What Is Shockwave Therapy?

Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses externally applied acoustic pressure waves directed toward a specific area of the body.

It is most commonly used as an adjunct treatment for certain persistent musculoskeletal conditions, particularly some tendon and soft-tissue problems.

Shockwave therapy is not appropriate for every injury, and it is usually most effective when it is used as part of a broader rehabilitation plan rather than as a stand-alone treatment.

How Does Shockwave Therapy Work?

Shockwave therapy delivers controlled acoustic energy through the skin to the targeted tissue.

The exact biological mechanisms are still being studied. Proposed effects include changes in pain sensitivity and local tissue responses that may support rehabilitation, but it is not accurate to say that shockwave therapy simply “breaks up scar tissue” or automatically “heals” a tendon.

The most important point is that shockwave therapy is a treatment adjunct. It does not replace the need to address strength, load tolerance, movement, activity demands, and other factors contributing to the condition.

What Conditions May Benefit From Shockwave Therapy?

Shockwave therapy may be considered for selected persistent musculoskeletal conditions, including:

• Plantar fasciopathy

• Lateral elbow tendinopathy (tennis elbow)

• Achilles tendinopathy

• Patellar tendinopathy

• Calcific rotator cuff tendinopathy

The evidence and expected benefit are different for each condition, so treatment should be based on an appropriate assessment rather than simply applying shockwave therapy to any painful area.

Shockwave Therapy for Plantar Fasciopathy

Plantar fasciopathy is a common cause of persistent heel pain, often felt near the underside of the heel and frequently worse with the first steps after rest.

For some patients with persistent symptoms, shockwave therapy may be considered as one component of treatment.

Rehabilitation may also include calf and foot strengthening, progressive loading, mobility work, footwear or activity advice, and strategies to manage the amount of stress placed on the plantar fascia.

Shockwave therapy should not replace these broader rehabilitation strategies.

Shockwave Therapy for Tennis Elbow

Tennis elbow, or lateral elbow tendinopathy, causes pain around the outer part of the elbow and may affect gripping, lifting, work, or recreational activities.

Shockwave therapy is sometimes used when symptoms have persisted despite initial conservative management.

However, the evidence is mixed. Some studies suggest improvement in selected patients, while other research has found limited or inconsistent benefit.

For this reason, shockwave therapy is best considered as part of an individualized treatment plan that may also include progressive forearm strengthening, load management, education, and gradual return to gripping or lifting activities.

Shockwave Therapy for Achilles and Patellar Tendinopathy

Shockwave therapy may be used in selected cases of persistent Achilles or patellar tendinopathy, particularly when symptoms have not improved adequately with an appropriate exercise-based rehabilitation program.

For Achilles tendinopathy, current evidence is still inconsistent, and treatment protocols vary.

For both Achilles and patellar tendinopathy, progressive tendon loading and strengthening remain central parts of rehabilitation. Shockwave therapy may be used as an adjunct rather than a substitute for exercise.

Shockwave Therapy for Calcific Shoulder Tendinopathy

Calcific rotator cuff tendinopathy occurs when calcium deposits develop within one or more rotator cuff tendons.

Among musculoskeletal conditions treated with shockwave therapy, calcific rotator cuff tendinopathy has some of the stronger supporting evidence.

Research suggests that shockwave therapy may reduce pain and improve function in some patients and may also contribute to changes in the calcific deposit. Outcomes can vary depending on the type and energy of shockwave used and the individual presentation.

Other treatments may also be appropriate, including exercise-based physiotherapy or, in selected cases, medical procedures such as ultrasound-guided needling or lavage.

What Happens During a Shockwave Therapy Session?

Before treatment, your physiotherapist will assess your symptoms and determine whether shockwave therapy is appropriate for your condition.

During treatment, a handheld device is positioned over the targeted area and delivers a series of acoustic pulses through the skin.

The intensity and treatment parameters are adjusted according to the condition being treated, the type of shockwave device, and your tolerance.

A session is usually relatively brief. Shockwave therapy may be delivered over several appointments, depending on the condition and treatment protocol.

Does Shockwave Therapy Hurt?

Shockwave therapy can feel uncomfortable, particularly over sensitive or painful tissue.

The sensation is often described as repeated tapping or pressure. Treatment intensity can usually be adjusted according to your tolerance.

Some people experience temporary soreness, redness, or bruising after treatment. These effects are usually mild and short-lived.

The goal is not to make the treatment as painful as possible. Treatment should be appropriately dosed and adjusted to the individual.

How Many Shockwave Therapy Sessions Will I Need?

There is no single number that applies to every person or every condition.

Some shockwave protocols use a series of treatments, while others may involve fewer sessions. The appropriate schedule depends on factors such as:

• The condition being treated

• How long symptoms have been present

• The type of shockwave therapy being used

• Your response to treatment

• Your overall rehabilitation plan

Your physiotherapist will discuss the recommended treatment schedule based on your assessment and progress.

When Is Shockwave Therapy Not Appropriate?

Shockwave therapy is not suitable for everyone.

It is generally avoided or used with additional caution in situations such as:

• Pregnancy, particularly when the treatment area could expose the fetus

• Active infection in the treatment area

• Known malignant tumour in the treatment area

• Significant bleeding or clotting disorders

• Certain patients taking anticoagulant medication

• Treatment directly over the lungs, major nerves, or sensitive vascular structures

• Treatment over open growth plates in skeletally immature patients

• Complete tendon rupture or other conditions where shockwave therapy is not clinically appropriate

Medical history matters. Your physiotherapist will review relevant health conditions, medications, and precautions before recommending treatment.

Shockwave Therapy and Exercise Rehabilitation

Shockwave therapy works best when it is integrated into a broader rehabilitation program.

For many tendon and soft-tissue conditions, long-term improvement depends on gradually restoring the tissue's ability to tolerate load.

Your treatment plan may therefore include:

• Progressive strengthening

• Tendon-loading exercises

• Mobility work

• Activity modification

• Movement retraining

• Gradual return to sport or work

• Education about symptom and load management

Shockwave therapy may help support this process in selected cases, but exercise and progressive loading remain key components of rehabilitation for most tendinopathies.

Why Choose Strathcona Physical Therapy for Shockwave Therapy?

At Strathcona Physical Therapy, shockwave therapy is not used simply because a patient has pain.

Our physiotherapists first assess your condition to determine whether shockwave therapy is clinically appropriate and whether it is likely to add value to your rehabilitation.

Our approach includes:

• Individualized physiotherapy assessment

• Careful selection of patients who may benefit from shockwave therapy

• Evidence-informed treatment

• Integration of shockwave therapy with exercise and progressive rehabilitation

• Ongoing reassessment of symptoms, function, and response to treatment

• Adjustment of treatment when progress indicates that another approach may be more appropriate

Our goal is to use shockwave therapy strategically and as part of a complete rehabilitation plan, rather than relying on a passive treatment alone.

Shockwave Therapy FAQs

Is shockwave therapy the same as ultrasound?

No. Shockwave therapy and therapeutic ultrasound use different types of energy and work differently.

Shockwave therapy delivers mechanical acoustic pressure waves, whereas therapeutic ultrasound uses high-frequency sound waves.

Is shockwave therapy a surgery?

No. Shockwave therapy is a non-invasive treatment and does not involve an incision or surgical procedure.

Does shockwave therapy break up scar tissue?

That is an oversimplification. The biological effects of shockwave therapy are complex and not completely understood. It should not be described simply as breaking up scar tissue.

Does shockwave therapy heal tendons?

It is better to say that shockwave therapy may help improve pain and function in certain tendon conditions.

Tendon recovery still depends heavily on appropriate loading, strengthening, activity management, and time.

Can shockwave therapy help plantar fasciitis?

It may help selected patients with persistent plantar heel pain or plantar fasciopathy, particularly when symptoms have not responded adequately to other conservative approaches.

Can shockwave therapy help tennis elbow?

It may be considered for persistent tennis elbow, but the research is mixed. It should be used as part of a broader rehabilitation plan rather than as a guaranteed treatment.

Can shockwave therapy help Achilles tendinopathy?

It may help some patients, but current evidence remains inconsistent. Exercise-based tendon rehabilitation remains an important part of treatment.

Is shockwave therapy effective for calcific shoulder tendinopathy?

There is evidence that shockwave therapy can improve pain and function in some patients with calcific rotator cuff tendinopathy, although results vary and other treatment options may also be appropriate.

Can I exercise while receiving shockwave therapy?

In many cases, yes. Exercise is often an important part of the rehabilitation program.

Your physiotherapist will advise you on the appropriate amount and type of exercise based on your condition and symptoms.

How quickly will I feel better?

Response varies. Some people notice improvement relatively early, while others improve gradually over several weeks.

Shockwave therapy should not be presented as an instant pain-relief treatment, and improvement also depends on the underlying condition and the rest of the rehabilitation program.