Is shockwave therapy right for you?
It may fit if you have tendon or heel pain that has lasted more than three months and has not improved with rest, stretching and physical therapy. An evaluation confirms the diagnosis first, since some conditions respond better than others. Learn more about shockwave therapy at PainTherapyCare and how it compares in shockwave vs cortisone for tennis elbow.
Frequently asked questions
Does shockwave therapy hurt?
It can be uncomfortable, often described as strong tapping. The intensity can be adjusted to what you can tolerate.
How many shockwave sessions do I need?
Most courses are 3 to 6 sessions, about a week apart.
How long does it take to work?
Some people notice relief within a few weeks. Full improvement often builds over two to three months after the course.
Is shockwave therapy covered by insurance?
Coverage varies a lot by plan and condition. Check with your plan before starting.
Should I stop anti-inflammatory medicine during shockwave therapy?
Some providers suggest limiting it, since shockwave works partly by triggering a healing response. Talk to the prescriber before changing any medication.
Take the next step
If this sounds like what you are dealing with, you do not have to figure it out alone. A pain management provider can evaluate what is going on and walk you through drug-free, non-surgical options that may fit your situation.
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Sources: Gollwitzer H, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015;97(9):701-708; Gerdesmeyer L, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573-2580.
