Are you frustrated by heel pain, tennis elbow or calcification of the shoulder that won’t respond to conservative treatment? Shockwave therapy can be a solution.
Shockwave energy interacts with tissue at a cellular level, modulating pain receptors and stimulating new blood vessels and bone repair. The treatment improves movement, boosts collagen production and decreases inflammation.
The Benefits of ESWT
This treatment targets injured tendons, ligaments and bone structures by stimulating them without harming healthy tissue. It stimulates the production of new blood vessels (angiogenesis) that increase oxygen and nutrient delivery, accelerating the healing process. It also encourages the release of growth factors that help to regenerate tissue and build stronger structural structures. Its effectiveness and benefits make it a great addition to many orthopedic practices, sports medicine clinics, pain management programs and physical therapy departments.
In tendons, ESWT breaks up calcium deposits, known as calcifications, that can cause painful irritation and restriction of movement. It can also break up scar tissue, removing fibrosis and allowing tendons to become more flexible and mobile. This is especially beneficial for plantar fasciitis, tennis elbow and rotator cuff tendinopathy.
Shockwave therapy decreases inflammation and desensitizes pain receptors, providing immediate symptom relief. It also helps to reset the environment of the joint, preventing chronic inflammation from impeding healing.
The shock waves produced by ESWT stimulate the growth of new cells, resulting in a stronger and more flexible tissue structure. The increased flexibility and mobility that result from ESWT can reduce pain and help you return to your regular activities.
ESWT treatments can be performed in your doctor’s office, without the need for surgery or other invasive procedures. You can expect to experience some discomfort during the treatment, but it is typically well tolerated. The effects of ESWT usually begin to take effect after just one session, and they continue to improve over the course of several weeks or even months.
The most common conditions treated with ESWT are plantar fasciitis, knee pain, rotator cuff tendinopathy, shoulder pain and heel spurs. Studies have shown that ESWT can treat these conditions with greater effectiveness than traditional conservative therapies such as medications, orthotics, injections and physiotherapy, and with less pain and more rapid recovery time. Some patients experience pain relief after just one treatment session, but most benefit from a series of three to six weekly sessions. During your first treatment, your doctor will perform an ultrasound evaluation of the affected area to ensure that you are a good candidate for this procedure and to customize your therapy plan.
ESWT is a Non-Surgical Treatment
Unlike surgery, the shockwave treatment doesn’t remove or damage tissue. Instead, it stimulates the body’s natural healing process by increasing blood flow and removing adhesions. In a few sessions, most patients experience pain relief and improved mobility. Shockwave therapy is gaining favor with athletes because it helps them avoid rotator cuff injuries, and it’s also effective for patients with plantar fasciitis, tennis elbow, and more.
The treatment works by generating high or low-energy acoustic shock waves. These waves are transmitted through the skin to the complaint area. They resemble the sound of someone snapping their fingers and help break down adhesions, dissolve calcification, and trigger the body’s natural healing response.
Most protocols call for three to six treatments spaced a week apart. Each session lasts about fifteen minutes, with little or no downtime. Patients generally notice improvement within a few weeks, with benefits building over months.
A few situations make shockwave therapy a poor fit, although they’re not absolute contraindications. Bleeding disorders or blood-thinning medications are a concern, as shockwaves disrupt tiny blood vessels by design; impaired clotting raises the risk of significant bruising and bleeding into tissue. Pacemakers are an obvious exclusion, and pregnancy requires physician approval or a deferral. An active infection or open wound at the treatment site also calls for a discussion with your doctor.
Radial ESWT emits a wider field of energy than focused ESWT, making it suitable for most musculoskeletal problems. Most patients describe a tapping sensation that stings for the first half minute, but it’s usually more tolerable after that. Most therapists use local numbing to ease the discomfort.
One honest caveat: Shockwave therapy does best when it’s paired with rehab. Clinics that see the most impressive results almost universally pair it with progressive loading exercise, and it’s that combination, not the machine itself, that’s proven to work. Moreover, shockwave isn’t a cure for arthritis; some small studies support its use for knee osteoarthritis, but major guidelines recommend it as an accelerant to other therapies, not a replacement.
ESWT is a Non-Invasive Treatment
Shockwave therapy delivers acoustic energy to recalibrate your body’s natural repair mechanisms. The acoustic pulses stimulate blood flow, trigger the production of collagen and other essential proteins, break down calcifications, and promote angiogenesis (growth of new micro-blood vessels). This process is particularly effective in treating injured tissue that has poor vascular supply, such as tendons and fascia.
Unlike other regenerative therapies, ESWT is non-invasive, meaning no medications are prescribed. Instead, a hand-held device delivers pulses of high-energy sound waves to the area of pain. These pulses penetrate the surface of the skin to reduce pain, stimulate tissue growth, and accelerate healing.
ESWT is a relatively new treatment modality for musculoskeletal conditions like chronic tendinopathy, and has a growing body of evidence for its efficacy. In particular, it has been shown to be effective in treating rotator cuff calcific tendonitis, plantar fasciitis, tennis elbow, and iliotibial band syndrome.
The treatment sessions are quick, and patients report little to no discomfort. A topical gel is applied to the area prior to treatment, and a handheld applicator is placed on the skin. The applicator delivers short bursts of shockwaves to the area, and patients often feel a tapping sensation during treatments.
Following the application of the acoustic pulses, there is a brief period of rest before resuming normal activity. Many patients notice improvement after just a few treatment sessions. Inflammation decreases, movement feels smoother, and strength improves. The results build over time, and the acoustic energy continues to support your body’s innate healing processes.
Unlike more invasive modalities, the effects of ESWT last long after the session is complete. The acoustic pulses have a direct effect on mesenchymal stem cells, which are responsible for tendon and bone repair. Additionally, it reduces substance P, a chemical messenger that transmits pain signals to the brain, and increases nitric oxide, which can help lower inflammation levels.
The best way to determine if you’re a good candidate for ESWT is to schedule a clinical assessment with one of our experts. We’ll ensure you don’t have any contraindications to this non-invasive, drug-free treatment option that can provide a safe and effective middle ground between conservative care and surgery.
ESWT is a Painless Treatment
For anyone staring down surgery for chronic tendon problems like plantar fasciitis or tennis elbow, a low-risk, noninvasive treatment that works is a very attractive offramp. ESWT fits that bill, but it’s important to remember that the therapy itself isn’t a cure-all.
Instead, it’s a powerful tool that accelerates the body’s natural healing processes and helps it overcome chronic injury. The shockwaves themselves do little physical damage: they’re simply mechanical energy that sends a message to the cells that they need to heal.
The exact mechanism isn’t fully understood, but the shockwaves seem to stimulate mechanotransduction: the mechanical pressure from the shockwaves is converted into biochemical signals that enhance cell repair and growth. The waves also encourage the release of pain-inhibiting chemicals and promote the regeneration of tendon fibers.
Most treatments involve a therapist placing the ESWT applicator on or over your skin, then running it over the affected area for about five to fifteen minutes. The therapist can vary intensity and position to target different layers of the tissue. Some patients experience mild soreness and bruising shortly after the procedure, though this usually passes quickly.
A typical course runs from three to six sessions, spaced about a week apart. Your therapist will start with a full evaluation to make sure that you’re a good candidate for the therapy and to plan your course of treatment. Some protocols ask you to avoid high-impact activities for a day or two, but you can typically resume normal movement very soon afterwards.
The best way to understand how ESWT works is to see it in action. The video above shows a physiotherapist using a focused ESWT machine on the back of the foot and ankle of a patient with plantar fasciitis.
Focused ESWT draws from medical lithotripsy technology (kidney stone treatment) and was adapted for orthopedic indications in the early 2000s. Focused devices are able to target specific calcific or degenerative tissues, but their tiny treatment zones make it challenging to cover an entire heel or elbow within a single session. Wider-area radial machines are able to deliver more generalized shockwaves, but their biological effects are less clear.