Shockwave Therapy: How It Works, Its Benefits, and Its Expanding Role in Medicine
Oct 15, 2026 · Dr. James A. Wright · Sports Medicine
If you've been living with heel pain, a stubborn tendon problem, or an injury that just won't heal, you may have heard about shockwave therapy. Once known mainly as a way to break up kidney stones, shockwave technology is now used across orthopedics, sports medicine, podiatry, wound care, and rehabilitation. It is noninvasive, it is done in the office, and for the right conditions it can help the body restart a healing process that has stalled.
Shockwave therapy, known medically as extracorporeal shockwave therapy or ESWT, uses short, high-energy acoustic pulses delivered through the skin to an injured area. "Extracorporeal" simply means the energy is generated outside the body. There are no incisions, no injections, and typically no anesthesia.
Interest in shockwave has grown for a few reasons. Many chronic tendon and soft tissue problems respond poorly to rest, medication, and repeated injections, and patients are looking for options before surgery. Professional and elite athletes have embraced it as a way to treat injuries without long downtime. And research over the past two decades has expanded both the evidence for established uses and the list of conditions being studied. As a practice that sees professional athletes every week, we can definitively say that the results from ESWT have revolutionized how we do sports medicine.
This guide explains what shockwave therapy is, how it works, which conditions it treats, what the evidence shows, and where the field is headed. It also covers what treatment feels like, who is and isn't a good candidate, and what it typically costs.
As with any treatment, shockwave isn't right for everyone, and it works best as part of a complete plan built around an accurate diagnosis.
What Is Shockwave Therapy?
A shockwave is a pulse of acoustic energy that rises to very high pressure in a fraction of a microsecond and then dissipates. In medicine, these pulses are generated by a device, transmitted through a gel on the skin, and directed into tissue. The energy passes through soft tissue and is absorbed where tissues of different density meet, such as where tendon attaches to bone.
The term "shockwave therapy" is commonly used for two related but distinct technologies.
Focused shockwave
Focused shockwave devices concentrate energy at a specific depth and point, much like a magnifying glass focuses sunlight. The energy can reach deeper structures, often several centimeters below the skin, with the greatest intensity at the target. Focused shockwave is the original form used in orthopedics and is the type most studied for conditions such as plantar fasciitis, calcific tendinitis of the shoulder, and bone healing. Devices generate the pulse in different ways, including electrohydraulic, electromagnetic, and piezoelectric systems.
Radial pressure wave therapy
Radial devices use compressed air or an electromagnetic driver to fire a projectile against an applicator on the skin. The energy is strongest at the surface and spreads outward, decreasing as it travels deeper. Strictly speaking, these are pressure waves rather than true shockwaves, but they are commonly grouped under the same name. Radial therapy is well suited to larger, more superficial areas and is widely used for tendon and muscle problems.
Why the distinction matters
Focused and radial devices are not interchangeable. They reach different depths and deliver energy differently, and the research supporting one doesn't automatically apply to the other. Energy level matters too: treatments are described as low, medium, or high energy, and protocols vary by condition. When comparing providers or reading about results, it's reasonable to ask which type of device is being used and why it suits your condition. Many practices use both.
How Does Shockwave Therapy Work?
Early on, researchers assumed shockwave worked by physically breaking things apart, as it does with kidney stones. That turned out to be only part of the story. Today, shockwave is understood mainly as a biological stimulus. The mechanical energy triggers a cascade of responses in cells and tissues, a process called mechanotransduction, in which cells convert a physical force into chemical signals.
Research has identified several effects that likely contribute to its benefits:
New blood vessel formation. Shockwave stimulates the release of growth factors that promote neovascularization, the growth of new small blood vessels. Chronic tendon problems often involve tissue with poor blood supply, and improved circulation supports repair.
Restarting the healing response. Chronic tendinopathies are often less about active inflammation and more about a healing process that has stalled. Shockwave appears to prompt a controlled, short-term response that encourages the tissue to resume remodeling.
Collagen production and tissue remodeling. Studies show increased activity of the cells that produce collagen, the main structural protein in tendons and ligaments.
Pain modulation. Shockwave affects pain signaling in several ways, including reducing certain pain-related nerve chemicals in the treated area and temporarily overstimulating local nerve endings. This helps explain why some patients notice less pain early, while longer-term improvement follows as tissue heals.
Breaking down calcium deposits. In conditions such as calcific tendinitis of the shoulder, shockwave can help fragment calcium deposits so the body can reabsorb them.
Stimulating bone formation. In bone, shockwave encourages the activity of bone-building cells, which is why it is used for fractures that have failed to heal.
Effects on stem cells and muscle tone. Shockwave appears to activate tissue repair cells and can reduce muscle stiffness, which has opened the door to its use in neurologic conditions.
Because these processes take time, the full benefit of shockwave therapy usually develops over weeks to a few months after treatment, not immediately.
From Kidney Stones to Tendons: A Brief History
Shockwave medicine began with urology. In 1980, physicians in Germany treated the first patient with shockwave lithotripsy, using focused shockwaves to break apart kidney stones without surgery. It quickly became a standard treatment worldwide and remains so today.
As lithotripsy spread, researchers noticed something unexpected: bone near the treated area showed signs of increased bone formation. That observation led European physicians in the late 1980s and 1990s to test shockwaves on fractures that had failed to heal, and then on chronic tendon problems such as tennis elbow, calcific shoulder tendinitis, and heel pain.
In the United States, the first shockwave devices for musculoskeletal use were approved by the FDA in the early 2000s for chronic plantar fasciitis, followed by approval for chronic lateral epicondylitis (tennis elbow). Since then, additional devices have reached the market, radial devices have become widespread, and in 2017 the FDA authorized a shockwave device to help treat diabetic foot ulcers, marking its entry into wound care.
Today, shockwave therapy is used across a wide range of specialties:
Urology: kidney and ureteral stones, and research into other uses
Orthopedics, podiatry, and sports medicine: tendon, fascia, and bone conditions
Wound care: chronic and diabetic wounds
Physical medicine and rehabilitation: muscle spasticity and myofascial pain
Cardiology: investigational use in heart disease
Aesthetics: cellulite and skin applications
The evidence behind each of these varies considerably. Some uses are well established; others remain early or experimental. The sections below separate the two.
Shockwave Therapy for Foot and Ankle Conditions
The foot and ankle are where shockwave therapy has some of its strongest track record.
Plantar fasciitis and chronic heel pain
Plantar fasciitis, irritation and degeneration of the thick band of tissue along the bottom of the foot, is the most common cause of heel pain in adults. Most cases improve with stretching, supportive footwear, orthotics, activity changes, and time. But some people still have pain after six months or more of these treatments.
For these chronic cases, shockwave therapy is one of the best-studied nonsurgical options. Multiple randomized trials and systematic reviews have found that it reduces pain and improves function compared with placebo treatment, and many patients improve enough to avoid surgery. It offers an alternative to repeated corticosteroid injections, which carry a risk of thinning the fat pad or weakening the plantar fascia. Shockwave works best combined with stretching, footwear changes, and other conservative care rather than as a replacement for them.
Achilles tendinopathy
The Achilles tendon is the largest tendon in the body and a frequent source of pain in runners and active adults. Shockwave is used for both forms of Achilles tendinopathy: midportion (in the middle of the tendon) and insertional (where the tendon attaches to the heel bone). Research supports its use, particularly combined with a structured loading and strengthening program, which remains the foundation of treatment. Insertional Achilles pain, which can be stubborn to treat, is one area where shockwave is often considered.
Other foot and ankle uses
Posterior tibial and peroneal tendinopathy: tendon problems along the inside and outside of the ankle
Stress fractures and slow-healing fractures: including certain fractures of the metatarsals, the long bones of the foot, that are prone to healing problems
Medial tibial stress syndrome (shin splints): studied in athletes and military recruits
Diabetic foot ulcers: as part of comprehensive wound care, discussed below
In every case, the most important first step is an accurate diagnosis. Heel pain, for example, can also come from a nerve entrapment, a stress fracture, or arthritis, and these call for different treatment.
Other Musculoskeletal Uses and What the Evidence Shows
Beyond the foot and ankle, shockwave is used for tendon, muscle, and bone conditions throughout the body. The strength of the evidence differs by condition, and it's worth being clear about where it is strong and where it is still developing.
Condition | Evidence | Notes |
Chronic plantar fasciitis | Strong | Among the most studied uses; for pain lasting several months despite standard care |
Calcific tendinitis of the shoulder | Strong | Focused shockwave can help break down calcium deposits and reduce pain |
Greater trochanteric pain syndrome (outer hip pain) | Moderate to strong | Often compared favorably with injections and home exercise |
Achilles tendinopathy | Moderate | Best results combined with a loading and strengthening program |
Patellar tendinopathy (jumper's knee) | Moderate | Used in jumping and running athletes alongside rehab |
Delayed-healing and nonunion fractures | Moderate | Used as an alternative to surgery in selected fractures |
Lateral epicondylitis (tennis elbow) | Mixed | Results vary across studies; some patients benefit |
Non-calcific rotator cuff tendinopathy | Limited to mixed | Less consistent than for calcific tendinitis |
Myofascial pain and trigger points | Emerging | Promising early studies, smaller trials |
Hamstring and other muscle injuries | Emerging | Studied in athletes; protocols still developing |
"Strong" here means support from multiple randomized trials and systematic reviews. "Emerging" means early or smaller studies with promising but less certain results. Even for well-supported uses, not every patient responds, and results depend on an accurate diagnosis, proper device and energy selection, and a good rehabilitation program.
The Evolving Frontiers of Shockwave Medicine
Some of the most interesting developments in shockwave therapy are happening outside orthopedics. These uses range from FDA-authorized to experimental, so it's important to be clear about where each one stands.
Wound healing
Chronic wounds, particularly diabetic foot ulcers, often fail to heal because of poor blood flow and stalled tissue repair. Shockwave's ability to stimulate new blood vessels and growth factors makes it a logical fit. In 2017, the FDA authorized a shockwave device for treating chronic diabetic foot ulcers alongside standard wound care. Research is also exploring its use in burns, venous leg ulcers, and pressure injuries. It is an add-on to good wound care, including offloading pressure, infection control, and blood sugar management, not a substitute.
Bone healing
Shockwave's bone-stimulating effect, first noticed during lithotripsy, has led to its use for fractures that heal slowly or not at all. In selected cases, outcomes have been comparable to surgery, without the risks of an operation. Researchers are also studying it for early-stage avascular necrosis, a loss of blood supply to bone, most often in the hip.
Spasticity and neurologic rehabilitation
After a stroke, or in conditions such as cerebral palsy and multiple sclerosis, muscles can become tight and stiff. Studies show shockwave can temporarily reduce spasticity and improve range of motion, making it a promising addition to rehabilitation. Effects are typically temporary, so research continues on how to make them last.
Calcified arteries
A related technology called intravascular lithotripsy uses sonic pressure waves delivered from inside a balloon catheter to crack calcium deposits in narrowed arteries before a stent is placed. It is FDA-cleared and now widely used in cardiology and vascular medicine, a striking example of how the original stone-breaking principle has been adapted.
Heart disease
Cardiac shockwave therapy, which applies low-energy pulses to the heart muscle, has been studied for chronic chest pain that doesn't respond to standard treatment and as a way to improve blood flow to damaged heart muscle. Early trials are encouraging, but it remains investigational in the United States.
Erectile dysfunction and other urologic uses
Low-intensity shockwave therapy for erectile dysfunction has attracted heavy marketing. Some studies suggest benefit for certain men with blood-flow-related ED, but results are inconsistent, and professional urology organizations have been cautious, with many regarding it as investigational. Similar research is underway for Peyronie's disease and chronic pelvic pain. Patients considering these treatments should be wary of bold claims and should discuss the evidence with a urologist.
Aesthetic uses
Acoustic wave devices are marketed for cellulite and skin texture, and they are being studied for lymphedema. Evidence for aesthetic uses is limited, and results tend to be modest and temporary.
The overall trend is clear: shockwave is moving from a single-purpose tool to a platform technology applied across medicine. As research continues, expect clearer protocols, better patient selection, and both new uses and some claims that don't hold up.
What to Expect During Treatment
Shockwave therapy is performed in the office and doesn't require any special preparation.
Evaluation first. Before treatment, your doctor confirms the diagnosis with an examination and, when needed, imaging such as X-ray, ultrasound, or MRI. This step matters because shockwave works only for the conditions it's suited to.
Locating the target. The doctor identifies the most tender area, sometimes with ultrasound guidance, and marks it.
Applying gel. A gel is spread on the skin to carry the energy from the device into the tissue.
Treatment. The applicator is placed against the skin and delivers a series of pulses, usually a few thousand per session. You'll hear a rhythmic clicking or tapping. A typical session takes about 5 to 15 minutes.
Afterward. You can walk out and return to most daily activities right away.
Does it hurt?
Most patients describe the sensation as an uncomfortable tapping or pulsing. It can be sore over the most irritated spots, which are often the areas that need treatment most. The intensity can be adjusted for comfort, and most people tolerate treatment well. Low- and medium-energy treatments are usually done without anesthesia. Some high-energy protocols may use local anesthesia.
How many sessions?
A typical course is four to five sessions, usually spaced up to 4 days apart, though the number varies with the condition, the device, and how you respond. Some physicians may do 7 days apart based on their treatment protocol.
When will I notice results?
Some patients notice less pain soon after the first sessions, but the main benefit builds over the following weeks to months as the tissue remodels. It is common to judge the full result about three months after the final session.
After treatment
Your doctor may recommend avoiding strenuous, high-impact activity for a short period after each session. Anti-inflammatory medications such as ibuprofen are discouraged during treatment, since the therapy relies on the body's own healing response. Continuing your stretching, strengthening, footwear, or orthotic program is important for the best results.
Benefits, and How Shockwave Compares With Other Treatments
Key benefits
Noninvasive: No incisions, injections, or stitches
No significant downtime: Most patients return to work and daily activities the same day
No general anesthesia: Most treatments need no anesthesia at all
Quick sessions: Typically 5 to 15 minutes
Works with the body's healing: Targets stalled tissue repair rather than only masking symptoms
Low risk: Side effects are usually mild and short-lived
Compatible with rehab: Can be combined with physical therapy, orthotics, and exercise programs
A potential alternative to surgery: For selected chronic conditions that haven't responded to conservative care
Compared with other options
Treatment | Strengths | Drawbacks |
Conservative care (stretching, footwear, orthotics, physical therapy) | First-line, low cost, effective for most people | Some cases don't improve after months |
Corticosteroid injections | Fast short-term pain relief | Benefit often fades; repeated injections can weaken tendons and fascia or thin the heel fat pad |
Platelet-rich plasma (PRP) injections | Uses the body's own healing factors | Requires injection; evidence varies by condition; usually not covered by insurance |
Shockwave therapy | Noninvasive, no downtime, good evidence for several chronic conditions | Several sessions needed; benefit builds gradually; often not covered by insurance |
Surgery | Can be definitive for some conditions | Longer recovery, surgical risks, higher cost |
Shockwave is generally not a first-line treatment. It is most often considered for chronic conditions that haven't improved after several months of standard care, and it typically fits between conservative treatment and surgery. For some patients, it is used alongside other treatments rather than instead of them.
Who Is a Good Candidate?
You may be a good candidate for shockwave therapy if:
You have a diagnosed tendon, fascia, or bone condition that shockwave is known to help
Your symptoms have lasted for several months
You've tried standard treatments such as rest, stretching, footwear changes, orthotics, or physical therapy without enough improvement
You want to avoid or delay surgery, or you aren't a good surgical candidate
You prefer to avoid repeated steroid injections
When shockwave may not be appropriate
Shockwave therapy is not recommended, or requires special caution, in certain situations:
Pregnancy
Bleeding disorders or use of blood-thinning medications, depending on the treatment and dose
Active infection in the treatment area
Cancer or tumors in the treatment area
Open growth plates near the treatment area in children and adolescents may require special changes to the treatment protocol
Areas over the lungs, major blood vessels, or nerves
Recent corticosteroid injection in the treatment area
Some implanted devices, such as certain pacemakers, depending on the device and the treatment location
Poorly controlled neuropathy or reduced sensation in the treatment area, which may need individual consideration
Your doctor will review your medical history before recommending treatment.
Side effects
Shockwave therapy is considered safe when performed appropriately. Side effects are usually mild and resolve within days:
Temporary soreness or a flare of pain after treatment
Redness or mild swelling
Small bruises or tiny red spots on the skin
Temporary tingling or numbness
Serious complications are rare.
Cost and Insurance Coverage
Coverage for shockwave therapy is limited. Medicare and most commercial insurance plans do not cover shockwave therapy for musculoskeletal conditions, often classifying it as investigational, even for conditions with good supporting evidence. There are, however, some insurance plans that do cover shockwave therapy so it is important to reach out to the medical practice to have them verify benefits and coverage prior to proceeding.
Cost varies with the condition, the type of device, the number of sessions, and the region. Many practices offer package pricing for a full course of treatment. When comparing costs, ask:
Is it focused or radial shockwave, and why is that type right for my condition?
How many sessions are included, and what happens if I need more?
Does the price include the evaluation and follow-up visits?
Can I use a health savings account (HSA) or flexible spending account (FSA)? Many patients can, but check your plan.
When weighing the cost, consider what you've already spent on ongoing treatments that haven't solved the problem, along with the cost, recovery time, and time off work that surgery would involve.
Frequently Asked Questions
Is shockwave therapy FDA approved?
Specific shockwave devices are approved or cleared by the FDA for specific uses, including chronic plantar fasciitis, tennis elbow, and diabetic foot ulcers. Approval applies to a particular device and indication, not to shockwave therapy in general. Many other uses are considered "off-label," which is common and legal in medicine, but it's reasonable to ask your provider about the evidence for your condition.
How successful is shockwave therapy?
Results depend on the condition. For chronic plantar fasciitis and calcific shoulder tendinitis, many studies report meaningful improvement in most patients who haven't responded to other treatments. For other conditions, results are more variable. No treatment works for everyone.
Is shockwave the same as ultrasound therapy?
No. Both use sound energy, but therapeutic ultrasound delivers continuous or pulsed waves that mainly produce gentle heating. Shockwaves are brief, high-pressure pulses that create mechanical stimulation, which drives the healing effects described above.
Can shockwave therapy replace surgery?
For some chronic conditions, such as plantar fasciitis and certain slow-healing fractures, shockwave can help patients avoid surgery. It isn't a replacement for surgery when there is a structural problem, such as a complete tendon tear, that requires repair.
Can I exercise after shockwave therapy?
You can usually walk and do normal activities right away. Your doctor may recommend avoiding high-impact or strenuous activity for a few days after each session and will guide you on returning to sports.
Is shockwave used by professional athletes?
Yes. Shockwave therapy is widely used in professional and elite sports to treat tendon and muscle injuries, because it can be performed without significant downtime and combined with ongoing rehabilitation.
How long do the results last?
When shockwave successfully restarts healing in a chronic condition, the improvement is often long-lasting. Results last best when the factors that contributed to the problem, such as footwear, training errors, or muscle weakness, are also addressed.
Can I take anti-inflammatory medication during treatment?
No, many providers advise against anti-inflammatory medications such as ibuprofen or naproxen during the treatment course, since shockwave works partly by stimulating a healing response. Ask your doctor what's appropriate for you.
Is Shockwave Therapy Right for You?
If heel pain, Achilles pain, or another stubborn tendon or bone problem hasn't responded to standard treatment, shockwave therapy may be worth considering. The first step is an accurate diagnosis. The team at Quantum Foot and Ankle Group can evaluate your condition, explain whether shockwave is a good fit, and build a treatment plan around your goals, whether that's walking comfortably or getting back to competition. Our team of physicians have years of experience with shockwave therapy and elite / professional athletes. We will do everything possible to address your concern and try to get you back active as soon as possible.
Quantum Foot and Ankle Group 577 Chestnut Ridge Rd, Suite 9, Woodcliff Lake, NJ 201-571-0900·
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Individual results vary, and not every patient is a candidate for shockwave therapy. Consult a qualified healthcare provider about your specific condition.
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