Does shockwave therapy work?

What is shockwave therapy?

Extracorporeal shockwave therapy (ESWT) delivers short, high-energy acoustic pressure waves through the skin to the painful area using a hand-held applicator. It is used for conditions such as plantar heel pain, tendon problems around the shoulder, elbow, knee and Achilles, and calcific tendinopathy.

It is thought to stimulate tissue healing, change pain signalling and break down calcium deposits, although the exact mechanisms are not fully understood.

Does it work for plantar heel pain?

A meta-analysis of seven randomised trials included people whose heel pain persisted despite at least three months of conservative treatment, with 294 people receiving shockwave therapy and 369 receiving placebo 1. Shockwave therapy improved pain scores compared with placebo 1.

People treated with shockwave therapy were more likely to achieve a 60 per cent improvement in heel pain on first steps in the morning (risk ratio 1.30) and during daily activities (risk ratio 1.44) 1. A clinical practice guideline on heel pain also includes shockwave therapy among the treatment options for plantar heel pain 2.

What about tennis elbow and other tendon problems?

Studies of shockwave therapy for tennis elbow, patellar tendinopathy and Achilles tendinopathy have shown mixed results. Some people improve, but the benefit over placebo or exercise alone is less consistent than for plantar heel pain.

For these conditions, progressive loading exercise is the main treatment, and shockwave therapy may be considered for persistent symptoms after a well-conducted exercise programme.

What is the treatment like?

Treatment usually involves several sessions, often a week apart. Each session lasts a few minutes. The pulses can be uncomfortable or painful, and the intensity is often adjusted to tolerance.

Continuing exercises and load management alongside shockwave therapy is usually recommended.

Are there side effects?

Common side effects include temporary pain, redness, swelling or bruising at the treatment site. Serious side effects are uncommon.

Shockwave therapy is generally avoided over areas with infection, tumours, open growth plates in children, during pregnancy, and in people with bleeding disorders or taking certain blood thinners, depending on the device and area treated.

Who is shockwave therapy not suitable for?

Shockwave therapy is not a first treatment for recent pain. Most heel and tendon problems settle with load management, footwear changes and exercise, and a reasonable trial of these usually comes first. People with pain that is spreading, pain at rest or at night, or symptoms in both feet or several joints need a diagnosis before any device-based treatment is considered.

It is also less suitable when expectations are unrealistic. Shockwave therapy may reduce pain enough to allow more activity, but it does not rebuild tendon capacity by itself. People who stop exercising after treatment often find that symptoms return when they increase their activity again.

How can I tell whether shockwave therapy is working for me?

A useful approach is to record a few simple measures before treatment and repeat them every few weeks, for example pain with the first steps in the morning, how long you can walk or stand before pain starts, and pain the day after activity. Change is usually gradual rather than immediate.

If there is no meaningful improvement several weeks after a completed course, repeating the same treatment is less likely to help. At that point it is worth reviewing the diagnosis, the exercise programme and daily load with your clinician.

When should heel or tendon pain be assessed first?

Before considering shockwave therapy, pain should be assessed to confirm the diagnosis. Heel pain with numbness, night pain, swelling, fever or pain after an injury may have another cause.

Sudden severe pain with a snap at the back of the ankle may indicate an Achilles rupture and needs urgent assessment.

Frequently asked questions