If you’ve been dealing with a stubborn tendon injury, chronic heel pain, or a musculoskeletal condition that hasn’t responded to conventional treatment, there’s a good chance shockwave therapy has come up in conversation. It’s a treatment we use routinely in the clinic, and one of the most frequently misunderstood.

Below, we set out what shockwave does, the biological mechanisms behind it, and how we use it.

What Shockwave Therapy Actually Is

Shockwave therapy is a non-invasive treatment that delivers high-energy acoustic waves into injured or dysfunctional tissue. These are not electrical shocks but mechanical pressure waves, similar in nature to sound waves, produced by a handheld device applied to the skin. The rapid rise and fall in pressure as the wave travels through tissue is what distinguishes it from therapeutic ultrasound, and it produces fundamentally different biological effects.

Two main types are used clinically. Radial shockwave therapy (RSWT) delivers lower-energy waves that disperse from the point of contact, suiting more superficial structures like plantar fasciitis, Achilles tendinopathy, and tennis elbow. Focused shockwave therapy (FSWT) produces a higher-energy beam that penetrates deeper and can be targeted precisely within tissue, suiting calcific tendinopathy, bone healing, pelvic conditions, and chronic deep-seated tendon pathology. At our clinics, we use the Storz Duolith and the EMS Doloclast Piezoclast, both established clinical-grade systems.

The Biological Mechanisms: What Happens Inside the Tissue

Shockwave doesn’t simply numb pain or briefly increase circulation. The acoustic waves trigger biological responses that promote tissue repair, which helps explain why the treatment suits some conditions and not others.

Kick-starting a Stalled Healing Response

Chronic tendon and soft tissue injuries often persist because the healing process has stalled: cells stop turning over, new collagen isn’t being laid down, and structural repair switches off. Shockwave disrupts this dormancy, stimulating tenocytes and fibroblasts to produce new collagen. A systematic review of the biological effects of shockwave on tendon tissue found an upregulation of growth factors, including TGF-beta1 and VEGF, following treatment, both central to soft tissue regeneration.

Increased Blood Flow and Neovascularisation

Healthy repair depends on adequate blood supply, and injured tendons are often poorly vascularised at high-load areas like the mid-portion Achilles or patellar insertion. Shockwave causes vasodilation and promotes the formation of new blood vessels by stimulating VEGF and eNOS, delivering more oxygen and nutrients to the repair site.

Pain Modulation via Substance P

Patients often report a reduction in local pain within the first few sessions. One proposed mechanism involves Substance P, a neuropeptide involved in transmitting pain signals. Shockwave appears to reduce local concentrations of Substance P and influence C-fibre nerve endings, which is thought to contribute to a sustained change in pain perception rather than a short-term analgesic effect alone.

Breaking Down Calcific Deposits

For calcific tendonitis, shockwave has a specific additional mechanism. Calcium hydroxyapatite crystals respond to focused acoustic energy by fragmenting and softening, after which the body can reabsorb the particles. This is particularly relevant for calcific shoulder tendinopathy, where a single deposit can cause severe pain and loss of movement. Focused shockwave has a reasonable evidence base here and may be considered before more invasive procedures such as barbotage. Suitability depends on the size and location of the deposit and on a proper clinical and imaging assessment.

What Conditions Does Shockwave Therapy Treat?

We use shockwave across a range of musculoskeletal and soft tissue conditions, with the strongest evidence base for chronic tendinopathies. A 2022 systematic review of randomised controlled trials examined its effectiveness for mid-portion and insertional Achilles tendinopathy. Common reasons patients book a course include stubborn plantar fasciitis that has not settled with orthotics or stretching. A second is persistent Achilles tendon pain in active patients.

The figures below are averages drawn from clinical practice and the published literature. Individual courses are tailored to the diagnosis and response.

Condition	Type of Shockwave	Average Sessions
Plantar fasciitis	Radial or focused	3-5
Achilles tendinopathy	Radial or focused	4-6
Calcific tendonitis (shoulder)	Focused	6-8
Patellar tendinopathy	Radial or focused	4-6
Greater trochanteric pain syndrome	Radial	3-5
Tennis elbow	Radial	3-5
Bone stress injuries	Focused	6-8
Medial tibial stress syndrome	Radial	3-5
Chronic pelvic pain	Focused	6-8
Erectile dysfunction	Focused (low-intensity)	6-12

Conditions resistant to standard physiotherapy for three months or more often respond best to shockwave. It tends to suit tissue that is degenerative rather than acutely inflamed, which is why a thorough assessment is essential before any course is started.

What to Expect During a Session

A shockwave session typically takes 15 to 20 minutes. We apply a coupling gel to the skin over the target area, then deliver the acoustic waves through a handheld applicator. Most people describe a dull aching pressure, similar to a deep tissue massage. The first session can feel more uncomfortable over areas with active pain, and we calibrate intensity to a level the patient can tolerate, generally in the 4 to 6 out of 10 range, since the literature suggests this is the therapeutic window for most tendon conditions.

There is no downtime afterwards. Most patients return to normal activities immediately, though we advise reducing high-impact loading for 24 to 48 hours. Responses vary, but mild aching for 24 to 72 hours is common; some patients notice a short-term flare after the first session that settles within days, and improvement is usually gradual rather than dramatic.

How Many Sessions Will You Need?

It depends on the condition, its severity, and how long it has been present. As a general guide, moderate tendinopathies tend to need 3 to 5 sessions, while calcific tendonitis, bone healing, and chronic pelvic conditions often require 6 to 8. These are averages, not guarantees of outcome. Sessions are usually spaced five to seven days apart, with progress reviewed at each appointment.

Is Shockwave Therapy Safe?

Shockwave therapy has a strong safety record in the published literature. It is non-invasive, does not involve radiation, and does not require anaesthesia. The most common side effect is temporary local soreness; rarer reported effects include minor skin bruising or a short-term increase in symptoms before improvement.

The list below covers the main contraindications we screen for at assessment. It is not exhaustive, and decisions about suitability are made on an individual basis:

• Active infection or open wounds at the treatment site.
• Malignancy in or near the treatment area.
• Pregnancy (in the pelvic or lower abdominal region).
• Growth plates in skeletally immature patients.
• Pacemakers or similar devices near the chest.

If you are on blood-thinning medication or long-term steroids, we will discuss this at assessment. In many cases, it doesn’t prevent treatment, but it does inform how we approach it. If you have other significant medical conditions, please mention them and, where appropriate, speak to your GP before starting treatment.

Shockwave Therapy Versus Corticosteroid Injections

“Should I have a steroid injection or shockwave?” is a common question in the clinic. Both have a role; the right choice depends on the diagnosis, the stage of the condition, and what has been tried already. The comparison below relates to tendon conditions generally and is not a recommendation for any specific individual.

	Corticosteroid Injection	Shockwave Therapy
Speed of pain relief	Fast (days to weeks)	Gradual (weeks)
Duration of benefit	Variable, often 4-12 weeks	Long-term, in many cases
Effect on tissue healing	May inhibit collagen production	May promote tissue repair
Number of treatments	Usually 1-3	3-8 sessions
Risk of tendon damage	Higher with repeated use	Low
Best suited to	Acute flare, bursitis	Chronic tendinopathy, calcific deposits

Steroid injections can help reduce an acute inflammatory flare, particularly in conditions like bursitis or early frozen shoulder. For chronic tendinopathy, the evidence increasingly favours shockwave because it addresses the structural problem rather than temporarily suppressing pain. A large systematic review published in The Lancet found that corticosteroid injections reduce pain in the short term, but that benefit was reversed at intermediate and long-term follow-up for several tendon conditions. We use both treatments where the evidence supports doing so, and you can read more on our joint injections service page.

Why We Use Shockwave Therapy at Core Body Clinic

We have used shockwave across a range of presentations since the clinic was founded in 2014. We use it alongside structured rehabilitation rather than as a standalone fix: shockwave stimulates the repair process, and progressive loading translates that biological response into a clinical result.

Our shockwave assessments are carried out by qualified physiotherapists. Every patient starts with a detailed assessment, and diagnostic ultrasound is available where appropriate. If the assessment points to a different problem, such as a partial tendon tear needing a surgical opinion, we’ll say so and adjust the plan. When shockwave is the right call, the course is structured, reviewed at each appointment, and paired with an integrated loading programme from session one.

Book an Assessment

If you’ve been dealing with a persistent tendon or soft tissue injury and feel you’ve run out of options, it’s worth finding out whether shockwave is suitable for you. We’d rather tell you it isn’t the right treatment than have you go through a course that won’t change your outcome.

You can read more about how we deliver the treatment on our shockwave therapy service page. When you’re ready to start, get in touch with us to book your assessment.

This article is for general information only and is not a substitute for individual clinical assessment or treatment. If you have a specific health concern, please consult a qualified healthcare professional.