Shockwave

Recovery for stubborn pain

Radial Shockwave (RSWT) using high energy acoustic pulses to physically REBOOT your body’s natural healing response.

It turns chronic, stalled injuries back into acute, healing ones.

The Science

Chronic injuries often get stuck in a metabolic stall: your body created a cast for you with soft tissue, but you’ve lost mobility an/or have pain. Shockwave re-injures to re-heal by triggering mechanotransduction - a process that sends an SOS signal to your body’s Mesenchymal Stem Cells (MSCs).

How?

  1. Triggers Healing: The acoustic waves produce a controlled inflammatory response, increasing local metabolic activity to stimulate and accelerate the body's natural self-healing mechanisms.

  2. Breaks Down Tissue: The mechanical energy helps break down dysfunctional scar tissue and calcifications.

  3. Blocks Pain: It down-regulates neurological pain transmission pathways to provide rapid relief.

Success Rate: Most people have an improvement of pain or range of motion even in the first visit! We see meaningful improvement in 75% of patients who complete a full treatment cycle (3-6 visits, defined as a minimum 75% pain reduction (!!) within 3 months). The long-term biological tissue remodeling can take 3-4 months.

Most patients receive at home instructions to improve results. Shockwave also works great alongside PRP injections, Physical Therapy, and Acupuncture.

What Does It Treat

Overuse injuries that have been around for at least 6 weeks:

    • Promotes tissue healing — rESWT stimulates neovascularization and collagen synthesis, healing the degenerated or inflamed plantar fascia at a biological level rather than just suppressing symptoms. (Angkananard et al., 2024, ScienceDirect)

    • Significant pain reduction — In a 245-patient RCT, radial shockwave produced a 72.1% reduction in pain scores vs. only 44.7% in the placebo group at 12 weeks, with results even stronger at 12 months. (Hammer et al., 2003, as cited in Boston Sports & Biologics, 2022)

    • Reduces fascia tension & stiffness — Dose-escalating rESWT significantly decreased plantar fascia attachment tension and myofascial stiffness alongside improvements in patient-reported pain scores. (Szajkowski, S., Pasek, J., & Cieślar, G., 2024, Medicina, 60(5), 766)

    • Improves how you walk — A 2026 biomechanical study found rESWT redistributes plantar pressure by reducing rearfoot loading, directly relieving the mechanical stress that perpetuates plantar fasciitis. (Shang, H., Ma, T., Wei, Y., et al., 2026, Frontiers in Rehabilitation Sciences)

    • High overall success rate — A meta-analysis of 2,500+ patients found ~75.3% had successful outcomes (at least 60% pain reduction and return to normal activities) after radial shockwave therapy. (Journal of Orthopaedic Surgery and Research, as cited in Yavapai Foot and Ankle Center, 2024)

    • Triggers biological tissue repair — rESWT activates the body's own healing mechanisms, including growth of new blood vessels, stimulation of tenocyte proliferation, collagen synthesis, and removal of damaged tissue components from the tendon. (Scientific Reports, 2026 — Nature.com)

    • Reduces pain via neurochemical pathways — Immediate pain relief from rESWT may be explained by reduced local levels of substance P, which alters pain perception at the tendon site. (Alsulaimani, B., Perraton, L., Bourke, J., Powers, T., & Malliaras, P., 2025, Clinical Rehabilitation)

    • Effective for both insertional & mid-portion Achilles tendinopathy — ESWT produced significant improvements in pain scores and ankle function, along with measurable reductions in tendon thickness, decreased calcifications, and improved tendon structure on ultrasound in both insertional and non-insertional cases. (Egyptian Rheumatology and Rehabilitation, Springer Nature, 2020)

    • Broad evidence across tendinopathies including Achilles — A 2024 meta-analysis of 45 RCTs concluded that shockwave therapy delivers significant pain reduction across multiple tendinopathies, with Achilles tendinopathy among the conditions where it is deemed a highly effective option. (Vale Medical, citing meta-analysis, 2024)

    • Works best combined with exercise — Clinical evidence supports combining rESWT with eccentric loading programs, as shockwave helps reduce pain enough to allow effective rehabilitation when rest and exercise alone have plateaued. (Charles, R., Fang, L., Zhu, R., & Wang, J., 2023, Frontiers in Immunology, 14, 1193835)

    • Reduces pain & improves function — rESWT significantly decreased pain scores and functional impairment, and increased pain-free grip strength in patients with tennis elbow, leading researchers to conclude it is a safe and effective therapy. (Delia, C., Santilli, G., Colonna, V., et al., 2024, Journal of Functional Morphology and Kinesiology, 9(4), 201)

    • Outperforms corticosteroid injections long-term — A meta-analysis of 6 RCTs found that while corticosteroid injections provided faster short-term relief (1 month), ESWT produced superior pain reduction, grip strength recovery, and functional outcomes at both the 3- and 6-month marks, with a similarly low rate of mild side effects. (Zhang et al., 2024, Orthopaedic Surgery — Wiley Online Library)

    • Promotes tissue healing at a biological level — ESWT works by inhibiting pain receptors, reducing inflammatory cytokines, enhancing blood vessel growth, and boosting cellular proliferation and extracellular matrix synthesis in the affected tendon tissue. (Zhang et al., 2024, Orthopaedic Surgery — Wiley Online Library)

    • Competitive with all major injection therapies — A network meta-analysis of 40 RCTs found ESWT outperformed placebo for both short- and medium-term pain relief in lateral epicondylitis, performing comparably to PRP and botulinum toxin A injections without the associated injection risks. (ScienceDirect, 2022 — Extracorporeal Shock Wave Therapy Shows Superiority Over Injections)

    • ESWT outperforms other conservative treatments for pain — A 2023 systematic review and meta-analysis found that while ESWT showed a negligible advantage over placebo when both groups also did eccentric exercise, it did produce significantly greater pain reduction compared to other standard conservative treatments alone. (Charles, R., Fang, L., Zhu, R., & Wang, J., 2023, Frontiers in Immunology, 14, 1193835)

    • Accelerates pain relief when combined with PRP — A 2024 RCT of 33 athletes found that combining ESWT with PRP injection facilitated earlier pain relief than PRP alone over a 12-month follow-up, with no adverse effects reported in either group. (Jhan, S.W., Wu, K.T., Chou, W.Y., et al., 2024, Knee Surgery & Related Research, 36, 47)

    • Significant functional improvements in basketball players — A retrospective study of in-season basketball players treated with ESWT showed a mean VISA-P score increase of 30 points, far exceeding the minimum clinically important difference of 13 points, alongside a 4.6-point improvement in pain during training. (Punnoose, A., Norrish, A., & Pak, K., 2017, Physiotherapy & Rehabilitation, 2, 124)

    • High-energy ESWT consistently beats placebo — A systematic review of 20 RCTs published in the Annals of Internal Medicine found that high-energy ESWT was significantly superior to placebo across all three key outcomes: pain reduction, shoulder function improvement, and resorption of calcium deposits. No such benefit was found for non-calcific tendinitis, making ESWT particularly well-suited to the calcific form. (Del Buono, A., et al., 2014, Annals of Internal Medicine, 160(8))

    • Proven to physically break down and resorb calcium deposits — A 2022 study found high-energy ESWT to be effective and strongly recommended for calcific rotator cuff tendinopathy, producing significant improvements in pain, functionality, and quality of life, alongside measurable decreases in the size of calcified deposits on ultrasound imaging. (Fatima, A., Ahmad, A., Gilani, S.A., et al., 2022, BioMed Research International, 2022, 1230857)

    • Outperforms injections, dry needling, and other conventional treatments for neck pain — A 2022 meta-analysis of 8 studies covering 571 patients found ESWT produced significantly greater pain reduction for upper trapezius and neck myofascial pain than other common modalities, including trigger point injection, dry needling, and pulsed radiofrequency. (Annals of Translational Medicine, 2022, as cited in CK Physio / MDPI Life, 2025)

    • Significant improvements in pain, pressure threshold, and neck function — A 2022 study found that after just three sessions of ESWT targeting upper trapezius trigger points, participants showed significant reductions in VAS pain scores, increased pressure pain thresholds, improved cervical range of motion, and reduced neck disability index scores. (Albomahmood, K.H., et al., 2022, Journal of Modern Rehabilitation, 16(4), 298–303)

    • ESWT outperforms corticosteroid injections at 12 months — An RCT of 104 patients comparing focused ESWT to ultrasound-guided corticosteroid injection found no clear difference at 3 months, but by 12 months the shockwave group showed meaningfully reduced pain intensity, improved Harris Hip Score, and likely positive effects on quality of life — while corticosteroid patients frequently experienced symptom recurrence. (Heaver, C., Pinches, M., Kuiper, J.H., et al., 2023, Hip International, 33(3), 490–499)

    • Radial shockwave outperforms exercise alone for pain — A Bayesian network meta-analysis of 8 studies and 596 GTPS patients found ESWT produced a significantly greater VAS pain reduction than exercise alone, and ranked second overall in treatment efficacy (81%) behind only ultrasound-guided PRP (99%). (PMC10214555, 2023, NIH/PMC)

    • Dramatically outperformed conservative treatment at 12 months in athletes — The landmark Level 1 RCT on this topic enrolled 40 professional athletes with chronic PHT and found that 80% of the shockwave group were rated "much improved or completely recovered" at 12 months and had returned to pre-injury sport participation, compared to zero in the traditional conservative treatment group. Three patients in the conservative group also required surgery, versus only one in the shockwave group. (Cacchio, A., Rompe, J.D., Furia, J.P., Susi, P., Santilli, V., & De Paulis, F., 2011, American Journal of Sports Medicine, 39(1), 146–153)

    • Safe and effective across hip/pelvis tendinopathies including PHT — A comprehensive 2025 systematic review of 18 studies covering GTPS, calcific tendinopathy, and PHT found that ESWT significantly improved pain and function in 17 of 18 studies, with all studies assessing pain showing improvement from 0.5 to 27 months post-treatment. Six studies demonstrated superior outcomes versus conservative treatment, sham ESWT, or corticosteroid injections. (Rau, O.R., Cheng, J., Jivanelli, B., Tenforde, A.S., & Wyss, J.F., 2025, Sports Health)

    • Equivalent outcomes to individualised physiotherapy — A high-quality 2025 RCT of 100 participants with PHT found no significant difference in pain or function between shockwave and individualised physiotherapy at 4, 12, 26, or 52 weeks — with the shockwave group reporting significantly greater patient satisfaction at 26 weeks. This positions ESWT as a legitimate standalone alternative to physio for chronic cases. (Rich, A., Ford, J., Cook, J., & Hahne, A., 2025, American Journal of Sports Medicine, 53(14), 3396–3407)

    • Accelerates return to sport after hamstring tendon surgery — While focused on post-surgical recovery rather than tendinopathy alone, this prospective RCT found ESWT reduced return-to-pivoting-sport time from 42.6 weeks to 27.9 weeks and produced significantly better IKDC, Lysholm, and VAS scores at all follow-up points — underscoring shockwave's biological capacity to promote hamstring tendon healing and remodeling. (PMC10219043, 2023, NIH/PMC)

Who is NOT a candidate?

We can’t use shockwave if you are pregnant, have a blood clotting disorder, have a tumor/infection in the area, have hardware in the area, have a pacemaker, or have had a steroid (cortisone) injection in the last 6 weeks. It doesn’t work well for new injuries, rotator cuff tendinopathies, osteoarthritis, nerve pain, or stress fractures.

The Process

Treatment Length

Each area takes 3-8 minutes. Weekly (or about every 4-10 days) is ideal.

  • The 3-Visit Jumpstart (Acute): For recent injuries (<3 months old). Designed to disrupt pain and fast-track your return to the trail.

  • The 6-Visit Structural Overhaul (Chronic): For long-standing injuries (6+ months). Deep, consistent stimulation required to re-organize scar tissue and recruit stem cell repair.

The Healing Curve

  • During the Protocol (Weeks 1–6): You’ll likely feel waves of improvement. Some days will be great, and some might feel like a temporary regression as your tissue processes the mechanical stimulus. This is normal. Most people feel best AFTER their last treatment.

  • The Remodeling Phase (The 4 weeks after last treatment): This is where the healing really happens. Your body is still busy synthesizing new collagen, reorganizing scar tissue, and strengthening the tendon-to-bone interface. Many patients report the most significant jump in pain relief and functional strength weeks after their final treatment.

  • The Long-Term Result: Because we are inducing actual biological change rather than just numbing the nerves, the structural integrity of your tissue continues to solidify for up to 3 months post-treatment. Most people don’t need maintenance. Sometimes we do a 1-3 session booster.

Home Care

  • No ice, no ibuprofen. We need your body’s inflammatory response to do the work

  • I’ll email you exercise homework. The more you do your homework, the better the results!

  • Downtime: It’s best to take it easy 24 hours after the first treatment, after that, there should be zero downtime. Sometimes there’s some soreness or redness, but it should be minimal.

  • Avoid sudden, massive spikes in activity (e.g. going from running 2 miles a week to 15 miles a week)

How It Feels

It’s no massage, but for chronic pain, many report that it actually feels pretty good - something like “therapeutic discomfort”. It’s a tiny, fast-moving jackhammer. We control the intensity, so we always keep it within your tolerance.