Shockwave physiotherapy, also called extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses high-energy acoustic sound waves directed at injured soft tissues to stimulate blood flow, break down scar tissue, and trigger the body’s natural healing response. It is most commonly used to treat chronic tendon conditions like plantar fasciitis, Achilles tendinopathy, tennis elbow, and calcific tendinitis of the shoulder. Sessions last about 5 to 10 minutes, most patients need 3 to 5 treatments spaced a week apart, and the procedure requires no anaesthesia, no incisions, and no downtime.

This blog explains how shockwave therapy works, which conditions it treats, what the evidence says about its effectiveness, what the treatment feels like, who should avoid it, and how it compares to other non-invasive modalities like laser therapy that target the same conditions.

What Is Shockwave Physiotherapy and How Does It Work?

Shockwave physiotherapy is a treatment that delivers controlled acoustic sound waves through the skin into injured tendons, muscles, and other soft tissues to stimulate cellular repair, increase blood vessel formation, and modulate pain pathways. The technology originated in urology, where high-energy sound waves (lithotripsy) have been used since the early 1980s to break apart kidney stones. Decades later, researchers adapted the technology for orthopaedic and musculoskeletal conditions, and it is now a well-established tool in physiotherapy clinics worldwide.

Shockwave therapy works through a process called mechanotransduction. When the acoustic waves pass through the skin and into the target tissue, they create a mechanical force at the cellular level. That mechanical force triggers several biological responses: cells in the treatment area begin to proliferate and migrate toward the injury site, new blood vessels form (a process called neovascularisation) to deliver more oxygen and nutrients to the damaged tissue, collagen production increases to rebuild the structural matrix of tendons and ligaments, and pain pathways are modulated through overstimulation of local nerve endings and reduction of substance P (a chemical messenger involved in pain signalling). According to a 2025 article by Dr. Joshua Romero at Mayo Clinic, these cellular changes can stimulate tissue remodelling, with more durable improvements in pain and function appearing 8 to 12 weeks after treatment.

There are two distinct types of shockwave devices, and the distinction matters because each delivers energy differently. Focused shockwave (FSW) generates a true shockwave using electrohydraulic, electromagnetic, or piezoelectric technology. FSW concentrates its maximum energy at a specific depth within the tissue, which makes it effective for both tendon conditions and bone-related pathologies like delayed fracture healing and avascular necrosis. Radial pressure wave (RPW) therapy uses a projectile mechanism that strikes an applicator tip, producing a wave that reaches its maximum energy near the skin surface and dissipates as it travels deeper. RPW is most effective for superficial tendinopathies and fasciopathies. Both types can be used separately or together depending on the condition being treated.

What Conditions Does Shockwave Therapy Treat?

Shockwave therapy treats chronic tendinopathies, fasciopathies, calcific deposits, and certain bone pathologies that have not responded to conservative care like rest, stretching, and anti-inflammatory medication. The International Society for Medical Shockwave Treatment (ISMST) maintains a consensus list of supported indications based on current clinical evidence.

Condition	What It Is	How Shockwave Helps
Plantar Fasciitis	Inflammation and degeneration of the thick tissue band connecting the heel bone to the toes, causing heel pain	Stimulates blood flow and collagen production in the plantar fascia; breaks down scar tissue at the heel insertion
Achilles Tendinopathy	Chronic degeneration of the Achilles tendon at the back of the ankle, causing pain and stiffness	Promotes neovascularisation and tendon remodelling; reduces pain through nerve pathway modulation
Tennis Elbow (Lateral Epicondylopathy)	Chronic tendon degeneration at the outer elbow from repetitive gripping and wrist extension	Stimulates cellular repair at the tendon insertion; breaks down disorganised scar tissue
Calcific Tendinitis of the Shoulder	Calcium deposits form within the rotator cuff tendons, causing pain and restricted movement	Breaks down calcium deposits through acoustic energy; promotes reabsorption of calcified material
Patellar Tendinopathy (Jumper’s Knee)	Chronic tendon degeneration below the kneecap, common in sports involving jumping and landing	Stimulates tendon healing and collagen remodelling; reduces pain during activity
Greater Trochanter Pain Syndrome	Pain on the outer hip caused by tendon degeneration or bursitis at the greater trochanter	Promotes tissue repair at the gluteal tendon insertions; reduces inflammation around the bursa

Sources: International Society for Medical Shockwave Treatment (ISMST), Mayo Clinic, U.S. Food and Drug Administration

Plantar fasciitis affects approximately 10 percent of the population over a lifetime, according to the American Academy of Family Physicians. Tennis elbow affects 1 to 3 percent of adults each year. Achilles tendinopathy affects roughly 6 percent of the general population. These conditions share a common feature: they involve chronic tendon degeneration rather than acute inflammation, which is why they often resist standard treatments like ice, rest, and anti-inflammatory medication. Shockwave therapy targets the underlying degeneration by stimulating the cellular repair processes that tendons need to rebuild their structural integrity.

Does Shockwave Therapy Actually Work?

Yes, shockwave therapy works for specific chronic tendon conditions, with the strongest evidence supporting its use for plantar fasciitis, calcific tendinitis of the shoulder, and lateral epicondylopathy. Multiple systematic reviews and randomised controlled trials have demonstrated meaningful improvements in pain and function compared to placebo and other conservative treatments.

For plantar fasciitis, systematic reviews report success rates of 76 to 80 percent, with patients experiencing significant pain reduction and improved function at 12-week follow-up. For calcific tendinitis of the shoulder, focused shockwave therapy has been shown to dissolve calcium deposits and restore range of motion in the majority of treated patients. The ISMST recognises these conditions as established indications based on consistent positive findings across multiple high-quality trials.

The evidence is more mixed for some conditions. Achilles tendinopathy and patellar tendinopathy show positive trends in clinical research, but the effect sizes are smaller and the study quality more variable. The Mayo Clinic’s Dr. Romero notes that while the evidence base is expanding, patients should understand that durable improvements in pain and function may take 8 to 12 weeks to fully develop after treatment. Shockwave therapy works best as part of a comprehensive rehabilitation plan that includes targeted exercise rehabilitation, manual therapy, and activity modification. The shockwave stimulates the cellular repair process; the exercise program ensures the repaired tissue is strong enough to handle the demands of daily life and sport.

What Does Shockwave Therapy Feel Like?

Shockwave therapy feels like a rapid series of strong tapping or pulsing sensations at the treatment site, and most patients describe the intensity as uncomfortable but tolerable. The sensation varies depending on the type of device (focused shockwave is generally more intense than radial pressure wave), the energy level used, and the sensitivity of the tissue being treated.

The clinician applies a coupling gel to the skin over the treatment area and presses a handheld applicator against the surface. The device then delivers the acoustic pulses in rapid succession. Patients typically feel increased discomfort when the applicator targets the most damaged portion of the tendon, which is actually a useful clinical indicator because it confirms the sound waves are reaching the right tissue. The intensity is adjusted throughout the session based on the patient’s feedback, and most clinicians start at a lower energy setting and gradually increase as the patient acclimatises.

Sessions last approximately 5 to 10 minutes per treatment area. Mild soreness, redness, or light bruising at the treatment site can occur afterward, but there is no major downtime and most patients return to their normal activities immediately. The soreness typically settles within 24 to 48 hours. Patients should avoid high-impact activities and anti-inflammatory medications for 48 hours after treatment, because the inflammatory response triggered by the shockwave is part of the healing mechanism and suppressing it with medication can reduce the treatment’s effectiveness.

Who Should Not Get Shockwave Therapy?

People with malignancy in the treatment area, pregnant patients where the treatment zone overlaps with the fetus, patients with severe coagulation disorders, and children with open growth plates (epiphyseal plates) in the treatment area should not get shockwave therapy.

The full list of contraindications recognised by the ISMST includes:

• Malignant tumour in the treatment area (acoustic waves could stimulate tumour cell activity)
• Pregnancy, when the treatment area overlaps with the fetus
• Severe coagulopathy or blood clotting disorders (risk of hematoma formation)
• Epiphyseal plates (growth plates) in the treatment area for pediatric patients (risk of growth disturbance)
• Lung tissue in the treatment area for high-energy focused shockwave (risk of pneumothorax)
• Brain or spinal cord in the treatment area for high-energy focused shockwave
• Active infection at the treatment site
• Cortisone injection at the treatment site within the previous 6 weeks (tissue may be weakened)

Your physiotherapist or treating clinician screens for all contraindications before the first session. The screening includes a health history review, a physical examination of the treatment area, and confirmation that the patient is not taking anticoagulant medications that could increase bruising or hematoma risk. Shockwave therapy has a strong overall safety profile when administered by a trained clinician, with documented side effects limited to temporary skin redness, mild bruising, and localised soreness at the application site.

How Many Sessions of Shockwave Therapy Do You Need?

Most patients need 3 to 5 sessions of shockwave therapy, spaced approximately one week apart. The total number depends on the condition being treated, the severity of the tendon degeneration, and how the patient responds to the initial sessions. Some patients feel improvement after the first or second session; others need the full course before noticing a meaningful change.

The one-week spacing between sessions allows the tissue to respond to the mechanical stimulus before receiving the next dose of acoustic energy. Treating too frequently does not accelerate healing and can overload the tissue before the repair process has progressed. Treating too infrequently allows the tissue to return to its baseline state before the next session reinforces the healing response.

After the final session, the full benefit of shockwave therapy continues to develop over the following 8 to 12 weeks as the stimulated tissue completes its remodelling process. During this period, patients typically follow a structured physiotherapy program that includes progressive loading exercises to strengthen the healing tendon. The combination of shockwave-stimulated cellular repair and exercise-driven mechanical loading produces the strongest and most durable outcomes. Chiropractic care can also support recovery by addressing joint restrictions or biomechanical imbalances that contributed to the tendon overload in the first place.

What Should You Not Do After Shockwave Therapy?

You should not take anti-inflammatory medications (such as ibuprofen or naproxen), apply ice to the treatment area, or perform high-impact activities for 48 hours after shockwave therapy. These restrictions exist because the treatment deliberately triggers a controlled inflammatory response in the damaged tissue, and suppressing that inflammation reduces the therapeutic effect.

Anti-inflammatory medications block the prostaglandin cascade that drives the cellular repair process shockwave therapy is designed to initiate. Ice constricts blood vessels and reduces the blood flow that carries repair cells and growth factors to the treatment site. High-impact activities like running, jumping, or heavy lifting can overload the tissue before the repair process has gained enough traction to withstand mechanical stress.

After the 48-hour window, patients can gradually resume their normal activities and continue their prescribed rehabilitation exercises. Light walking, gentle stretching, and daily functional activities are encouraged throughout the treatment course. Massage therapy to surrounding muscles can complement the recovery by reducing compensatory tension patterns that develop when a painful tendon alters the way the body moves.

How Shockwave Therapy Compares to Other Non-Invasive Treatments

Shockwave therapy compares favourably to other non-invasive treatments for chronic tendon conditions, and it fills a specific gap in the treatment continuum between failed conservative care and surgical intervention. Patients who have tried rest, stretching, orthotics, and anti-inflammatory medication without lasting relief are the primary candidates for shockwave therapy.

Laser therapy in physiotherapy shares some of the same treatment targets as shockwave. Class IV laser therapy delivers red and near-infrared light energy that stimulates cellular energy production (ATP), reduces inflammation, and promotes tissue repair at the mitochondrial level. Laser therapy is generally painless, requires no recovery restrictions, and treats a broader range of conditions including chronic back and neck pain, sports injuries, and post-surgical inflammation. Shockwave therapy delivers a stronger mechanical stimulus specifically to tendon and fascia tissue, which makes it more targeted for chronic tendinopathies but less versatile across other musculoskeletal conditions.

Both modalities work best alongside therapeutic exercise and manual therapy rather than as standalone treatments. The physiotherapy profession’s strongest evidence base supports active, exercise-based rehabilitation as the foundation for chronic musculoskeletal recovery. Modalities like shockwave and laser therapy enhance that foundation by addressing the tissue-level healing that exercise alone may not fully achieve. According to the Canadian Physiotherapy Association, 76 percent of Canadians with musculoskeletal pain report significant improvements after physiotherapy, and the addition of targeted modalities can further improve outcomes for patients with stubborn tendon conditions.

Frequently Asked Questions

Can Shockwaves Heal Tendonitis?

Shockwaves can help heal chronic tendinopathy (tendon degeneration) by stimulating the cellular repair processes that tendons need to rebuild their structural integrity. Shockwave therapy is most effective for tendons that have failed to respond to standard conservative treatments like rest, stretching, and anti-inflammatory medication. The treatment promotes new blood vessel formation, collagen production, and tissue remodelling over an 8 to 12 week period following the final session. Acute tendonitis (recent inflammation without structural degeneration) typically responds well to conservative care and does not require shockwave therapy.

How Long Does Shockwave Therapy Last?

The effects of shockwave therapy last months to years in the majority of successfully treated patients. Clinical studies show sustained improvements in pain and function at 6-month and 12-month follow-up periods for conditions like plantar fasciitis and calcific tendinitis. The durability of the results depends on whether the underlying biomechanical factors that caused the tendon overload have been addressed through rehabilitation, footwear changes, activity modification, or custom orthotics.

Does Insurance Cover Shockwave Therapy in Canada?

Most extended health insurance plans in Canada do not cover shockwave therapy as a standalone treatment. The U.S. Food and Drug Administration has approved shockwave for plantar fasciitis, but coverage policies vary by insurer and by country. When shockwave is delivered as part of a physiotherapy or chiropractic appointment by a registered practitioner, the physiotherapy or chiropractic benefit may apply to the session as a whole. Check with your specific insurance provider to confirm whether your plan covers the treatment.

Can You Do Your Own Shockwave Therapy at Home?

You cannot safely replicate clinical shockwave therapy at home. Consumer-grade percussion massage devices and vibration tools do not generate the acoustic waveforms (focused shockwave or radial pressure wave) that produce the mechanotransduction effects responsible for tissue remodelling. Clinical shockwave devices are calibrated to deliver specific energy levels at specific depths, and the treatment parameters must be adjusted by a trained clinician based on the condition, the tissue response, and the patient’s tolerance.

What Is the Difference Between Shockwave and Ultrasound Therapy?

Shockwave therapy delivers high-energy acoustic pulses that create a strong mechanical force in the target tissue, stimulating cellular repair and tissue remodelling. Therapeutic ultrasound delivers high-frequency sound waves at much lower energy levels, producing mild heat and gentle mechanical vibration. Shockwave therapy has a stronger evidence base for chronic tendinopathies and calcific conditions, while therapeutic ultrasound evidence has weakened in recent years for most musculoskeletal conditions. The two modalities serve different purposes and are not interchangeable.

Is Shockwave Therapy Better Than Cortisone Injections?

Shockwave therapy and cortisone injections address tendon pain through opposite mechanisms. Cortisone suppresses inflammation and provides rapid short-term pain relief, but repeated injections can weaken tendon tissue over time. Shockwave therapy stimulates a controlled inflammatory and repair response that strengthens the tendon, but the pain relief develops gradually over weeks. For chronic tendinopathies where long-term tissue health matters, shockwave therapy offers a tissue-building approach that cortisone does not. Many clinicians reserve cortisone for acute flares and use shockwave for chronic structural degeneration.

The Takeaway

Shockwave physiotherapy uses high-energy acoustic sound waves to stimulate tissue repair, break down scar tissue and calcium deposits, and reduce chronic tendon pain without surgery or medication. The strongest evidence supports its use for plantar fasciitis, Achilles tendinopathy, tennis elbow, calcific tendinitis, and patellar tendinopathy. Most patients need 3 to 5 sessions spaced one week apart, with full results developing over 8 to 12 weeks as the tissue completes its remodelling process. Shockwave therapy works best alongside physiotherapy, targeted exercise, and manual therapy.

If you are dealing with a chronic tendon condition that has not responded to rest, stretching, or medication, a thorough assessment can identify which treatment approach is right for your situation. At KC Rehab in Markham, our physiotherapists, chiropractors, and registered massage therapists use a range of evidence-based modalities including Class IV laser therapy, manual therapy, and exercise rehabilitation to treat the same chronic musculoskeletal conditions that shockwave therapy targets. Call us at 905-205-1668 or book online to schedule your assessment.