What is shockwave therapy, and can it help with chronic pain conditions?
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment that uses acoustic pressure waves to stimulate healing in damaged or degenerated tissues. Originally developed to break up kidney stones, shockwave therapy has been adapted for musculoskeletal conditions and is now backed by substantial clinical evidence. A meta-analysis published in the British Journal of Sports Medicine (Mani-Babu et al., 2015) found that ESWT produced significant improvements in pain and function for tendinopathies, with success rates ranging from 65% to 91% depending on the condition treated.
For patients in Newmarket, Toronto, and the Greater Toronto Area who have been living with chronic tendon pain, heel pain, or other persistent musculoskeletal conditions that have not responded to conventional treatments, shockwave therapy offers a compelling alternative to surgery or long-term medication use.
How Shockwave Therapy Works
Shockwave therapy delivers high-energy acoustic waves to the affected area through a handheld applicator placed on the skin. These waves are not electrical shocks; rather, they are mechanical pressure pulses similar to sound waves but with much higher energy.
How Acoustic Waves Promote Healing
Shockwave therapy works through several biological mechanisms. The acoustic waves create controlled microtrauma in the tissue, which restarts the body's natural healing cascade. This triggers neovascularization (new blood vessel formation), increases growth factor production, stimulates stem cell activation, and breaks down calcific deposits. The waves also overstimulate pain nerve endings, leading to a neurological pain reduction effect. In essence, shockwave therapy converts a chronic, stalled healing process into an active, acute one that the body can resolve.
Types of Shockwave Therapy
There are two main types of shockwave therapy used in clinical practice:
- Radial Shockwave Therapy (RSWT): The most commonly used type in physiotherapy clinics. The waves are generated at the tip of the applicator and spread radially into the tissue. It is effective for superficial conditions and larger treatment areas. This is the type most commonly available at rehabilitation clinics across the GTA.
- Focused Shockwave Therapy (FSWT): Delivers concentrated energy to a precise focal point deeper within the tissue. It is used for deeper structures and more targeted treatment. This type is sometimes used for calcific tendonitis and deeper tendinopathies.
Both types have demonstrated clinical effectiveness, and the choice between them depends on the specific condition being treated, the depth of the affected tissue, and the clinical judgment of the treating therapist.
Conditions Treated by Shockwave Therapy
Shockwave therapy has been studied extensively for numerous musculoskeletal conditions. The following table summarizes the key conditions treated, along with the evidence for effectiveness based on published research.
| Condition | Success Rate | Evidence Level | Typical Sessions |
|---|---|---|---|
| Plantar Fasciitis | 70-80% | Strong (multiple RCTs) | 3-5 sessions |
| Lateral Epicondylitis (Tennis Elbow) | 65-80% | Strong (multiple RCTs) | 3-5 sessions |
| Calcific Shoulder Tendonitis | 75-91% | Strong (gold standard) | 3-6 sessions |
| Achilles Tendinopathy | 60-75% | Moderate to strong | 3-5 sessions |
| Patellar Tendinopathy (Jumper's Knee) | 65-75% | Moderate | 3-5 sessions |
| Greater Trochanteric Pain Syndrome | 65-75% | Moderate | 3-5 sessions |
| Myofascial Trigger Points | 70-80% | Moderate | 3-6 sessions |
| Medial Tibial Stress Syndrome (Shin Splints) | 70-80% | Moderate | 3-5 sessions |
Success rates are based on published systematic reviews and randomized controlled trials (RCTs). Individual results may vary.
The Shockwave Therapy Treatment Process
Understanding what happens during a shockwave therapy session can help you feel prepared and comfortable. Here is a step-by-step overview of the typical treatment process at our Newmarket clinic.
Before Treatment
Your therapist will conduct a thorough assessment to confirm that shockwave therapy is appropriate for your condition. This includes:
- Review of your medical history and current symptoms
- Physical examination of the affected area
- Discussion of previous treatments and their results
- Screening for contraindications (pregnancy, blood clotting disorders, infections, tumors near the treatment area, or pacemakers)
- Explanation of the procedure, expected sensations, and potential side effects
During Treatment
- Positioning: You will be positioned comfortably to allow access to the treatment area
- Gel application: Ultrasound gel is applied to the skin to facilitate the transmission of acoustic waves
- Locating the treatment point: Your therapist will identify the most tender or affected area through palpation and may use the shockwave handpiece to locate the exact point of maximum tenderness
- Treatment delivery: The handpiece is applied to the skin, and the acoustic waves are delivered. You will feel a rapid tapping or pulsing sensation. The intensity starts low and is gradually increased to your tolerance level
- Duration: Each session typically involves 2,000 to 3,000 pulses and lasts approximately 5 to 10 minutes per treatment area
- Post-treatment: The gel is removed, and your therapist may provide advice on activity modification for the next 24 to 48 hours
"Extracorporeal shockwave therapy has emerged as a safe, effective, non-invasive treatment option for chronic tendinopathies, particularly when conservative management has failed. The evidence supports its use as a first-line alternative to surgical intervention."
International Journal of Surgery, 2015 - Review of ESWT for musculoskeletal conditions
After Treatment
Following a shockwave therapy session, you can typically return to your normal daily activities immediately. However, there are some important guidelines:
- Avoid high-impact activities for 48 hours after treatment to allow the healing response to develop
- Do not apply ice to the treated area, as the inflammatory response is part of the healing process
- Avoid anti-inflammatory medications (NSAIDs like ibuprofen) for 4 to 6 weeks during the treatment course, as they may interfere with the healing mechanism
- Light stretching and movement of the affected area are encouraged
- Some soreness is normal for 24 to 48 hours and indicates the treatment is stimulating a healing response
The Evidence Base for Shockwave Therapy
The clinical evidence supporting shockwave therapy has grown substantially over the past two decades. Here are some of the key findings from the research literature:
Plantar Fasciitis
A 2013 meta-analysis in The American Journal of Sports Medicine (Yin et al.) analyzed 7 randomized controlled trials and found that ESWT significantly reduced pain in chronic plantar fasciitis compared to placebo, with effects lasting at least 12 months. The National Institute for Health and Care Excellence (NICE) in the UK has recommended ESWT as a treatment option for refractory plantar fasciitis.
Calcific Shoulder Tendonitis
Shockwave therapy is considered the gold standard non-surgical treatment for calcific tendonitis of the shoulder. A study in the Journal of Bone and Joint Surgery (Gerdesmeyer et al., 2003) demonstrated that focused ESWT achieved complete or partial calcium resorption in up to 86% of patients, with significant pain reduction in 91% of cases at 6-month follow-up.
Tennis Elbow (Lateral Epicondylitis)
A 2020 systematic review in BMC Musculoskeletal Disorders concluded that ESWT was effective for lateral epicondylitis, particularly in patients who had failed other conservative treatments. The review noted that radial shockwave therapy showed particularly promising results for this condition.
Why Chronic Tendon Injuries Stall
Chronic tendinopathies often fail to heal because the tissue becomes trapped in a degenerative cycle. Unlike acute injuries that progress through orderly inflammation, repair, and remodeling phases, chronic tendon injuries develop disorganized collagen fibers, poor blood supply (tendons are naturally avascular), and failed healing attempts. This is why rest alone rarely resolves chronic tendon pain. Shockwave therapy breaks this cycle by introducing a controlled stimulus that restarts the healing process with increased blood flow and cellular activity.
Who Is a Good Candidate for Shockwave Therapy?
Shockwave therapy may be appropriate for you if:
- You have a chronic tendon condition that has persisted for more than 3 months
- Conservative treatments (rest, stretching, physiotherapy exercises, orthotics) have not provided adequate relief
- You want to avoid surgery or cortisone injections
- You have calcific tendonitis with calcium deposits visible on imaging
- You are physically active and want to return to sport or activity as quickly as possible
- You have chronic trigger points or myofascial pain that has not responded to manual therapy alone
Who Should Avoid Shockwave Therapy?
Shockwave therapy is not appropriate for everyone. Contraindications include:
- Pregnancy (treatment near the uterus)
- Blood clotting disorders or patients on anticoagulant therapy
- Active infection or tumor at or near the treatment site
- Patients with pacemakers or other implanted cardiac devices
- Treatment over growth plates in children and adolescents
- Treatment over major blood vessels or nerves
Shockwave Therapy as Part of a Comprehensive Treatment Plan
While shockwave therapy is effective on its own, research suggests that combining it with other evidence-based treatments often produces superior outcomes. At Renew Rehab Clinic, we frequently integrate shockwave therapy into multidisciplinary treatment plans.
Shockwave + Physiotherapy
Physiotherapy is the most common complement to shockwave therapy. While ESWT addresses the tissue-level healing, physiotherapy provides targeted strengthening exercises, biomechanical correction, and movement retraining to address the underlying factors that caused the condition in the first place. A 2019 study in the Journal of Orthopaedic & Sports Physical Therapy found that combining ESWT with eccentric exercise for Achilles tendinopathy produced better outcomes than either treatment alone.
Shockwave + Massage Therapy
Massage therapy can complement shockwave treatment by addressing compensatory muscle tension and improving soft tissue flexibility around the affected area. For example, a patient receiving shockwave therapy for plantar fasciitis may also benefit from massage therapy to release tightness in the calf muscles and Achilles tendon, which contribute to plantar fascial loading.
Shockwave + Acupuncture
Acupuncture can be a valuable adjunct to shockwave therapy for pain modulation. While shockwave therapy works at the tissue level to promote healing, acupuncture can help with overall pain management, stress reduction, and promoting the body's natural healing response through different neurological pathways.
"The most successful treatment protocols for chronic tendinopathies combine shockwave therapy with a structured exercise program. This dual approach addresses both the biological healing process and the mechanical factors contributing to the condition."
British Journal of Sports Medicine, 2019
What Results Can You Expect?
Recovery timelines vary depending on the condition, its severity, and how long it has been present. Here is a general overview of what patients can expect:
- After Session 1-2: Some patients notice an immediate reduction in pain, while others may experience temporary soreness. It is common for the therapeutic effects to begin building over the first couple of weeks.
- After Session 3-4: Most patients report noticeable improvement in pain levels and function. The tissue healing process is well underway, with new blood vessel formation and collagen remodeling occurring at the cellular level.
- After Session 5-6: For most conditions, the full treatment course is complete. Continued improvement is expected over the following 6 to 12 weeks as the tissue continues to heal and remodel.
- 3-Month Follow-Up: Maximum improvement is typically reached 3 months after the last treatment session, as the biological healing processes initiated by the therapy continue to mature.
A study published in the Clinical Journal of Sport Medicine (Rompe et al., 2010) found that 88% of patients treated with ESWT for plantar fasciitis maintained their improvement at the 5-year follow-up, demonstrating the long-lasting effects of this treatment when combined with appropriate rehabilitation exercises.
Frequently Asked Questions
Does shockwave therapy hurt?
Most patients describe shockwave therapy as mildly uncomfortable rather than painful. You will feel a rapid tapping or pulsing sensation at the treatment site. The intensity is adjustable, and your therapist will start at a lower energy level and gradually increase it based on your tolerance. Some areas may be more sensitive than others, but the treatment is generally well-tolerated. Each session lasts only 5 to 10 minutes, and any discomfort typically subsides immediately after treatment.
How many shockwave therapy sessions will I need?
Most conditions require 3 to 6 sessions, spaced one week apart. Some patients experience noticeable improvement after the first or second session, while others may need the full course of treatment before significant relief is achieved. Your therapist will reassess your progress after each session and may adjust the treatment plan accordingly. Chronic conditions that have been present for years may require sessions at the higher end of this range.
What are the side effects of shockwave therapy?
Side effects of shockwave therapy are generally mild and temporary. The most common include redness or slight swelling at the treatment site, mild soreness or aching for 24 to 48 hours after treatment, and occasional minor bruising. These effects are actually part of the healing response, as the therapy works by stimulating inflammation to restart the body's repair process. Serious side effects are rare. Shockwave therapy is contraindicated over areas with blood clots, infections, tumors, or during pregnancy.
Does insurance cover shockwave therapy in Ontario?
Shockwave therapy coverage varies by insurance provider and plan. When shockwave therapy is administered by a registered physiotherapist or chiropractor, it is often covered under your physiotherapy or chiropractic benefits as part of the overall treatment session. Some plans may cover it as a separate modality. Motor vehicle accident claims and WSIB workplace injury claims may also cover shockwave therapy when deemed medically necessary. Our clinic staff can help verify your coverage before treatment begins.
Can shockwave therapy be combined with physiotherapy?
Yes, combining shockwave therapy with physiotherapy is often recommended and can produce better outcomes than either treatment alone. Shockwave therapy addresses the tissue healing and pain reduction component, while physiotherapy provides targeted exercises to strengthen the affected area, correct biomechanical issues, and prevent recurrence. At Renew Rehab Clinic in Newmarket, our therapists frequently integrate shockwave therapy into comprehensive physiotherapy treatment plans for conditions like plantar fasciitis, tennis elbow, and tendinopathy.
Is Shockwave Therapy Right for You?
If you have been living with chronic tendon pain, heel pain, or a stubborn sports injury that has not responded to other treatments, shockwave therapy at Renew Rehab Clinic may be the solution. Contact us today for an assessment.
