Suffering with persistent tendon pain? It may be time to consider Shockwave Therapy…

What is Shockwave therapy?

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality that delivers acoustic waves via a handheld device to the affected tissues. The purpose of this treatment is to trigger the body’s own natural healing response. The exact mechanisms of ESWT are not fully understood1 . The theory behind this modality is that it creates mechanical stress and microtrauma in the tendon which triggers a cascade of biological responses, including increased blood flow2, formation of new blood vessels2, release of growth factors2,3, cell proliferation and increased collagen production 2,3.These changes ultimately lead to tissue regeneration and repair 2 . Finally, ESWT may help to relieve pain via a number of different pathways including stimulation of nociceptive c-fibres, increased pain inhibiting substances and nociceptor hyperstimulation (via the gate-control theory)1.

Who is this suitable for?

It is a non-invasive treatment option for any individuals who may be suffering with persistent tendon pain or plantar fasciitis/fasciopathy.

How is it delivered?

Using a handheld device, the shockwaves are delivered directly to the treatment area by your Physiotherapist. The duration of the treatment can vary, but it normally only takes a few minutes (often less than 5) to deliver each dose.

Is it safe?

This type of therapy is considered a safe and effective, non-invasive treatment option for a several pathologies of the musculoskeletal system4,5 without the dangers of the surgical procedures and postoperative pain4.  

Is it evidence based?

Yes, there have been several promising research papers and systematic reviews published to date supporting the use of ESWT to treat a number of musculoskeletal conditions, including Plantar fasciopathy/fasciitis6, Achilles tendinopathy7,8, patella tendinopathy8, greater trochanteric pain syndrome (GTPS)8, tennis elbow9, calcific tendinosis of the rotator cuff10 and many more.

Research is still ongoing to determine who this treatment modality may be most effective for and what the optimal dosages are.

A study published in 2021 by Abdelkader and colleagues11 showed some particularly promising findings which is worth taking a deeper dive into. This was a double blinded, randomised controlled trial on the effectiveness of shockwave therapy specifically on noninsertional Achilles tendinopathy. They recruited 50 adults (18-40 years) with persistent tendon pain that had failed conservative management. Both the control group and the treatment group completed guided physiotherapy rehabilitation exercises, but the treatment group also received shockwave therapy once a week for 4-weeks. Pain scores for both groups were measured at 4-weeks and 16-weeks post commencement of treatment. The main findings were that the study group had significantly superior scores (statistically and clinically) than the control group at both time points. These results are very impressive and further support the use for this modality in Achilles tendinopathy alongside a rehabilitation program.

Of course, further high quality randomized controlled trials are needed to validate these findings and help us to determine optimal dosages for each individual condition. 

Does it hurt?

The treatment itself is normally well tolerated but it can be uncomfortable for some people as the areas we are treating are often sensitive. Your Physiotherapist can adjust the settings or technique as needed to make it more comfortable.  

How many sessions will I need?

This depends on a number of factors including the site, severity and duration of symptoms. However, we normally recommend between three and six sessions for most conditions.

How do I find out more about this?

If you are suffering with persistent tendon pain or plantar fasciitis/fasciopathy despite trialling a period of rehabilitation, you may want to consider trialling a course of ESWT.

We have a brand new ESWT machine at Alaia so please get in touch with us if you would like to discuss this further or book in for an initial consultation. Following an assessment, we can discuss whether you would be a suitable candidate to start this intervention based on our findings and the available scientific evidence to date.

Ready to book your assessment? Book with one of our Physiotherapists HERE.

Questions? Reach out to us at

Sam Bellhouse, Registered Physiotherapist.


1: Schroeder, N, A. et al. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries, Current Sports Medicine Reports, 2021;20(6);p 298-305.

2: Wang, C.J., et al. An Overview of Shock Wave Therapy in Musculoskeletal Disorders. Chang Gung Med J. 2003;26(4):220–232.

3: Waugh, C.M., et al. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy. Eur Cell Mater. 2015; 29: 268-280.

4 Dedes, V., et al. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun; 30(2): 131–146. 

5:Schmitz, C., et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British Medical Bulletin, 2015 Dec; 116(1): 115–138. 

6: Melese, H, et al., 2022 Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials, Disabil Rehabil. 2022, Sep;44(18):5007-5014.

7: Feeney.K. M., The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review. Cureus. 2022, Jul 18;14(7).

8: Mani-Babu, S. et al. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. American Journal of Sports Medicine. 2015. Mar;43(3)3:752-61.

9: Yao, G., et al. Efficacy of Extercorporeal Shock Wave Therapy for Lateral Epidondylitis: A systematic Review and Meta-Analysis. Biomed Research International. 2020. 

10:  Bionka M.A. et al. Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis – A systematic review. Manual Therapy. 2011, Volume 16, Issue 5.

11: Abdelkader, N., et al.. Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy. Foot Ankle Int. 2021 Jun;42(6):788-797.