Shockwave Therapy (ESWT)

Shockwave therapy is used mainly for chronic tendon and fascia problems that have not healed with standard care. Recognized uses include plantar fasciitis, Achilles and patellar tendinopathy, calcific tendinitis of the shoulder, tennis elbow, outer-hip (greater trochanteric) pain and trigger finger^[10]. It is also studied for slow-healing fractures and wounds. In our practice it is used for musculoskeletal pain, usually after several months of stretching, therapy and activity changes have not been enough.

For some conditions, yes. The best evidence is for chronic plantar fasciitis, where about 70% of patients improved meaningfully at 12 weeks across the studies reviewed by foot and ankle surgeons^[9], and for calcific shoulder tendinitis^[12]. Evidence for tennis elbow is weak^[13], and results for other tendons are promising but less certain^[15]. It does not work for everyone, and it works best combined with an exercise program.

It is usually uncomfortable rather than very painful. Most people describe a strong, rapid tapping over the sore spot, and the more tender the tissue, the more it is felt. The intensity can be started low and raised gradually as you get used to it. Numbing injections are generally avoided because local anesthesia appears to reduce the effect of low-energy treatment^[9]. The discomfort stops when the session ends, though the area may ache for a day or two.

Most treatment plans use three to five sessions, about one week apart^[9]. New York workers’ compensation guidelines describe one to three sessions for chronic plantar fasciitis and three to four weekly sessions for chronic Achilles tendinopathy^[7]. Each session takes about 10 to 20 minutes. If you have improved but not fully, another course may be discussed; if nothing has changed about three months after a full course, a different treatment is usually a better choice.

Each session lasts about 10 to 20 minutes, but the benefit builds over the following weeks, and results are usually judged at about 12 weeks^[9]. When shockwave works, the improvement is meant to last, because the aim is to help the tendon or fascia heal rather than to mask pain. Long-term studies are fewer, and pain can return if the original strain — such as overtraining, unsupportive footwear or weak muscles — continues, so ongoing exercise matters^[15].

Shockwave should not be aimed at a cancerous tumor, a developing baby, or a pacemaker or defibrillator, and high-energy focused treatment is avoided over the lungs, brain, spine, skull and ribs and in people with a significant bleeding disorder^[10]. It is also not the first choice for heel pain that started recently, which usually improves with stretching^[9]. Tell us about blood thinners, pregnancy and any implanted devices so we can decide together whether it is right for you.

The main drawbacks are cost — it is rarely covered by insurance — the need for several visits, and the fact that it does not work for everyone^[9]. Side effects are usually minor: discomfort during treatment and temporary redness, swelling, bruising or soreness. Serious complications are rare, although tendon rupture and bone injury have been reported with focused shockwave in older adults^[14]. Because results build slowly, it can take several weeks to know whether it has helped.

Focused shockwave concentrates energy at a chosen depth, so it can reach deeper targets such as the heel attachment of the plantar fascia or calcium in a shoulder tendon. Radial shockwave uses a handpiece driven by compressed air that sends pressure pulses spreading out from the skin^[6], so it treats broader, shallower areas. For chronic plantar fasciitis, a meta-analysis found firmer evidence for focused devices^[11]. The right choice depends on the tissue being treated and how deep it lies.

For specific uses, yes. The FDA has granted premarket approval to shockwave devices for chronic plantar fasciitis in adults whose heel pain has lasted six months or more despite other care^[2][3]. Earlier approvals for tennis elbow are now listed as withdrawn^[4], and uses such as Achilles or shoulder tendinitis are off-label. Many radial devices are FDA-cleared as therapeutic massagers for minor muscle aches and local circulation^[6], which is not the same as approval to treat a disease.

Preparation is simple. Wear clothing that gives easy access to the area and plan to walk normally afterward — no driver is needed. Tell us if you are pregnant, have a pacemaker, have cancer or take blood thinners^[10], and do not stop a blood thinner unless the doctor who prescribed it agrees. Numbing medicine is usually not used, since it may reduce the treatment’s effect^[9]. Bring any X-ray, ultrasound or MRI reports of the painful area.

You can walk out and return to most daily activities right away, and most people are back to full activity within a few days^[9]. For a day or two the area may be red, swollen or sore; ice or acetaminophen is reasonable if needed. Go easy on high-impact exercise until the soreness settles, then continue your stretching and strengthening program, which helps the treatment work^[15]. Call us if you notice increasing swelling, a sudden pop or new weakness.

Usually not. Most health plans consider shockwave therapy for tendon and heel pain investigational, so it is generally self-pay; lack of insurance coverage is one reason it is less widely used in the United States^[9]. New York workers’ compensation guidelines do recommend it for select patients with chronic plantar fasciitis or chronic Achilles tendinopathy^[7], but not for tennis elbow^[8]. Our staff will explain the cost before you begin and check whether any coverage applies.

Shockwave is non-invasive, while cortisone and PRP require a needle. A cortisone shot can ease heel pain within days, but its effect fades after about four weeks, and repeated shots carry a risk of fascia rupture and fat-pad thinning^[9]. PRP and percutaneous tenotomy are options for tendons that do not respond. Shockwave is often tried before injections and combined with physical therapy^[15]. Your physician can help you weigh speed, cost, risk and evidence for your diagnosis.