Shockwave therapy for chronic pain

Shockwave therapy has become a common feature of sports medicine and musculoskeletal clinics, but claims about what it can treat vary a lot depending on where you read about it. Rather than a general "shockwave helps with pain" pitch, this article looks specifically at what published research supports — condition by condition — including where the evidence is strong, and where it's still developing.

What Is Extracorporeal Shockwave Therapy (ESWT)?

Extracorporeal shockwave therapy delivers acoustic pressure waves through the skin to a targeted area, using a handheld device. It doesn't involve any incision or injection. The proposed mechanisms include stimulating local blood vessel formation, modulating pain signalling, and encouraging a localised healing response in affected tissue — research into the exact biological mechanisms is ongoing, and the picture isn't fully settled. There are two main types in clinical use: focused shockwave, which concentrates energy at a specific depth, and radial shockwave, which disperses energy more broadly from the point of contact and is generally used for more superficial structures.

The technology itself isn't new. It was originally developed for lithotripsy — breaking up kidney stones non-invasively — before researchers began investigating whether lower-intensity shockwaves could be applied to tendons, fascia, and other soft tissue for pain and healing purposes. It's been used in musculoskeletal medicine for several decades, which is part of why the evidence base for some conditions, like plantar fasciitis and calcific shoulder tendinopathy, is now relatively mature compared with more recently studied applications like chronic low back pain.

What Does the Research Actually Show?

Evidence quality and strength varies meaningfully by condition. Here's a general summary based on published systematic reviews and meta-analyses:

Plantar Fasciitis: The Strongest Evidence

Plantar fasciitis has the most consistent supporting evidence of any condition shockwave therapy is used for. A 2023 systematic review and meta-analysis published in Frontiers in Immunology, pooling data across multiple randomised controlled trials, found high-quality evidence of a large treatment effect on pain and function for plantar fasciitis specifically, sustained across short, mid, and long-term follow-up compared with placebo.

Calcific Shoulder Tendinopathy: One of ESWT's Longest-Established Uses

Shockwave therapy for calcific tendinopathy of the rotator cuff is one of its longest-studied applications. A 2024 systematic review and meta-analysis in BMC Musculoskeletal Disorders, covering 16 randomised controlled trials and over 1,000 patients, found statistically significant improvements in pain scores and multiple shoulder function measures compared with control treatment.

Chronic Low Back Pain: Promising, Still Developing

Two separate meta-analyses — one published in the Journal of Orthopaedic Surgery and Research in 2023 (pooling 632 patients), and an earlier 2021 review of 10 randomised controlled trials — both found statistically significant short-term reductions in pain and disability for chronic low back pain, with no serious treatment-related adverse events reported. Both sets of authors were consistent on one point worth repeating honestly: the evidence is promising, but more high-quality trials are still needed before it can be considered as well-established as the evidence for plantar fasciitis.

Tennis Elbow (Lateral Epicondylitis): Reasonable Support

Systematic reviews using formal levels-of-evidence grading have found shockwave therapy may be effective for lateral epicondylitis based on higher-quality trial data, generally used either alone or alongside targeted exercise therapy.

Achilles and Patellar Tendinopathy: A Genuinely Mixed Picture

This is worth being direct about rather than glossing over: evidence for shockwave therapy in Achilles and patellar tendinopathy specifically is inconsistent between reviews. Some meta-analyses report meaningful improvement compared with other treatments; the 2023 Frontiers in Immunology review noted above found a comparatively negligible pooled effect for these two conditions specifically, in contrast to the strong result for plantar fasciitis in the same analysis. If shockwave therapy is being suggested for Achilles or patellar tendinopathy, it's reasonable to ask your practitioner how they weigh this mixed evidence for your specific case, rather than assuming it's equally well-supported across every tendon in the body.

What Conditions Is Shockwave Commonly Used For?

In practice, shockwave therapy is most commonly offered for:

• Plantar fasciitis — heel and arch pain, particularly first thing in the morning
• Calcific and non-calcific rotator cuff tendinopathy — shoulder pain, sometimes linked to visible calcium deposits on imaging
• Achilles tendinopathy — pain and stiffness through the Achilles tendon, often worse with activity
• Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) — pain around the elbow linked to repetitive gripping or wrist movement
• Patellar tendinopathy (jumper's knee) — pain below the kneecap, common in jumping and running sports
• Chronic low back pain, as part of a broader treatment plan rather than a stand-alone approach
• Other chronic tendon-related pain, assessed case by case against the current evidence for that specific structure

What Does a Shockwave Therapy Session Involve?

A typical session takes around 10 to 15 minutes. The practitioner applies gel to the treatment area and moves the handheld applicator over the affected structure while delivering pulses of acoustic energy. It's common to feel some discomfort during treatment — it's not usually described as painless — and this is generally used as a guide to correct positioning over the affected tissue rather than something to push through regardless. Most people don't need anaesthetic for radial shockwave; higher-energy focused shockwave sometimes involves local anaesthetic, depending on the area treated. Treatment is typically delivered as a course of several sessions, often spaced around a week apart, rather than a single visit.

What Are the Possible Side Effects?

Reported adverse events from shockwave therapy are generally mild and temporary. The most commonly reported effects include:

• Temporary soreness, redness, or mild swelling at the treatment site
• Minor bruising, more common with higher-energy focused shockwave
• A short-term increase in pain in the treated area for a day or two following a session, before settling

Serious adverse events are uncommon across the published trials reviewed above, several of which specifically reported no serious treatment-related complications. As with any treatment, individual response varies, and your practitioner should talk you through what to expect and what to watch for after your specific sessions.

How Does Shockwave Compare to Other Conservative Options?

Shockwave therapy is generally considered alongside, not instead of, other conservative treatments — exercise-based rehabilitation, activity modification, and manual therapy remain a core part of managing most of the conditions listed above, with shockwave used as an adjunct rather than a stand-alone fix. Compared with corticosteroid injection, shockwave therapy doesn't carry the same tissue-weakening risks associated with repeated steroid injections into a tendon, though injections can offer faster short-term symptom relief in some cases. Compared with surgery, shockwave therapy is non-invasive with a far lower complication profile, which is part of why it's often tried as a conservative option before surgical treatment is considered for appropriate conditions — though it isn't a guaranteed alternative to surgery in every case, and some presentations genuinely need a surgical opinion regardless of conservative treatment tried.

Who Shouldn't Have Shockwave Therapy?

Shockwave therapy isn't appropriate for everyone. It's generally avoided or requires specific caution in the following situations:

• Pregnancy
• Bleeding disorders, or being on blood-thinning medication
• Known or suspected malignancy in the treatment area
• Active infection at the treatment site
• Over open growth plates in children
• Directly over a major nerve or blood vessel
• Certain cardiac devices, depending on treatment location and shockwave type

A proper assessment before treatment, including a review of your medical history, is what determines whether shockwave therapy is appropriate for you specifically.

What to Expect at Velca

If you're dealing with a chronic tendon issue or persistent pain that hasn't responded to other approaches, Velca offers shockwave therapy as part of a broader assessment — including whether it's genuinely a good fit for your specific condition, based on the evidence above, rather than a default recommendation for every kind of pain.

Frequently Asked Questions

Does shockwave therapy hurt?
Most people find it uncomfortable rather than severely painful, and discomfort is generally used to help confirm correct positioning over the affected area. Your practitioner should be able to adjust intensity and check in with you throughout.

How many sessions will I need?
This varies by condition and individual response, typically somewhere in the range of three to six sessions spaced roughly a week apart, though your practitioner should confirm an expected course based on your specific presentation rather than a fixed number applied to everyone.

Is shockwave therapy the same as ultrasound therapy?
No — they're different technologies with different mechanisms, despite sometimes being confused. Ultrasound therapy uses sound waves at a different frequency and intensity, primarily for a mild heating or tissue-stimulation effect, while shockwave therapy delivers higher-energy acoustic pulses aimed more specifically at pain modulation and tissue healing responses.

How soon will I notice results?
This varies considerably. Some people notice improvement within a couple of weeks; for others, particularly with more chronic or long-standing tendon issues, it can take several weeks after completing a course of treatment for the full effect to become apparent.

Can shockwave therapy replace surgery?
For some conditions, particularly calcific shoulder tendinopathy, shockwave therapy is sometimes used as a conservative alternative before surgery is considered. It isn't a guaranteed substitute for surgery in every case, and whether it's appropriate depends on your specific diagnosis and how you've responded to other conservative treatment.

Is shockwave therapy covered by ACC or insurance?
This depends on your specific circumstances, including whether your condition is linked to an accident or injury. Check with the clinic or your insurance provider about what applies to your situation before starting a course of treatment.

Can shockwave therapy be combined with exercise or physiotherapy?
Yes, and for several conditions — Achilles tendinopathy in particular — combining shockwave with a structured eccentric exercise programme is a common and often preferred approach rather than shockwave used in isolation. Your practitioner should be able to explain how the two fit together for your specific condition.

Will shockwave therapy work for every type of chronic pain?
No, and it's worth being wary of anyone who suggests it will. As the evidence summary above shows, support varies significantly by condition — it's well-supported for some, and genuinely uncertain for others. A proper assessment should tell you honestly whether your specific condition falls into the well-supported category before you commit to a course of treatment.

References

• Charles R, Fang L, Zhu R, Wang J. The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis. Frontiers in Immunology, 2023. Read the study
• Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 2024. Read the study
• Liu K, Zhang Q, Chen L, et al. Efficacy and safety of extracorporeal shockwave therapy in chronic low back pain: a systematic review and meta-analysis of 632 patients. Journal of Orthopaedic Surgery and Research, 2023. Read the study
• Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. 2021. Read the study

Getting Started

If you're considering shockwave therapy for a chronic tendon issue or persistent pain, the most useful next step is an assessment that looks honestly at whether the evidence for your specific condition supports it — not just whether it's available. Velca offers a complimentary check for new patients — book online or call 09 950 6801 to get started.

This article is general information and isn't a substitute for individual assessment or advice from a registered health practitioner.