What Is It?
Shockwave Therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a non-invasive physiotherapy treatment used to help manage persistent tendon pain and musculoskeletal conditions.
The treatment involves delivering controlled acoustic (sound) waves through the skin into the affected tissue using a handheld device. These high-energy pulses stimulate the body’s natural healing processes within injured or irritated tissues.
Shockwave therapy does not involve injections or surgery. Instead, it works by mechanically stimulating the tissue to encourage repair and reduce pain.
Shockwave therapy aims to:
- Reduce persistent tendon and soft tissue pain
- Stimulate tissue healing and repair
- Improve blood flow to injured areas
- Break down abnormal or degenerative tissue changes
- Support improved movement and function
How Does It Work?
Shockwave therapy delivers short bursts of high-energy acoustic waves into the affected area of tissue. These waves create a mechanical stimulus that triggers biological responses in the body.
Research suggests shockwave therapy can:
- Stimulate new blood vessel formation (angiogenesis)
- Promote collagen production and tissue repair
- Reduce pain by altering nerve signalling
- Increase local metabolism and circulation
These processes help restart the body’s healing response in tissues that may have become chronically irritated or slow to heal, particularly in long-standing tendon injuries.
By stimulating tissue repair and reducing pain sensitivity, shockwave therapy can help patients progress more effectively into strengthening and rehabilitation exercises.
What Conditions Can It Help With?
The evolving list of diagnoses for which ESWT shows potential includes:
- Tennis elbow (lateral epicondylitis)
- Golfer’s elbow (medial epicondylitis)
- Patellar tendinopathy (jumper’s knee)
- Greater trochanteric pain syndrome
- Hamstring tendinopathy
- Medial tibial stress syndrome
- Achilles tendinopathy
- Plantar fasciitis
- Knee osteoarthritis
- Spasticity of spinal and supraspinal origin (stroke, multiple sclerosis, brain injury, cerebral palsy)
Your physiotherapist will determine whether shockwave therapy is appropriate for your specific condition and stage of injury.
What Should I Expect During a Session?
During treatment:
- Your physiotherapist will assess the painful area and identify the target tissue.
- A gel is applied to the skin to assist transmission of the shockwaves.
- A handheld device delivers a series of pulses to the treatment area.
- You may feel a tapping or pulsing sensation during treatment.
A typical session:
- Takes approximately 5–10 minutes per treatment area
- Usually involves 2000–3000 pulses depending on the condition
- May cause temporary discomfort, but the intensity can be adjusted
Most treatment programs involve 3–5 sessions spaced about 5-7 days apart, depending on the condition and response to treatment.
What Are The Benefits?
Potential benefits of shockwave therapy include:
- Reduced tendon and soft tissue pain
- Improved healing in chronic injuries
- Improved movement and function
- Non-invasive treatment option
- May reduce the need for injections or surgery in some cases
Evidence suggests shockwave therapy can be effective for certain musculoskeletal and neurological conditions, particularly when combined with exercise-based physiotherapy rehabilitation.
What Are The Risks and Side Effects?
Shockwave therapy is generally considered safe when performed by a trained physiotherapist. However, as with any procedure, there are potential side effects.
Common (Mild and Short-Term)
- Temporary discomfort during treatment
- Redness or skin irritation
- Mild swelling or bruising
- Local tenderness for 24–48 hours
These symptoms usually settle quickly.
Less Common
- Increased soreness for several days
- Temporary numbness or tingling
- Lightheadedness
Rare
Serious complications are extremely uncommon, but may include:
- Nerve irritation
- Tissue irritation if applied incorrectly
Your physiotherapist uses appropriate assessment, dosage settings and clinical judgement to minimise risks.
When Should Shockwave Therapy Not Be Performed?
A full assessment and informed consent process occurs before treatment.
Absolute Contraindications
Shockwave therapy will not be performed if there is:
- Pregnant individuals
- People with blood clotting disorders or on anticoagulants
- Areas with metal implants or prostheses
- Tumours or active cancer in the treatment region
- Infections or open wounds
Relative Contraindications / Precautions
Additional care or medical clearance may be required if you have:
- Anticoagulant therapy or bleeding disorders
- Reduced sensation in the treatment area
- Acute inflammatory injuries
- Severe osteoporosis
- Growth plates in children or adolescents
- Certain neurological conditions
Your physiotherapist will determine whether shockwave therapy is appropriate for your individual situation.
What Should I Do After Treatment?
After shockwave therapy you may experience mild soreness for 24–48 hours.
To assist recovery:
- Continue gentle movement and normal daily activity
- Follow your prescribed exercise program
- Avoid heavy loading of the treated area for 24–48 hours
- Stay well hydrated
If you experience increasing pain, swelling, or unusual symptoms, contact your physiotherapist for advice.