Shockwave therapy: what it is and what the research says

Shockwave therapy, in professional terms radial ESWT, is a variant of shockwave therapy, which was originally used for kidney stones. Sound waves are sent into the area with a handheld device [5]. The method is used for long-standing tendon problems and pain in the musculoskeletal system, not for acute injuries [5].

The mechanism of action is not fully understood. The physiotherapist interviewed by NHI mentions two hypotheses: that the treatment may break down scar tissue in chronic tendon injuries and start a repair process, and that it may improve blood circulation [5].

The interview in NHI describes calcific shoulder tendinopathy and plantar fasciitis as the conditions with the best documentation. Achilles problems, jumper's knee and muscular problems around the hip joint are mentioned as conditions where the treatment is also used, and a possible effect is mentioned for long-standing tendon problems in the shoulder and elbow [5]. This is the physiotherapist's assessment, and the interview gives no figures for the effect.

On plantar fasciitis, NHI writes that shockwave therapy can help some people, and that it is relevant when usual treatment does not lead to improvement [6]. The British review found most research on tendon conditions and plantar fasciitis [1].

Health Technology Wales reviewed research on shockwave therapy for various musculoskeletal conditions. For most outcomes and conditions they found no statistically significant difference between shockwave therapy and no treatment, placebo or sham treatment. The effect varied between conditions and outcome measures [1].

Three network meta-analyses, for jumper's knee, plantar fasciitis and Achilles tendinopathy, generally found that shockwave therapy was not superior to other available interventions [2]. The review is based on few trials per condition, and the trials had small samples [2]. The evidence base was judged too heterogeneous for Health Technology Wales to give a recommendation [1].

The report is from November 2020. More recent studies are not assessed here.

The 2024 guideline for Achilles tendon pain recommends loading exercise as the first choice and gives this recommendation its highest grade of evidence. Shockwave therapy has no recommendation in the guideline. In the studies comparing exercise and shockwave therapy, exercise gave similar results, and in one study adding shockwave therapy to exercise gave no statistically significant difference in function [3].

The 2023 guideline for heel pain treated shockwave therapy as outside the scope of physical therapist practice in that update, and likewise gives no recommendation on the method [4].

The treatment is usually given as three to five sessions with at least one week between each. You start with low intensity and increase gradually [5]. It should be felt, but within what the patient can tolerate [5].

The interview in NHI points out that exercises and prevention are an important part of the treatment, and that the risk of recurrence increases without them [5].

Health Technology Wales assesses the evidence as showing that shockwave therapy is a safe option [1]. NHI describes the side effects as few. The treatment can feel uncomfortable, and some people get bruising [5].

According to NHI, caution applies to people who use blood-thinning medication, are pregnant, have an acute infection or wound, have cancer, or have recently received corticosteroid treatment. The treatment is primarily intended for adults [5]. Tell the therapist about such conditions before any treatment.

If you have had tendon problems for a long time, a physiotherapist can examine what triggers them and assess whether shockwave therapy is relevant as an addition to exercise and load management. You can read more on the page about shockwave therapy. For pain under the heel, you will find more on the page about plantar fasciitis.

What is shockwave therapy?

Shockwave therapy is a variant of extracorporeal shockwave therapy. Sound waves are sent into the area with a handheld device, usually for long-standing tendon problems [5].

Does shockwave therapy hurt?

The treatment can feel uncomfortable. It should be felt, but within what the patient can tolerate. Some people get bruising [5].

How many treatments are needed?

NHI describes usually three to five treatments, with at least one week between each [5].

Is shockwave therapy safe?

Health Technology Wales assesses the evidence as showing that the method is a safe option. Caution applies, among others, in pregnancy, with blood-thinning medication, acute infection or wounds, and cancer [1][5].

Does shockwave therapy work?

The research is mixed. For most outcomes and conditions, a British review found no statistically significant difference between shockwave therapy and placebo or no treatment [1][2]. The guidelines for Achilles tendon pain and heel pain give no recommendation on the method [3][4].

The article on plantar fasciitis describes symptoms, assessment and treatment of pain under the heel. If you have osteoarthritis in the knee or hip, the page about Aktiv med artrose may be relevant. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Extracorporeal shockwave therapy. Evidence Appraisal Report EAR022, November 2020. Health Technology Wales. Page last modified 19 December 2023. Link

2. Extracorporeal shockwave therapy for the treatment of musculoskeletal conditions. Health Technology Wales, 2021. INAHTA database. Link

3. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision, 2024. J Orthop Sports Phys Ther. 2024;54(12). Link

4. Koc TA Jr, et al. Heel pain, plantar fasciitis: revision 2023. J Orthop Sports Phys Ther. 2023. Link

5. Lein M. Trykkbølgebehandling: hva er det? (Shockwave therapy: what is it?) Interview with Benny Storheil, physiotherapist and manual therapist. NHI.no. 25 January 2023. Link

6. Plantar fasciitt (hælsmerter) (plantar fasciitis, heel pain). NHI.no. Last updated 22 September 2025. Link