Shockwave Therapy

Safe, Effective Pain Relief - Backed By Science.

Extracorporeal shockwave therapy is an established pain management tool. Its main application in physiotherapy is healing bone and soft tissue. Surprisingly, it was initially developed for use in urology and continues to have a wide range of medical applications.

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The History of Exercise Prescription In Physiotherapy

Shockwave therapy was first discovered in the 1960s when German researchers studied the effects of soundwaves on living tissue. By 1980, it entered medicine as ‘lithotripsy—the use of intense soundwaves to break down kidney stones. Initially approved by the FDA in 1984, its use grew widely across hospitals worldwide. In the 1990s, researchers discovered that bones near treated areas increased their density. This led to physiotherapists using shockwave therapy to heal stress fractures. Further research leading to the 2000s revealed an even broader application in healing soft tissues. Today, shockwave is a global gold standard treatment for many musculoskeletal disorders, from stress fractures to calcified tendinopathy and plantar fasciitis.

Diverse Medical Applications - Beyond Physiotherapy

Physiotherapists first used shockwaves to shatter kidney stones. Urologists continue this method today with excellent results. Today, we are amidst an explosion of research into shockwave therapy, which has led to a broad list of applications. Erectile dysfunction, wound healing, peripheral artery disease, fibromyalgia, lymphedema, and myocardial ischemia are just a few examples. At the cutting edge of shockwave research, it is even considered for its potential usefulness in treating Alzheimer’s plaques. See below for a longer list of conditions targeted with shockwave therapy.

Research Supporting Exercise Prescription Use In Physiotherapy

Shockwave therapy has over 2,000 studies since the 1980s proving its positive effects on the body and its excellent safety profile. Physiotherapists cite a 2012 review showing it heals tendons in 65-85% of cases with consistent treatment. A 2020 study found it reduces joint pain by 30% over time. Research from the 1990s confirmed it speeds up fracture healing. Hundreds of trials since 2000 examine knees, wrists, and shoulders with clear findings. Physiotherapists rely on this evidence—it’s a strong base and continues to expand.

Physiological Effects: How Physiotherapists Use Exercise Prescription To Reduce Pain

Shockwaves can have a profound and often surprisingly fast effect on pain. Many people feel better so quickly that they often assume it’s a placebo because of how fast it works. But a mountain of research has shown that the effects of sound waves go way beyond placebo.

Yet the truth is that shockwave therapy does not target pain. It is about tissue healing. The intense sound waves of shockwave therapy activate stem cells and trigger a wide range of tissue regenerative effects in the body, including, but not limited to, resorption of calcification in tendons, bone regeneration, new blood vessel growth, cartilage regrowth, and release of growth factors.

When we are in pain, it is so unpleasant that we just want the feeling to go away. Yet, at a scientific level (rather than emotional), it is the healing of the body we crave. Healthy tissues stop hurting naturally. This is the best way to become pain-free instead of just masking symptoms.

The Big Picture: Beyond Physiotherapy

It can be enlightening to look at the full range of conditions that shockwave has been used for and may be used for in the future based on clinical observations and early-stage research. This shockingly broad scope highlights the fact that its true role is in the physical healing of a wide range of tissues. At our clinic, we generally stick to musculoskeletal conditions that have been studied extensively.
Below is an extensive bullet-point list of conditions treated with ESWT based on established uses, emerging research, and some “outside-the-box” applications. This list reflects clinical practice and areas under investigation as of March 16, 2025.

Established Musculoskeletal Conditions

Plantar Fasciitis: Widely used to treat chronic heel pain, ESWT promotes healing in the plantar fascia by enhancing blood flow and breaking down calcifications. Success rates range from 65-91% in studies.
Lateral Epicondylitis (Tennis Elbow): Applied to reduce pain and improve function in the elbow’s extensor tendons, with FDA approval since 2002. Evidence is mixed but often positive for chronic cases.
Calcific Tendinitis of the Shoulder: Effective in dissolving calcium deposits in the rotator cuff, improving mobility and reducing pain, especially calcifying tendinopathy.
Achilles Tendinopathy: Treats insertional and non-insertional forms by stimulating tendon repair and reducing inflammation. Studies show improved pain scores and function.
Patellar Tendinopathy (Jumper’s Knee): Used for chronic knee pain in athletes, promoting tendon regeneration and reducing stiffness.
Greater Trochanteric Pain Syndrome: This syndrome addresses hip pain from tendon or bursa issues, and ESWT shows promise in reducing discomfort and improving mobility.
Proximal Hamstring Tendinopathy: Helps alleviate pain and promote healing in this often stubborn condition, especially in runners.
Bone Non-Union and Delayed Union Fractures: This procedure stimulates osteogenesis and angiogenesis to heal fractures that fail to unite naturally, with success in tibial and long-bone cases.
Myofascial Pain Syndrome: This treatment targets trigger points to relieve muscle tension and pain, often outperforming traditional therapies in small studies.
Chronic Calcific Tendinopathies (General): Beyond the shoulder, ESWT breaks down calcium deposits in various tendons, enhancing recovery.

Other Orthopedic and Soft Tissue Conditions

Medial Tibial Stress Syndrome (Shin Splints): Emerging evidence suggests ESWT reduces pain and speeds recovery in this overuse injury.
Osteonecrosis of the Femoral Head: Early-stage cases (ARCO I-II) show pain relief and functional improvement, potentially delaying surgical intervention.
Frozen Shoulder (Adhesive Capsulitis): Limited studies indicate ESWT may improve the range of motion and reduce pain by addressing inflammation and adhesions.
Kissing Spine (Baastrup’s Disease): ESWT reduces back pain from vertebral impingement in veterinary and some human cases.
Spinal Calcifications: Anecdotal use in humans and animals suggests relief from stiffness and pain in calcified spinal tissues.
Tendinopathy of the Hand/Wrist: Applied to conditions like de Quervain’s tenosynovitis, with preliminary success in reducing inflammation.

Neurological and Post-Stroke Applications

Post-Stroke Spasticity (Upper Limb): ESWT reduces muscle tone and improves function in stroke survivors by altering nerve conduction and promoting tissue repair.
Multiple Sclerosis (Experimental): Though evidence is nascent, early research explores ESWT’s potential to reduce spasticity and improve mobility.
Peripheral Neuropathy: Investigated for pain relief and nerve regeneration, particularly in diabetic neuropathy, with mixed results.

Urological and Sexual Health Conditions

Erectile Dysfunction (Vasculogenic): Low-intensity ESWT (LI-ESWT) promotes neovascularisation in penile tissue, improving blood flow and erectile function in clinical trials.
Peyronie’s Disease: Breaks down penile plaques and reduces curvature, with growing use as a non-surgical option.
Chronic Pelvic Pain Syndrome: Shown to reduce pelvic floor muscle tension and pain, with moderate success in small studies.

Dermatological and Wound Healing

Chronic Wounds (e.g., Diabetic Ulcers): Enhances microcirculation and tissue regeneration, accelerating healing in non-responsive wounds.
Burn Scars: Preliminary research shows ESWT softens scar tissue and reduces pain, possibly via collagen remodelling.
Calcinosis Cutis: Used to break down subcutaneous calcium deposits, as seen in connective tissue diseases like scleroderma.

Cardiovascular and Ischemic Conditions

Myocardial Ischemia: In pilot studies, cardiac shockwave therapy (CSWT) stimulates angiogenesis in ischemic heart tissue, improving blood flow and function.
Peripheral Artery Disease: Low-energy ESWT promotes vascular growth in limbs, reducing pain and improving walking distance in early trials.

Emerging and Experimental Uses

Osteoarthritis: Investigated for pain relief and cartilage regeneration in knees and hips, with animal studies showing promise but limited human data.
Fibromyalgia: Small trials suggest ESWT may reduce widespread pain and fatigue, possibly by targeting myofascial trigger points.
Cellulite Reduction: Cosmetic use to improve skin texture by stimulating collagen and breaking down fat deposits, though efficacy is debated.
Lymphedema: Early research explores ESWT’s ability to improve lymphatic flow and reduce swelling post-cancer treatment.
Temporomandibular Joint Dysfunction (TMJD): Applied to relieve jaw pain and improve function, with anecdotal success in chronic cases.
Carpal Tunnel Syndrome: Experimental use to reduce nerve compression symptoms, though the evidence is sparse.

Veterinary and Animal Applications

Tendon and Ligament Injuries in Horses: A staple in equine medicine, ESWT heals bowed tendons and suspensory ligament issues.
Navicular Syndrome: Reduces heel pain in horses, improving lameness scores.
Arthritis in Dogs: Shockwave therapy is used to manage joint pain and stiffness and is gradually being adopted by veterinary clinics.

Outside-the-Box and Speculative Research Areas

Alzheimer’s Disease (Theoretical): Lab studies hint that shockwaves may disrupt amyloid plaques or enhance brain blood flow, but no human trials have yet been conducted.
Cancer Adjunct Therapy: Controversial research suggests ESWT might enhance tissue repair in cancer survivors or reduce tumour-related pain, though contraindicated near active tumours.
Hair Regrowth: Speculative use in androgenetic alopecia, with low-intensity waves potentially stimulating follicles, inspired by angiogenesis effects.
Tinnitus: Fringe exploration into ESWT for inner ear conditions, based on its microcirculatory effects, but unproven.
Autism Spectrum Disorders (Speculative): Hypothetical use to modulate neural activity via mechanotransduction, purely theoretical at this stage.
Obesity and Fat Reduction: Experimental animal studies explore fat cell disruption, but human application is far off.

Notes on Research and Limitations

Evidence Gaps: While musculoskeletal uses are well-supported, many emerging applications (e.g., neurological and dermatological) lack large-scale trials and higher-quality evidence.

Conclusion

Extracorporeal Shockwave Therapy (ESWT) uses acoustic shockwaves to stimulate healing and promote tissue regeneration. Initially developed for breaking up kidney stones (lithotripsy), its applications have expanded significantly, particularly in musculoskeletal medicine and less conventional and experimental areas.

Shockwave therapy began with kidney stones in the 1980s but is now used to treat a far broader range of conditions. Physiotherapists use it to heal tendons and joints with soundwaves that enhance blood flow and repair tissues. Over 2,000 studies have highlighted its potential value in reducing pain and restoring tissue integrity.

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