In this article, you will find out everything you need to know about shockwave and the most effective alternatives, including an advanced treatment called Prolotherapy.
Shockwave Therapy for Pain Relief
Shockwave Therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a clinically recognized, non-invasive treatment widely used in orthopaedics, physiotherapy, and sports medicine. Increasingly, it is also applied in urology and veterinary medicine. The primary goal of ESWT is to promote healing, restore mobility, and alleviate pain in patients with restricted movement due to injuries or chronic conditions.(1)
Shockwave therapy has broad clinical application in musculoskeletal and bone conditions, including tendinopathies, bone healing, and joint disorders, where targeted application techniques and treatment parameters are essential for improved outcomes.
It is also being explored as a potential treatment for spasticity in neurological disorders such as cerebral palsy and stroke, with emerging evidence supporting its effectiveness.
Shockwave therapy is increasingly integrated into physical medicine and rehabilitation programs, where both didactic and clinical training in ESWT are emphasized.
Introduction to Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) is a non-invasive medical shockwave treatment designed to accelerate the body’s natural healing process. By delivering high-energy shockwaves to targeted soft tissue injuries, ESWT stimulates cell regeneration, enhances blood flow, and supports the repair of damaged tissues. This therapy is widely used for musculoskeletal injuries such as plantar fasciitis, Achilles tendinopathy, and tennis elbow, offering patients a way to reduce pain and restore function without surgery. Each treatment session typically lasts 10 to 15 minutes, and the number of sessions required depends on the severity of the condition and the patient’s response. ESWT has become a trusted option for those seeking effective pain relief and improved healing in both acute and chronic soft tissue conditions.
History of Shockwave Therapy
ESWT was first introduced in 1982 for the treatment of urological conditions, particularly kidney stones.(2) Following its success, healthcare professionals expanded its use to orthopaedics and sports medicine, where it proved beneficial in managing hip pain and other musculoskeletal disorders.
The International Society for Medical Shockwave Treatment (ISMST) is recognized as a leading authority in establishing guidelines and best practices for shockwave therapy.
Before the adoption of ESWT, conservative treatment options such as NSAIDs and physical therapy were typically used for musculoskeletal conditions. Over time, it has become a trusted therapy for fasciopathies, tendinopathies, and soft tissue injuries.
Forms of Shockwave Therapy
There are two primary forms of extracorporeal shockwave therapy: radial extracorporeal shockwave therapy (R-ESWT) and focused extracorporeal shockwave therapy (F-ESWT). Radial ESWT uses a special device to deliver pressure waves that disperse energy over a broader area, making it suitable for treating larger or more superficial musculoskeletal injuries. Focused ESWT, on the other hand, concentrates shockwaves at a specific point within the affected area, allowing for deeper penetration and targeted treatment of more severe or deep-seated conditions. The choice between radial and focused therapy is determined by the patient’s individual needs and the nature of the injury, ensuring the most effective approach for optimal healing and pain relief.
Technique of Extracorporeal Shockwave Therapy
As a non-invasive procedure, ESWT uses a handheld device, similar to an ultrasound wand, applied to the skin. Electrical energy generates shockwaves that penetrate the targeted area. These shockwaves stimulate healing by inducing inflammation, increasing blood flow, and enhancing tissue regeneration in soft tissues, including tendons, ligaments, and surrounding structures often involved in musculoskeletal conditions.(3)
Proper ergonomics and technique are essential when performing ESWT, including correct device handling, patient contact, and setup, to ensure effective treatment and prevent equipment damage.
Principle
Shockwaves are acoustic waves that deliver energy to painful or injured tissues. In addition to stimulating tissue repair, shockwaves can also promote bone healing by encouraging the regeneration of bone in affected areas. Their propagation causes both direct and indirect effects such as cavitation, reducing hematoma formation and stimulating bone and tissue repair. Shockwave therapy also enhances blood circulation in the treated tissues, which supports recovery. The therapy’s effectiveness largely depends on the amount of energy delivered and the type of device used. One of the main therapeutic effects of shockwave therapy is reducing pain in musculoskeletal conditions.
Mechanism of Action
During treatment, a gel is applied to the treated area on the skin to allow smooth transmission of shockwaves. Shockwave therapy is precisely targeted to the injured area, such as damaged tendons, muscles, or soft tissues, to maximize therapeutic benefit.
High-energy waves may require local anesthesia due to discomfort, while low-energy treatments are generally well tolerated. Typically, multiple sessions are needed to achieve lasting results, with patients providing feedback to ensure precise targeting of the pain site.
Treatment Parameters
The effectiveness of extracorporeal shockwave therapy treatment depends on carefully tailored parameters for each patient and condition. Before the procedure, the treatment area is identified and marked to ensure precise targeting. A coupling gel is applied to the skin to facilitate the smooth transmission of shockwaves. During the session, the energy level is typically set between 0.05 and 0.25 mJ/mm², with a frequency ranging from 10 to 20 Hz. Each treatment session may involve 1,000 to 3,000 pulses, adjusted according to the patient’s tolerance and the specific musculoskeletal condition being addressed. These customizable parameters help maximize the benefits of the treatment while minimizing discomfort and ensuring a safe, effective procedure.
Conditions Treated with Shockwave Therapy for Soft Tissue Injuries
Shockwave Therapy is highly effective in treating chronic musculoskeletal pain conditions. These include:
- Plantar fasciitis and heel pain(4)
- Plantar fasciopathy
- Achilles tendinopathy
- Insertional achilles tendinopathy
- Patellar tendinopathy (Jumper’s knee)
- Lateral epicondylitis (Tennis elbow)
- Golfer’s elbow
- Calcific tendonitis of the shoulder
- Greater trochanteric pain syndrome
- Medial tibial stress syndrome
ESWT is also used in the clinical application for bone-related conditions such as nonunion fractures, avascular necrosis, and osteonecrosis of the femoral head.
The National Institute for Health and Care Excellence (NICE) supports its use for Achilles tendon injuries and related conditions.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat pain and increase mobility.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help treat pain.
As prolotherapy is helping to treat the root cause of pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Who Should Avoid Shockwave Therapy?
While ESWT is safe for many patients, certain groups should avoid it. Contraindications include:
- Pregnant or breastfeeding women
- Patients with bone tumors or bone marrow disorders
- Those with implanted electronic devices such as pacemakers
- Individuals with cancer, severe vascular disorders, or recent surgical wounds
- Patients with infections at the treatment site
Although ESWT is generally considered safe, there is a small risk of adverse effects, such as tendon rupture or hematoma formation.
In such cases, healthcare providers will recommend alternative treatments.
Potential Risks and Side Effects
While extracorporeal shockwave therapy is generally safe and well-tolerated, patients should be aware of potential risks and side effects. Some individuals may experience increased pain, bruising, swelling, or numbness at the treatment site following a session. Although rare, more serious complications such as tendon rupture or nerve damage can occur, particularly if the procedure is not performed correctly or if contraindications are overlooked. Patients with a cardiac pacemaker, open wounds, or certain other medical conditions may not be suitable candidates for ESWT. It is important to communicate any concerns or unusual symptoms to your healthcare provider promptly to ensure the right treatment and minimize risks.
Why Choose Shockwave Therapy?
ESWT provides rapid, non-invasive relief from pain, especially in conditions like rotator cuff injuries, shoulder tendonitis, and adhesive capsulitis.(6) Patients often experience reduced pain and improved mobility without the need for surgery or corticosteroid injections.
Comparison to Other Treatments
Extracorporeal shockwave therapy has been compared to a range of other treatments for musculoskeletal injuries, including physical therapy, conservative treatments like anti-inflammatory medications, and surgical treatment. Research suggests that ESWT can be a highly effective alternative to surgery for conditions such as plantar fasciitis and Achilles tendinopathy, often providing significant pain relief and improved function with less downtime. In some cases, ESWT has demonstrated greater effectiveness than conservative treatments, especially when previous therapies have failed. However, the best approach depends on the individual patient and the specific condition being treated. A systematic review of available evidence and a thorough assessment by a healthcare professional are recommended to determine the most appropriate line treatment for each patient.
Success Rate of Shockwave Therapy
Clinical studies show success rates between 78% and 91%, depending on the condition, protocol, and device used.(7) ESWT is particularly effective in treating plantar fasciitis, tennis elbow, calcific tendonitis, and Achilles tendinopathy, offering a safe and cost-effective solution with minimal downtime.
Frequently Asked Questions
How long does it take for shockwave therapy to work?
Most patients notice significant improvement within 6–8 weeks of treatment.
Who should not get shockwave therapy?
Patients with open wounds, blood disorders, bone conditions, cancer, or those who are pregnant should avoid ESWT.
What should you not do after shockwave therapy?
Avoid high-impact activities such as running for at least 48 hours post-treatment. Gentle rehabilitation exercises can be resumed after this period.
What is the success rate of shockwave therapy?
ESWT is 60–80% effective for most pain-related conditions.
Is shockwave therapy good for arthritis?
Yes, ESWT helps reduce inflammation and pain in arthritis, particularly knee arthritis.
How often can you get shockwave therapy?
Typically, 3–5 sessions are recommended, spaced 3–10 days apart.
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Author Bio
Having performed over 10,000 procedures, Mr. Oliver Eaton is one of the UK’s leading practitioners in the field of treating pain, with patients travelling from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms and providing effective treatment options. He trained in Prolozone Therapy and Prolotherapy with the American Academy of Ozonotherapy and completed further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University, and Heidelberg University in Germany. He has treated elite-level athletes, including Olympic and Commonwealth medallists.
LinkedIn: Oliver Eaton
References
- Shrivastava, S. K., & Kailash. (2005). Shock wave treatment in medicine. Journal of Biosciences, 30(2), 269–275. https://doi.org/10.1007/bf02703708
- Vincent, K. C. S., & d’Agostino, M. C. (2018). History of Shockwave Treatment and Its Basic Principles. Shockwave Medicine, 6, 1–16. https://doi.org/10.1159/000485050
- Auersperg, V., & Trieb, K. (2020). Extracorporeal shock wave therapy: an update. EFORT Open Reviews, 5(10), 584–592. https://doi.org/10.1302/2058-5241.5.190067
- Kudo, P., et al. (2006). Randomized, placebo-controlled clinical trial on plantar fasciitis and ESWT. Journal of Orthopaedic Research, 24(2), 115–123. https://doi.org/10.1002/jor.20008
- van der Worp, H., et al. (2013). ESWT for tendinopathy: technology and clinical implications. Knee Surgery, Sports Traumatology, Arthroscopy, 21(6), 1451–1458. https://doi.org/10.1007/s00167-012-2009-3
- Notarnicola, A., & Moretti, B. (2012). Biological effects of ESWT on tendon tissue. Muscles, Ligaments and Tendons Journal, 2(1), 33–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/
- Mittermayr, R., et al. (2012). ESWT for wound healing: Technology, mechanisms, and clinical efficacy. Wound Repair and Regeneration, 20(4). https://doi.org/10.1111/j.1524-475x.2012.00796.x