Shockwave Therapy

A handpiece is pressed against the skin over the painful area and delivers rapid pulses of acoustic energy into the tissue underneath. "Shockwave" sounds electrical; it isn't. There's no current, no heat and nothing injected.

What the pulses do is mechanical. The tissue is repeatedly loaded and unloaded at speed, and your cells respond to that signal by changing their behaviour: the measurable effects in tendon and bone include a drop in the chemicals involved in transmitting pain, new small blood vessels forming through the treated area, and increased bone-cell activity where that's relevant ¹.

In plain terms: it isn't breaking anything down or blasting anything apart. It's provoking a biological response in tissue that has stopped responding on its own.

If you want the longer explanation of how it works and everything it's used for, we've written it up separately in Shockwave Therapy: How It Works and What It Treats.

This is the part that matters most when you're deciding whether to spend your time and money on shockwave.

The strongest evidence, the highest level available, sits behind a specific list: calcific shoulder tendinopathy, tennis elbow, greater trochanteric pain syndrome (the stubborn outside-of-hip pain), plantar fasciitis, and delayed bone healing. Achilles tendinopathy and patellar tendinopathy sit at lower evidence levels than those ¹.

And there's a result we'd rather you heard from us than found later. A 2024 Australian sham-controlled trial tested radial shockwave for insertional Achilles tendinopathy, adding it to exercise and education. Its conclusion was that doing so "did not lead to improvements in pain, function or other outcomes compared to sham at 6 or 12 weeks" ². That's a real finding on a real condition, and it's why we don't offer shockwave as a standard add-on for every sore tendon that walks in.

National guidance reaches the same two-part conclusion on both of the tendon problems it has assessed most closely: for refractory plantar fasciitis ⁴ and for Achilles tendinopathy ⁵ alike, shockwave raises no major safety concerns, while the evidence on whether it works is inconsistent. Australia's own public health guidance treats it the same way: something your doctor may suggest when tendon pain hasn't settled, after load management has been given a fair go ³.

So the useful question isn't "does shockwave work?" It's "does shockwave have good evidence for my problem, and have I done the loading work first?" That's a conversation, not a booking form.

We assess before we treat. Shockwave isn't something you book by the session here. The first appointment is an assessment: what hurts, how long it's been going on, what loads make it worse, what you've already tried, and what you're trying to get back to. Then we test the tendon under load, because where it hurts and where the problem sits aren't always the same place.

Loading comes first, not last. Complete rest isn't the fix: long periods of doing nothing tend to make tendon problems worse, and gentle progressive exercise is what encourages the tissue to heal ³. So an exercise programme built for your specific tendon is the foundation of the plan whether or not shockwave ends up being part of it. When shockwave is used, it's used alongside that programme.

You'll get the uncertainty in writing, not just in passing. National guidance asks clinicians to make sure you understand that the evidence for how well shockwave works is uncertain, and to give you that in clear written information before you agree to it ⁴. We'd do that regardless.

If shockwave is indicated, here's what it feels like. It's an uncomfortable treatment. A typical session in the research delivers somewhere between 800 and 3,000 pulses to the area, and we work within your tolerance as we go ¹. We don't numb the area first, and that's deliberate rather than stingy: shock waves applied under local anaesthetic performed no better than placebo at 12 weeks, so numbing the treatment appears to remove the thing that makes it work ¹. Most people describe it as intense but manageable, and it's over in minutes.

Sessions are spaced out, and so is the verdict. Most protocols in the literature use around three sessions with roughly a week between them, and the effect is prolonged rather than immediate, which is why it's properly judged at least four months after the course finishes, not at the end of the last session ¹. If you feel very little on the day, that isn't a failure.

We don't sell shockwave as a package, because the number of sessions isn't the goal: walking the dog without limping for the first ten minutes is. Getting through a shift on your feet. Getting back to netball, or the run club, or the stairs at work. That's what the plan gets built around, and it's what tells us whether shockwave is earning its place.

Hands-on work has a similar role: manual therapy addresses the surrounding tissue and how the area moves, while shockwave targets one specific degenerative spot. Different jobs, and we haven't found reliable head-to-head evidence putting one above the other, so we won't pretend there is any. We choose between them, and combine them, based on what your assessment shows, not on what you booked.

For genuinely refractory tendon problems, the literature also describes options outside physiotherapy, including corticosteroid injection. Those are a doctor's call and a doctor's procedure, not ours. But if that's the direction your case is heading, we'd rather say so and help you get the right referral than keep treating something that isn't shifting.

You can see everything else we offer on our services page.

Shockwave has a good safety record: the large majority of studies report no significant adverse effects during or after treatment ¹. The common effects are temporary: soreness at the treatment site, some redness, occasionally small bruises.

There are clear situations where we won't use it, though. Shockwave isn't appropriate over an active infection, during pregnancy, over a growth plate in a child or adolescent, where a tendon has ruptured completely, or over tissue affected by cancer (including secondary deposits, myeloma and lymphoma). It's also not used where a bleeding or clotting disorder isn't well controlled ¹. Tell us about any of these at your assessment, and about any blood-thinning medication you take: they change the plan, and it's better to know before we start.

Some signs are worth getting looked at promptly rather than waiting: real weakness in the tendon, severe pain, pain that isn't improving over several days, or pain that's worst first thing in the morning or after you've been still ³.