Scott Rayment – Podiatrist
Extracorporeal Shockwave Therapy (ESWT) was first introduced between 1982 and 1988 to treat kidney stones. Its success, with a low complication rate, saw its use expand across other areas of health over the following decades. Including sports injuries and chronic tendon conditions.
How does it work?
In simple terms, shockwave therapy sends low-frequency, high-amplitude waves into the tissue to trigger a long-term healing response alongside short-term pain relief. Research points to a process called mechanotransduction, where the wave's mechanical force is converted into a biological signal that kickstarts tissue repair.
Happens in two stages:
Short to intermediate term (days to weeks): shockwaves temporarily reduce your nerves’ ability to transmit pain signals, giving relief early on.
Longer term (months and beyond): increased blood flow to the area, which supports healing and tissue regeneration rather than just masking symptoms.
How do I know if this is a good option for me?
Shockwave therapy suits persistent, chronic soft tissue injuries such as heel pain (plantar fasciitis), Achilles tendon, tennis elbow and patella tendon injuries. A 2024 meta-analysis of 45 clinical trials saw meaningful pain reduction across all of these conditions. The strongest results were for Achilles and rotator cuff tendinopathy (Majidi et al., 2024). Unsure whether it’s appropriate for your specific injury? That’s a reasonable question to bring towards your treating practitioner or raise with the clinic directly.
Does it hurt, and is it dangerous?
Treatment can cause some discomfort, depending on the individual and the injury being treated. But your practitioner will start gently and build intensity as you feel comfortable with it. The risk of complications is low, generally considered a safer option than cortisone injection for the conditions it’s used for (De la Corte-Rodríguez et al., 2023).
How many sessions will I need?
Most people need 1 to 2 sessions a week, for a total of 4 to 6 sessions. This varies by case and by how established the injury is. If there's no improvement after the first or second session, we generally won’t continue with the remainder of the course. This is usually a sign the injury needs a different approach rather than more of the same treatment.
Where it fits into broader treatment
Shockwave isn’t typically used in isolation. For conditions like Achilles tendinopathy and plantar heel pain, it tends to work well alongside a structured loading or exercise program, rather than as a standalone treatment. It's hard to say exactly how well or how quickly someone will respond without seeing the injury directly, but how long it’s been present is usually one of the bigger factors.
Got a persistent tendon or soft tissue injury that hasn’t settled with the usual first-line approaches, shockwave might be worth discussing as part of your plan. Book an assessment to discuss your concerns with us.
References
De la Corte-Rodríguez H, Román-Belmonte JM, Rodríguez-Damiani BA, Vázquez-Sasot A, Rodríguez-Merchán EC. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthcare. 2023;11(21):2830.
Majidi L, Khateri S, Nikbakht N, Moradi Y, Nikoo MR. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomised controlled trials. BMC Sports Science, Medicine and Rehabilitation. 2024;16:93.