What is Shockwave Therapy and How Does It Work?
An evidence-informed guide BY DR. ADAM GAVINE, BHK, M.CHIRO
Medically Reviewed By: Adam Gavine, BHK, M.Chiro https://www.backtofunction.com.au/about
Original Published: August 2019
Updated On: August 2026
To say that stubborn pain is difficult to manage is the understatement of the year. You may have reduced your activity, tried exercises or changed your footwear, yet the same symptoms continue to interfere with walking, work or sport.
Shockwave therapy is one non-invasive treatment that may be considered for selected musculoskeletal conditions, particularly when symptoms have persisted despite an appropriate period of conservative care.
However, the term “shockwave therapy” is used for several technologies, and the evidence is not equally strong for every condition. It should not be presented as a guaranteed cure or a replacement for proper assessment and rehabilitation.
At Back To Function, radial pressure wave therapy may be incorporated into a broader management plan when it is clinically appropriate for the individual.
What Is Shockwave Therapy?
Shockwave therapy is a non-invasive treatment that delivers mechanical acoustic energy through the skin into a targeted area.
In musculoskeletal care, two main technologies are commonly discussed:
Radial pressure wave therapy
A radial device uses compressed air to accelerate a small projectile inside the handpiece. The projectile strikes an applicator, creating pressure waves that spread outwards into the surrounding tissue.
The energy is highest near the applicator and disperses as it travels deeper. Radial pressure wave therapy is therefore commonly used for relatively superficial tendons, fascia and broader treatment areas.
This is the technology described in the original Back To Function article and used under the broader clinical term “shockwave therapy”.
Focused shockwave therapy
Focused devices generate acoustic energy using electrohydraulic, electromagnetic or piezoelectric technology. The energy can be concentrated at a selected depth within the body.
Focused and radial devices differ in how they generate and distribute energy. They should not be treated as technically identical, although both appear under the wider shockwave therapy category in research and clinical practice.
Neither technology is automatically better for every problem. Device selection should reflect the tissue being treated, its depth, the clinical evidence and the practitioner’s training.
How Does Shockwave Therapy Work?
The precise biological effects of shockwave therapy continue to be investigated. Research suggests that the mechanical stimulus can influence local tissue and nervous-system responses.
Proposed effects include:
Changes in local pain signalling
Temporary modulation of tissue sensitivity
Stimulation of cellular activity involved in tissue remodelling
Changes in local blood-flow responses
Effects on tendon structure and the tissue environment
Mechanical and biological effects on some calcific deposits
These are proposed mechanisms—not a guarantee that treatment will regenerate damaged tissue or immediately resolve pain.
The effect also depends on factors such as:
The condition being treated
How long symptoms have been present
The type of shockwave or pressure wave device
Treatment energy and number of pulses
The location and depth of the target tissue
Rehabilitation performed alongside treatment
The patient’s general health and physical demands
Which Conditions May Be Considered?
Shockwave therapy has been studied for several musculoskeletal conditions, but the quality and consistency of the evidence vary.
Plantar heel pain
Persistent plantar heel pain—commonly called plantar fasciitis or plantar fasciopathy—is one of the more extensively researched applications.
Symptoms often include pain near the underside of the heel, particularly during the first steps after rest or when standing and walking for extended periods.
A 2023 systematic review and meta-analysis found comparatively stronger evidence for improvements in pain and function in plantar fasciitis than for patellar or Achilles tendinopathy. However, the authors also identified differences between protocols and comparison treatments. Read the systematic review in Frontiers in Immunology.
Shockwave therapy is generally considered alongside other measures such as:
Load modification
Plantar fascia and calf exercises
Footwear advice
Progressive strengthening
Temporary activity modification
Management of relevant training or occupational demands
Lateral elbow tendinopathy
Lateral elbow tendinopathy—often known as tennis elbow—can affect people who repeatedly grip, lift or use tools, whether or not they play tennis.
Shockwave therapy may be considered for some persistent cases, particularly when symptoms have not responded adequately to activity modification and progressive exercise. Results vary, so treatment should be based on assessment rather than diagnosis alone.
Calcific shoulder tendinopathy
Shockwave therapy has been studied for calcific deposits within rotator-cuff tendons. The type of device and energy level matter, and focused shockwave technology has a more established role in some calcific applications.
A person with shoulder pain should first be assessed to determine whether the symptoms are consistent with calcific tendinopathy and whether further imaging or medical review is indicated.
Achilles and patellar tendinopathy
Shockwave therapy is sometimes used for Achilles or patellar tendon pain. Current evidence is mixed and may differ according to the tendon location, treatment protocol and exercise program used alongside it.
The 2023 systematic review found low-to-moderate evidence of negligible effects for patellar and Achilles tendinopathy compared with some control interventions. This does not mean no patient can benefit, but it does mean that claims of consistently high success rates are not justified.
Progressive tendon loading remains central to the management of most tendinopathies.
Other conditions
Shockwave therapy has been studied for other musculoskeletal and bone-related conditions. However, the technology, practitioner qualifications and evidence requirements differ substantially.
Applications such as fracture non-union or delayed bone healing generally involve specialised focused shockwave equipment, imaging and medical oversight. They should not be presented as routine indications for a radial pressure wave device.
Similarly, evidence for treating general back pain, tension headaches, lymphoedema, wounds or non-specific muscular trigger points is not equivalent to the evidence for established tendon and plantar heel applications.
What Causes Persistent Tendon Pain?
Tendinopathy often develops when the demand placed on a tendon exceeds its current ability to tolerate and recover from that load.
This may follow:
A rapid increase in running or training volume
Repetitive occupational activity
Returning to sport after a break
Introducing new hills, speed work or jumping
Reduced strength or conditioning
Inadequate recovery between sessions
Changes in footwear or playing surface
Repeated gripping or tool use
Tendinopathy is not simply ongoing inflammation. It involves changes in tendon structure, sensitivity and its response to load.
This is why passive treatment alone is rarely enough. Even when shockwave therapy helps reduce symptoms, the tendon generally still needs to be progressively prepared for the demands of work, sport or daily activity.
Shockwave Therapy and Exercise Work Together Differently
Shockwave therapy is a clinician-delivered intervention. Exercise rehabilitation helps the patient build long-term capacity.
They serve different purposes.
A complete plan may combine shockwave therapy with:
Isometric exercises for symptom-modulated loading
Progressive resistance exercise
Eccentric or heavy-slow resistance training where appropriate
Mobility exercises
Technique modification
Gradual return to sport
Review of training or occupational load
Treatment should not encourage indefinite rest. The goal is usually to identify a manageable level of activity and progressively increase the tendon’s tolerance.
What Does Treatment Feel Like?
During treatment, a clinician applies coupling gel to the skin and positions the applicator over the selected area. The handpiece delivers repeated mechanical pulses, often producing a tapping sensation.
The sensation varies according to:
The treatment area
Tissue sensitivity
Device settings
Pressure applied through the applicator
Individual pain tolerance
Some people describe the treatment as mildly uncomfortable. Others find sensitive areas more intense. Settings can generally be adjusted according to tolerance and clinical purpose.
A session may take approximately 5–10 minutes for one treatment area, although the complete appointment may be longer because assessment, reassessment and rehabilitation guidance are also required.
How Many Sessions Are Required?
There is no universal protocol for every condition. Research studies use different devices, doses, intervals and numbers of sessions.
A course often involves multiple treatments spaced over several weeks, but the recommendation should depend on:
Your diagnosis
Symptom duration
Response to previous care
Treatment tolerance
Functional goals
Progress between appointments
An ethical treatment plan should include regular review. If there is no meaningful improvement, the diagnosis and management strategy may need to be reconsidered rather than continuing treatment indefinitely.
What Happens After a Session?
You may experience temporary redness, tenderness, aching or mild bruising around the treated area. Some people feel relatively little afterwards.
Your practitioner may advise you to:
Monitor the area over the next 24–48 hours
Continue an agreed level of activity
Temporarily modify high-load exercise if the area is reactive
Complete prescribed rehabilitation exercises
Report unexpected or worsening symptoms
Follow any condition-specific recovery guidance
Immediate pain reduction can occur, but it is not guaranteed and does not necessarily indicate that the underlying condition has resolved. Improvement may develop gradually over the treatment and rehabilitation period.
Is Shockwave Therapy Safe?
Shockwave therapy is generally considered non-invasive and is commonly tolerated when delivered by an appropriately trained practitioner following clinical screening.
Potential adverse effects are usually temporary and may include:
Local discomfort
Redness
Minor swelling
Bruising
Temporary numbness or tingling
Short-term aggravation of symptoms
More significant complications are uncommon but remain possible, particularly if treatment is applied inappropriately or contraindications are overlooked.
The 2025 international expert recommendations published in the British Journal of Sports Medicine emphasise patient selection, standardised terminology, appropriate dosing and screening for contraindications. Review the expert recommendations for shockwave therapy in sports medicine.
When May Shockwave Therapy Be Unsuitable?
Treatment requires individual screening. Shockwave therapy may be unsuitable, require modification or need further medical clearance when there is:
Pregnancy with the fetus in or near the treatment field
Active malignancy in the treatment area
Active infection or an open wound at the proposed site
A significant bleeding or coagulation disorder
Anticoagulant medication or increased bleeding risk
A pacemaker or implanted electronic device near the field
Suspected tendon rupture
Reduced sensation that prevents reliable feedback
An acute fracture in the treatment area
Significant neurological or vascular compromise
Recent injection or procedure affecting the proposed site
Uncertain diagnosis requiring investigation
Contraindications differ according to the device, energy level and treatment location. Taking medication such as an anticoagulant does not always result in the same decision for every patient, but it must be disclosed and assessed before treatment.
Practical Advice Before Booking
Before beginning shockwave therapy, ask:
What condition is being treated?
Is the diagnosis reasonably clear?
Is the device radial or focused?
What does the evidence say for this particular condition?
What are the expected benefits and limitations?
What side effects or contraindications apply?
What rehabilitation will accompany the treatment?
How and when will progress be reviewed?
Be cautious of providers promising immediate healing, permanent results or a fixed success rate for every condition.
What to Expect at Back To Function
At Back To Function, shockwave therapy is not applied solely because an area is painful. Your first step is an assessment with Dr Adam Gavine to determine the likely nature of the condition and whether radial pressure wave treatment is a reasonable option.
The consultation may include:
A detailed history of your symptoms
Review of sporting, work and daily demands
Examination of the painful area
Assessment of movement, strength and function
Screening for contraindications
Review of previous treatment and relevant imaging
Discussion of your goals and care preferences
If shockwave therapy is appropriate, Dr Gavine will explain:
The area being treated
The proposed treatment approach
What the session may feel like
Potential benefits and limitations
Possible adverse effects
Alternative options
The accompanying rehabilitation plan
Treatment may be combined with Active Release Techniques®, myofascial treatment, chiropractic care, Kinesio Taping or exercise rehabilitation when clinically relevant. Not every patient will require every service.
Progress is reviewed according to changes in pain, function and activity tolerance—not simply whether the area feels tender during treatment.
Is Shockwave Therapy Right for You?
Shockwave therapy may be a useful component of care for selected persistent musculoskeletal conditions, particularly plantar heel pain and some tendon presentations. It is not equally supported for every diagnosis, and results cannot be guaranteed.
The strongest treatment plan is usually based on an accurate assessment, realistic expectations and active rehabilitation.
If persistent heel, tendon or activity-related pain is preventing you from walking, working or participating in sport, contact Back To Function to arrange an assessment with Dr Adam Gavine.
Appointments are available for patients from Mona Vale, Sydney’s Northern Beaches and the Central Coast. Call 0468 749 223, email adam@backtofunction.com.au, or book an initial chiropractic consultation online.
This article provides general health information and is not a substitute for individual healthcare advice, diagnosis or treatment.
AUTHOR BIO
Dr Adam Gavine, BHK, M.Chiro, is the Director and Chiropractor at Back To Function. With more than 19 years of clinical experience, he has a special interest in sports rehabilitation, musculoskeletal function and soft-tissue health.
Adam is a full-body certified Active Release Techniques® (ART) provider—one of only a handful in Australia—and co-founder of the Wasabi Method, a shockwave therapy education and clinical partnership. He is currently completing a PhD at the University of Sydney and provides care to patients across Sydney’s Northern Beaches and the Central Coast.
READ MORE
What Is Tendinopathy and What Can I Do About It? — Understanding tendon pain, load management and rehabilitation
What Causes Plantar Fasciitis and How to Find Treatment Options — Causes and management options for persistent plantar heel pain
What Exactly Is Tennis Elbow and How Can You Treat It? — Assessment and treatment considerations for lateral elbow tendinopathy
Go Hard, Then Go Home and Recover — Why training recovery matters for musculoskeletal health
