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Pressure waves delivered through the skin to a painful tendon. No needles, no anaesthetic, no downtime — and it works best for a specific set of stubborn problems rather than for pain in general.
Shockwave therapy, also written shock wave therapy, uses a handheld probe to deliver rapid pressure waves into the painful tissue. The waves irritate the area in a controlled way, which appears to restart a stalled healing response: new blood vessels form, and the nerve endings that have been signalling pain settle down.
It is used for tendon problems that have not settled on their own. Those tend to be the ones where the tissue has stopped repairing itself properly rather than being acutely inflamed — which is why shockwave suits long-standing pain better than a fresh injury.
It is not a quick fix, and not a first step. It is usually considered after several months of pain that has not responded to rest, load management, stretching and physiotherapy — and it is used alongside those, not instead of them.
Two machines, often both called shockwave. They are not the same, and they suit different problems.
| Radial | Focused | |
|---|---|---|
| How the wave behaves | Spreads out from the skin, strongest at the surface | Converges at a set depth, strongest at the target |
| Suits | Broad, shallow problems — plantar fascia, tennis elbow, trigger points | Deeper or precise targets — calcific deposits in the shoulder, deep tendon attachments |
| How it feels | A rapid tapping, uncomfortable over a tender spot | A deeper thud, and can be more intense |
| Anaesthetic | Not used | Not usually needed |
Which machine is used depends on where the problem sits and how deep it is. Both are given as a course rather than a single treatment.
Shockwave is genuinely useful for some conditions and marginal for others. It is worth knowing which is which before starting a course.
Shockwave therapy treatment is given as a course rather than a single session, and the exercises alongside it are part of the plan.
Examination, and imaging where the diagnosis is not clear. Shockwave is aimed at a specific structure, so the structure has to be identified first.
Gel on the skin, then the probe over the tender area for about 10 to 15 minutes. It is uncomfortable while the machine is running, and the intensity is adjusted to what you can tolerate. No anaesthetic, and you walk out afterwards.
Aching or tenderness for a day or two is normal, and occasionally some redness or bruising. Anti-inflammatory tablets are usually avoided just afterwards, since the treatment works through an inflammatory response.
Three to five sessions, about a week apart. Loading exercises alongside it matter: shockwave prepares the tendon, and the exercise is what rebuilds it.
Most of the improvement shows in the weeks after the course finishes, so it is judged at around two to three months. If nothing has changed by then, repeating it is not usually the answer.
For plantar fasciitis and calcific shoulder tendinitis, a good proportion of people improve substantially after a course, and some avoid an injection or an operation. For other tendon problems the effect is more modest, and it is best thought of as one part of a rehabilitation plan rather than a treatment on its own.
It is uncomfortable while the machine is running, particularly over a tender spot, and the intensity is adjusted to what you can tolerate. Most people describe aching for a day or two afterwards rather than pain.
Usually three to five, about a week apart. If there has been no change two to three months after the course, more sessions are unlikely to help.
Not immediately. Improvement usually builds over the weeks after the course finishes, which is why it is reviewed at around two to three months.
Yes, and the loading exercises you are given are part of the treatment. What is usually paused is the activity that keeps aggravating the tendon, and hard training on the treated area right after a session.
For most people, yes. It is avoided in pregnancy, over growth plates in children, where there is infection or a tumour in the area, and in people with bleeding disorders or on blood thinners.
No. Bring any scan reports, and a note of what treatment you have already had for the problem.
Plantar fasciitis · Tennis elbow · Achilles tendon injuries · Patellar tendonitis · Myofascial pain · Hip pain
Bring the history of what you have tried. Shockwave is chosen for problems that have stopped responding to the simpler things.
