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Shockwave Therapy:

An Effective Option for Treating Chronic Tendon Pain

Chronic tendon and soft-tissue injuries can be stubborn, painful, and slow to heal. Conditions like tennis elbow, plantar fasciitis, and Achilles tendinopathy often persist despite rest, stretching, or basic exercise. One treatment that has gained strong research support in recent years is Extracorporeal Shockwave Therapy (ESWT).

How common are these conditions?

  • Lateral epicondylitis (tennis elbow) affects 1–3% of adults annually, most commonly between ages 35–55, and often from repetitive gripping or lifting.¹

  • Plantar fasciitis is the most common cause of heel pain, accounting for up to 1 million patient visits per year in the U.S.²

  • Achilles tendinitis/tendinopathy occurs in approximately 6–18% of runners and is increasingly common in recreational athletes and active adults.³

These conditions often become chronic due to poor blood supply, repetitive overload, and incomplete tissue healing.

What is Shockwave Therapy and why does it work?

Shockwave therapy uses high-energy acoustic waves delivered to injured tissue. These waves stimulate a biological response that promotes healing rather than simply masking pain.  Research suggests shockwave therapy helps by:

  • Stimulating neovascularization (new blood vessel formation), improving tissue healing

  • Increasing cellular activity involved in tendon repair

  • Breaking up disorganized or calcified tissue

  • Reducing pain signaling by altering nerve sensitivity

Rather than suppressing inflammation, shockwave therapy restarts the healing process in chronically irritated tissues.

Evidence for effectiveness:

  • Plantar fasciitis: Multiple systematic reviews show shockwave therapy significantly reduces pain and improves function, particularly in chronic cases lasting longer than 6 months.⁴

  • Lateral epicondylitis: Studies demonstrate meaningful improvements in pain and grip strength compared to placebo or standard care.⁵

  • Achilles tendinopathy: ESWT combined with progressive loading exercises has been shown to improve pain and return-to-activity outcomes more effectively than exercise alone.⁶

Most patients require 6-10 sessions over several weeks as tissue remodeling occurs, but improvements can often be seen in as early as 3 sessions.

Shockwave therapy and physical therapy:

Shockwave therapy is most effective when paired with skilled physical therapy. Physical therapists can identify movement and loading patterns contributing to tendon overload. Your physical therapist will combine shockwave therapy with progressive strengthening and mobility work to safely guide you back to sport, work, or daily activities. This combination addresses both tissue health and mechanical stress, which is critical for long-term success.

Shockwave therapy is a non-invasive, evidence-based treatment for chronic tendon conditions that have not responded to traditional care. By stimulating the body’s natural healing processes, it offers an effective pathway to reduced pain and improved function, especially when integrated into a comprehensive physical therapy program.

 

 

References

  1. Shiri R, Viikari-Juntura E. Lateral epicondylitis. Lancet.

  2. Riddle DL, Schappert SM. Plantar fasciitis epidemiology. Foot Ankle Int.

  3. Magnussen RA, et al. Epidemiology of Achilles tendinopathy. Clin Sports Med.

  4. Dizon JN, et al. Effectiveness of ESWT for plantar fasciitis. J Orthop Sports Phys Ther.

  5. Buchbinder R, et al. Shockwave therapy for lateral epicondylitis. Cochrane Database.

  6. Rompe JD, et al. ESWT combined with eccentric training for Achilles tendinopathy. Am J Sports Med.