Shockwave Therapy (ESWT) for Tendon and Heel Pain: A Patient Guide

Quick answer: Shockwave therapy, or extracorporeal shockwave therapy (ESWT), sends strong sound pulses into injured tendons and soft tissue to restart the body’s healing process. It is mainly used for long-standing tendon and heel pain that has not improved with exercise. Of all common physiotherapy machines, it has some of the strongest evidence, especially for plantar fasciitis and calcific shoulder tendinitis.

What is shockwave therapy?

Shockwave therapy delivers high-energy sound pulses from a handheld device through the skin. “Extracorporeal” simply means from outside the body. No needles or cuts are involved.

The technology came from treatments used to break up kidney stones. There are two main types:

• Radial shockwave spreads energy over a wider, shallower area. It is the most common type in clinics.
• Focused shockwave concentrates energy into a small, deeper point.

Both types appear to give similar results for most tendon problems.

How does shockwave therapy work?

Long-standing tendon pain is often a healing process that has stalled. Shockwave therapy acts like a controlled stimulus that restarts it. Research suggests it:

• Triggers the growth of new small blood vessels
• Releases growth factors that help tissue repair
• Helps break down calcium deposits in tendons
• Reduces pain by calming over-sensitive nerve endings

What conditions can shockwave therapy help treat?

Shockwave works best for chronic problems, usually present for more than 3 months:

• Plantar fasciitis (heel pain)
• Calcific tendinitis of the shoulder
• Lateral hip pain (greater trochanteric pain syndrome)
• Achilles tendinopathy
• Patellar tendinopathy (jumper’s knee)
• Tennis elbow
• Shin splints (medial tibial stress syndrome)

What happens during a shockwave therapy session?

• Your clinician confirms the diagnosis and finds the most tender spot.
• Gel is applied to the skin.
• The applicator delivers around 2,000 pulses over 5 to 10 minutes. You will hear a loud clicking sound.
• The intensity starts low and is increased to a level you can tolerate.
• Most people need 3 to 5 sessions, one week apart. The area may feel sore or slightly red for 1 to 2 days afterwards. Improvement builds gradually over 6 to 12 weeks, as the tissue remodels.
• After each session, avoid high-impact or heavy activity on the treated area for about 48 hours. Many clinicians also advise avoiding anti-inflammatory painkillers during the course, as they may dampen the healing response.

Who should avoid shockwave therapy?

Shockwave should not be used if you have:

• Pregnancy
• Cancer in or near the treatment area
• A blood clotting disorder
• An infection in the treatment area
• Open growth plates in the area (children and teenagers)

It should also not be aimed over the lungs, major nerves or blood vessels.

Your clinician should take extra care if you:

• Take blood-thinning medicines
• Had a steroid injection in the same area within the last 6 weeks
• Have a pacemaker (especially with focused shockwave)

Bottom line: Shockwave is a strong option for stubborn tendon and heel pain, especially when combined with a progressive exercise programme. It is not a first-line treatment for fresh injuries.

Frequently asked questions

Does shockwave therapy hurt?

It is uncomfortable, and some people find it painful at higher settings. The intensity is adjusted to your tolerance, and discomfort stops when the session ends.

How soon will I feel better after shockwave therapy?

Some people feel relief within days, but the main improvement usually appears 6 to 12 weeks after the last session.

Is shockwave therapy better than a steroid injection?

Steroid injections often work faster but the benefit may fade. Shockwave aims for longer-lasting improvement and avoids the risk of tendon weakening linked to repeated injections.

Can I continue exercising during shockwave treatment?

Yes. Keep up your rehabilitation exercises, but avoid heavy or high-impact loading for about 48 hours after each session.

Does shockwave therapy dissolve calcium deposits?

It can help break down calcium deposits in shoulder tendons, which often reduces pain and improves movement.

What if shockwave therapy does not work for me?

Your doctor may review the diagnosis and consider other options, such as ultrasound-guided injections or a revised exercise plan.