Shockwave therapy is best suited to stubborn, long-standing tendon and soft-tissue problems such as plantar fasciitis, calcific shoulder tendinopathy and some cases of Achilles or elbow tendon pain, especially when exercise-based rehab alone has not been enough. Other modalities such as ultrasound, TENS, laser, manual therapy and dry needling each have their own strengths, but most work best as supports to an active exercise programme rather than as stand-alone cures. The right mix depends on your diagnosis, how long you have had symptoms and your goals.
This guide explains how shockwave therapy works, how it compares with the other common options in a physiotherapy clinic, and what to expect if you try it.
What shockwave therapy is
Extracorporeal shockwave therapy (ESWT) sends short, high-energy acoustic pulses through the skin into a painful area. The technology grew out of lithotripsy, which uses shockwaves to break up kidney stones, and has been adapted for musculoskeletal problems over the past few decades.
Radial vs. focused shockwave
- Radial shockwave spreads energy outward from the applicator over a wider, shallower area. It is the type most often found in physiotherapy clinics and is commonly used for plantar fasciitis, Achilles and elbow tendon pain, and trigger points.
- Focused shockwave concentrates energy at a specific depth, so it can reach deeper structures. It is often used for calcific deposits and deeper tendons.
How it is thought to help
Researchers are still working out the exact mechanisms, but the main theories are that shockwaves:
- trigger a controlled healing response in tissue that has become “stuck” in a chronic state
- encourage new small blood vessel growth and the release of growth factors involved in repair
- reduce pain signalling in the treated area, sometimes for weeks after treatment
- help break up calcium deposits in conditions such as calcific tendinopathy of the shoulder
Conditions where shockwave is most often used
Evidence is strongest for a handful of chronic tendon and fascia problems, typically those that have lasted longer than about three months:
- Plantar fasciitis (heel pain)
- Calcific tendinopathy of the shoulder
- Achilles tendinopathy
- Patellar tendinopathy (jumper’s knee)
- Lateral elbow pain (tennis elbow), where results are more mixed
- Greater trochanteric pain syndrome (outer hip pain)
It is generally not a first choice for a fresh, acute injury, where rest, load management and early rehab usually come first.
Shockwave therapy compared with other modalities
| Modality | What it does | Typically used for | Main limitation |
|---|---|---|---|
| Shockwave | Acoustic pulses that stimulate tissue repair and reduce pain | Chronic tendinopathy, plantar fasciitis, calcific deposits | Can be uncomfortable; several sessions needed |
| Therapeutic ultrasound | High-frequency sound waves that produce gentle heat or mechanical effects | Soft-tissue pain and stiffness | Research support is generally weak |
| TENS | Mild electrical current that interferes with pain signals | Short-term pain relief, home use | Relief usually lasts only while or shortly after it is used |
| Laser (photobiomodulation) | Light energy aimed at promoting healing and reducing pain | Superficial tendons, joints, wounds | Results vary by device and dose |
| Manual therapy | Hands-on mobilisation, manipulation and soft-tissue work | Joint stiffness, neck and back pain | Effects are often short-term without exercise |
| Dry needling | Fine needles inserted into tight muscle bands | Muscle pain and trigger points | Less targeted at tendon problems |
| Exercise therapy | Progressive loading and strengthening | Almost every musculoskeletal condition | Takes weeks to months and needs consistency |
Shockwave vs. ultrasound
Both use sound energy, but in very different ways. Therapeutic ultrasound delivers continuous or pulsed high-frequency waves at low intensity, mainly producing mild heat. Shockwave delivers short, powerful pulses. For chronic tendon problems and calcific shoulder tendinopathy, shockwave generally has better research support than ultrasound.
Shockwave vs. TENS
TENS is a pain management tool. It can make movement more comfortable and is cheap enough to use at home, but it does not aim to change the tissue itself. Shockwave is intended to influence the healing process in the tendon or fascia, so the two do different jobs and are sometimes used together.
Shockwave vs. laser therapy
Laser is painless and quick, and is often used for more superficial problems. Shockwave can reach deeper structures and tends to be chosen for chronic, stubborn tendon conditions, though it is less comfortable during treatment.
Shockwave vs. manual therapy and dry needling
Hands-on techniques and dry needling are excellent for easing muscle tension and joint stiffness and can make exercise easier. They are less focused on the tendon itself. Many physiotherapists combine them with shockwave, using manual therapy for surrounding muscles and shockwave for the painful tendon.
Why exercise still sits at the centre
Tendons adapt to load. Most current guidelines for tendinopathy put progressive strengthening at the heart of treatment, with passive modalities used to reduce pain and help people keep moving. Shockwave works well in this role: it can calm symptoms enough for you to progress your exercises, while the exercises build the capacity that prevents the problem returning. Our article on orthopedic and sports physiotherapy for injury management explains how clinicians structure that progression.
How a physiotherapist might combine them: three examples
Real treatment plans rarely rely on one tool. These simplified examples show how the pieces often fit together, though your own plan will depend on your assessment.
- A runner with heel pain for six months: calf and foot strengthening, a plantar fascia stretching routine, footwear and training-load changes, plus a course of radial shockwave because symptoms have not settled with exercise alone.
- An office worker with a stiff, sore neck after two weeks: manual therapy and perhaps dry needling for tight muscles, posture and movement advice, and a home exercise programme. Shockwave is unlikely to be needed.
- A tradesperson with calcific shoulder tendinopathy: focused shockwave aimed at the calcium deposit, graded rotator cuff strengthening, and TENS or ice for flare-ups at home.
The pattern is consistent: passive treatments are chosen to match the specific problem and stage, and active rehab carries the long-term load.
What a shockwave session is like
- Assessment: your physiotherapist confirms the diagnosis and checks that shockwave is appropriate for you.
- Preparation: gel is applied to the skin over the painful area.
- Treatment: the applicator delivers a set number of pulses, usually over about five to ten minutes. Intensity is adjusted to what you can tolerate.
- Afterwards: you can usually return to normal activity, though you may be advised to avoid heavy loading for a day or two.
A typical course is around three to six sessions spaced about a week apart. Temporary redness, tenderness or bruising is common. Improvement often builds gradually over the weeks after the final session rather than immediately.
Who should avoid it
Shockwave is usually avoided during pregnancy, over areas of cancer or infection, over growth plates in children, near a pacemaker, and in people with bleeding disorders or on certain blood thinners. Always share your full medical history with the clinician.
Finding shockwave therapy in Edmonton
In Alberta, shockwave is usually offered in private physiotherapy clinics. Clinics such as Family Physiotherapy Edmonton combine it with assessment, manual therapy and a home exercise programme rather than offering it on its own. When comparing options for shockwave therapy Edmonton residents might ask:
- Is the treatment delivered by a registered physiotherapist, and is it part of a full plan?
- Do they use radial or focused shockwave, and why is it right for my condition?
- How many sessions do they expect, and how will progress be measured?
- What does each session cost, and will my extended health benefits plan cover it? Coverage varies, and some plans only cover the physiotherapy visit itself.
Athletes may also be interested in how these tools fit into performance work; see our guide to advanced techniques in sports physiotherapy.
This article is general information, not medical advice. Please consult a registered physiotherapist or physician about your specific condition.
Frequently asked questions
Is shockwave therapy better than ultrasound therapy?
For chronic tendon problems and calcific shoulder tendinopathy, shockwave generally has stronger research support than therapeutic ultrasound. Both work best alongside an exercise programme.
Does shockwave therapy hurt?
It can be uncomfortable during treatment, especially over very sore spots, but intensity is adjusted to your tolerance. Mild soreness or redness afterward is common and usually settles within a day or two.
How many shockwave sessions will I need?
Many treatment plans involve around three to six sessions about a week apart, with improvement often continuing for several weeks after the last one.
Can shockwave therapy replace exercise?
No. Shockwave can reduce pain and support healing, but progressive exercise builds the tendon strength that helps prevent the problem from returning.
Who should not have shockwave therapy?
It is usually avoided during pregnancy, over cancer or infection, over children’s growth plates, near pacemakers, and in people with bleeding disorders or on some blood thinners.
