Shockwave therapy is a noninvasive treatment that involves delivering acoustic wave pulses of high energy to affected areas. It has been found to help ease tendon pain, jumpstart stalled healing, and restore function. Shockwave can be used when pain persists despite undergoing a structured rehabilitation program.
When Is Shockwave Used?
If you have chronic tendinopathy that has not responded to 3–6 months of conservative rehabilitation (e.g. rest, physiotherapy, loading programs), you may be considered a candidate for shockwave therapy.
Conditions of the Lower Limb:
- Achilles tendinopathy – symptoms include pain and stiffness along the back of the ankle.
- Plantar fasciitis – heel pain that is typically worse with your first steps out of bed in the morning.
Conditions of the Upper Limb:
- Rotator cuff calcification – these painful calcium deposits on shoulder tendons can lead to impingement symptoms and poor range of motion.
- Lateral epicondylitis (tennis elbow) – pain on gripping or extending the wrist.
Shockwave can be used alone or along with other treatment options such as progressive tendon loading exercises to successfully manage these injuries.
How Does Shockwave Therapy Work?
Controlled microtrauma
Shockwave pulses cause controlled microtrauma to the tendon, kickstarting repair. This activates tenocytes (specialized tendon cells) and upregulates tissue remodeling processes to heal microscopic tears.
Increased blood flow
The treatment causes the release of angiogenic growth factors like vascular endothelial growth factor (VEGF). New blood vessels then develop over time to improve circulation into the degenerate tendon.
This influx of oxygenated blood delivers nutrients to tissue that is normally hypovascular (has poor blood flow), which promotes healing.
Collagen repair
Your tendon strength is determined by collagen fibers arranged in parallel bundles. Shockwave encourages collagen production and cross-linking, allowing you to rebuild your tendon strength when you load progressively.
Decreased pain sensitivity
Research shows shockwave also affects nerves responsible for pain by:
- Decreasing Substance P (pain neurotransmitter)
- Modulating nerve sensitivity
- Decreasing chronic inflammation.
Patients experience both short-term and long-term pain relief from treatments.
Shockwave Treatment Details
Most shockwave programs involve:
- 3–5 total treatments
- 1 treatment per week
- 5–20 minutes per session
Intensity of pulses (range: 0.05–0.35 mJ/mm²) and frequency can be adjusted based on where the tendon is located, how long you’ve had symptoms, and how much discomfort you can tolerate. Patients often report some mild discomfort during treatments, but they are generally well tolerated.
Who Should Get Shockwave?
Ideal candidates get shockwave if they have:
- Tendon pain that’s been present for >3 months
- Localized tenderness and inability to load the area
- Failed to respond to physiotherapy or rest
Patients should NOT get shockwave if they have:
- Active infection/inflammation where the treatment will be applied
- Local cancer
- Pregnancy (if applying treatment over uterus)
- Bleeding disorders or blood clots/DVTs
Always be sure to provide your full medical history to your physical therapist before undergoing shockwave therapy.
Does Shockwave Therapy Really Work?
Several studies demonstrate shockwave can lead to faster decreases in pain when compared to standard care protocols like activity modification and physiotherapy. When combined with loading exercises that challenge your tendon progressively, success rates reach 50–70% for treating chronic tendinopathy that hasn’t responded to other measures.
Remember that tendons heal slowly, so it will take time before you notice lasting improvements from treatments. Improvements in patients with chronic tendon issues have been shown to continue for months after completing therapy.
What To Expect After Treatment
After each shockwave treatment, patients are often advised to expect:
- Mild soreness
- Swelling around the treatment site
- A bruise or area tenderness that lasts 24–72 hours.
These are normal responses to the treatment and should resolve on their own within a few days.
Rehab Exercises & Activity
It’s important to follow a smart rehabilitation program after each treatment session. You should be progressively loading the tendon with:
- Isometrics – helps decrease pain and maintain strength
- Eccentric loading – stimulates collagen remodeling and realignment
- Functional strengthening exercises – restore sport-specific movement patterns
Avoid vigorous or high impact activity for at least 48 hours after treatment. Slowly reintroduce load based on how your symptoms respond and track your pain to guide activity progression.
Here are the key points to remember about shockwave:
- Shockwave improves tendon healing by stimulating repair, encouraging blood flow, and realigning collagen fibers.
- It’s most effective when accompanied by strengthening and stretching exercises that load your tendon progressively.
- Don’t expect immediate results – give it time and be consistent with your rehabilitation program.
Overall, shockwave is a great treatment option to help decrease chronic tendon pain and reduce your reliance on injections or surgery.
Frequently Asked Questions
Q: Will shockwave hurt when I get it done?
A: During the treatment you may feel sharp tapping sensations, but the discomfort is typically tolerable for most people. The intensity of the shockwave can also be adjusted to whatever comfort level you desire.
Q: How soon will I start to feel better?
A: Some patients notice improvements after only 2-3 treatment sessions. However, the benefits will continue to build over time, with most patients seeing 6-12 weeks of tissue remodeling.
Q: Can I replace physical therapy with shockwave?
A: No. While shockwave has many benefits on its own, patients experience the greatest benefits when it’s used alongside a structured rehabilitation program. Your physical therapist will prescribe exercises that progressively load your tendon to build strength and prevent reinjury.