What shockwave therapy does

Extracorporeal shockwave therapy (ESWT) delivers a controlled mechanical pulse to a target tissue. The mechanism isn't fully understood — current evidence suggests effects on tendon remodeling, neovascularization, and pain modulation. Importantly: shockwave is not a passive cure. It works best when paired with progressive loading.

What the evidence supports

  • Plantar fasciopathy — moderate-quality evidence supporting ESWT as an adjunct to loading (multiple systematic reviews; JOSPT CPG 2023).
  • Achilles tendinopathy — evidence supports ESWT as an adjunct, particularly in chronic cases that haven't responded to loading alone (Speed 2014; subsequent reviews).
  • Patellar tendinopathy — moderate evidence as an adjunct.
  • Lateral epicondylopathy (tennis elbow) — modest evidence in chronic cases.
  • Greater trochanteric pain syndrome — some evidence for chronic cases.
“An adjunct, not a substitute. Loading still does most of the work.”

What to expect

A handheld device delivers acoustic pulses to the target tissue, typically 2000–4000 pulses per session. There's a noticeable thumping sensation that can be uncomfortable in sensitive areas — intensity is adjusted to your tolerance. Sessions take 10–15 minutes. Most protocols involve 3–5 sessions, one per week.

Side effects

Common and mild: temporary local soreness, redness, or minor bruising for 24–48 hours. Serious side effects are very rare. Shockwave isn't appropriate during pregnancy, over open growth plates in children, on certain medications, or near specific anatomical structures — all screened for during the assessment.

Who it helps

People with chronic tendon issues (more than 3 months) that haven't fully responded to progressive loading alone. It's not a first-line treatment — loading is. Shockwave joins the plan when loading has stalled.

Bottom line

An evidence-supported adjunct for chronic tendinopathy and plantar fasciitis. Used alongside — not instead of — progressive loading. 3–5 sessions typically.