Shockwave therapy, or extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses a handheld device to pass acoustic pressure waves through the skin into a painful area. It is most often considered for long-standing tendon and soft-tissue problems such as plantar fasciitis, tennis elbow and Achilles tendinopathy, usually when they have not settled with other care. The UK's National Institute for Health and Care Excellence (NICE) found no major safety concerns for these uses, but describes the evidence on how well it works as inconsistent, so it helps some people more than others and is best used as one part of a wider rehab plan.
Key Takeaways
- Shockwave therapy sends acoustic pressure waves through the skin to a painful area. Nothing is injected and there is no incision.
- It is mainly considered for stubborn tendon and heel pain, such as plantar fasciitis, tennis elbow and Achilles tendinopathy, that has not settled with other care.
- NICE found no major safety concerns for those uses but rates the evidence on effectiveness as inconsistent. A good clinic tells you that before you start.
- Treatment can be uncomfortable. Tell your practitioner, because the intensity can be adjusted.
- Shockwave is an add-on to exercise and hands-on care, not a replacement for the loading work that tendons need.
In This Article
Shockwave therapy is a non-invasive treatment that uses a handheld device to send acoustic pressure waves through the skin into a painful tendon or soft-tissue area. It is mostly considered for stubborn problems like plantar fasciitis, tennis elbow and Achilles tendinopathy that have not settled with other care, and the honest summary of the research is that it helps some people more than others.
If a physiotherapist has mentioned shockwave, or you have seen it advertised and want to know whether it is worth trying, here is what it is, what the evidence says, and what to expect from a session.
What Shockwave Therapy Is
The full name is extracorporeal shockwave therapy, or ESWT. "Extracorporeal" simply means the waves are generated outside the body.
The UK's National Institute for Health and Care Excellence (NICE) describes it as "a non-invasive treatment in which a device is used to pass acoustic shockwaves through the skin to the affected area." There are no needles and no incision. A practitioner applies gel to the skin and holds the applicator over the sore spot while the device delivers a rapid series of pulses.
NICE also notes that the waves "can be either focused or unfocused (often referred to as radial shock waves)." The two types reach tissue differently, and clinics use different machines, so it is reasonable to ask which kind a clinic uses.
What Shockwave Therapy Is Used For
Shockwave therapy is mainly used for long-standing tendon and soft-tissue pain. NICE has published guidance on three of the most common uses:
- Plantar fasciitis: heel pain that is often worst with the first steps in the morning
- Tennis elbow: pain on the outside of the elbow, often from repetitive gripping
- Achilles tendinopathy: pain and stiffness in the tendon at the back of the ankle
Two of those guidance documents use the word refractory, meaning the condition has not responded to other treatment. That is the typical place for shockwave therapy. It is usually something to consider after exercise-based rehab and hands-on care have had a fair trial, not the first thing to try for a sore heel that started last week.
What the Evidence Actually Says
This is the part many clinic websites skip, so here it is plainly.
For plantar fasciitis, NICE states that the evidence "raises no major safety concerns; however, current evidence on its efficacy is inconsistent." Its guidance on tennis elbow uses the same wording. For Achilles tendinopathy, NICE found no major safety concerns, but says the evidence on efficacy "is inconsistent and limited in quality and quantity."
In each case NICE asks clinicians to "ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information."
In practical terms, shockwave therapy is not considered risky for these conditions, and some people do well with it. Studies have not produced consistent results, though, partly because the machines, energy levels and treatment schedules vary so much. NICE is a UK body and some of this guidance dates back to 2009 and 2016, but it remains a clear and independent summary.
Any clinic offering shockwave therapy should be comfortable telling you all of that before you book a course.
What a Session Feels Like
Your first visit should start with an assessment, not the machine. Your practitioner needs to confirm what is actually causing the pain and whether shockwave therapy suits it. Be open about your health history, any medications and whether you might be pregnant, because those affect which treatments are appropriate.
If you go ahead, the treatment itself is straightforward:
- Gel goes on the skin over the painful area
- The practitioner places the applicator and the device starts pulsing
- You feel firm, rapid tapping, usually strongest over the most tender spot
- The intensity can be turned up or down depending on how you tolerate it
NICE notes that high-energy shockwave therapy "can be painful" and that treatment "may be applied in one or several sessions." Speak up during treatment. Uncomfortable is expected; pain you cannot tolerate is a reason to adjust.
Before you leave, ask what to expect over the next few days and whether to change your training or daily activity in the meantime.
Shockwave Is One Part of a Plan
Tendons respond to load. Shockwave therapy may help calm a stubborn, painful area, but it does not rebuild the capacity of the tendon to handle walking, running, gripping or lifting. That comes from a gradual, well-judged exercise program.
That is why a sensible plan pairs any shockwave sessions with strengthening, activity changes and a return to normal load over time. If you are heading back into the gym after a tendon problem, our guide to returning to exercise after an injury explains how to progress without flaring things up again.
Shockwave Therapy at Anchor in Keswick
At Anchor, shockwave therapy is one of the treatment options available at our clinic alongside hands-on physiotherapy, acupuncture and exercise-based rehab. It is not a stand-alone service. Your practitioner will assess you first and talk you through whether it is likely to be a reasonable option for your condition, along with the alternatives.
Because our clinic and gym share one building on The Queensway South, the loading program that goes with your treatment can carry straight on into personal training once you are ready. For people in Keswick, Sutton, Pefferlaw and across Georgina, that avoids juggling a clinic in one town and a gym in another.
To find out whether shockwave therapy fits your heel, elbow or tendon pain, learn more about physiotherapy in Keswick or call us at (905) 535-4449.
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