Shockwave Therapy: How It Works and the Conditions It Treats

Most musculoskeletal pain comes down to one of three things: a tendon that is not healing, a muscle that will not let go or a soft tissue area that is stuck in a chronic pain cycle. Whether the pain is recent or has been with you for years, what most patients want is the same thing: relief that lasts, and tissue that actually heals rather than just being managed.

Shockwave therapy is one of the most versatile non-invasive treatments available for this. It works on muscle pain and trigger points, on tendon injuries new and old, on heel pain, joint pain, post-injury scar tissue and chronic areas of tension that have not responded to anything else. The clinical evidence across these conditions is strong and the response is often substantial.

At our Sandton practice we use the EMS Swiss DolorClast Smart20, widely regarded as the gold standard in radial shockwave therapy and the most extensively researched shockwave system in clinical use. Below is what shockwave therapy actually is, how it works, the conditions it treats and what to expect from a course of treatment.

What is shockwave therapy?

Extracorporeal shockwave therapy (ESWT) uses high-energy acoustic pressure waves delivered through the skin into injured soft tissue. The word “shockwave” sounds dramatic, but it simply describes a fast pressure pulse, similar in principle to the technology used to break up kidney stones, adapted and refined for musculoskeletal use.

The shockwave treatment itself takes about 15 minutes. The applicator is pressed against the skin over the affected area and delivers between 2 000 and 3 000 pulses, depending on the condition. In practice we rarely use shockwave on its own. It is paired with a chiropractic adjustment, manual therapy and targeted rehabilitation work in the same visit, because that combination consistently produces better results than shockwave in isolation. The number of sessions depends on what we are treating: most published trials use 3 to 5 sessions delivered one a week, with the exact dose tailored to your condition and response. We will give you a clear answer specific to your case at your assessment.

How does it actually work?

Radial shockwave therapy delivers high-energy acoustic waves into the targeted tissue and produces three complementary effects (Wang, 2012; Schmitz et al., 2015):

An analgesic effect. Shockwave inhibits Substance P, the neurotransmitter responsible for amplifying pain signals at the treated site. This is why many patients notice a meaningful reduction in pain within the first one or two sessions, before any structural change in the tissue has had time to occur.

An anti-inflammatory action. Shockwave reduces neurogenic inflammation and decreases prostaglandin E2, mimicking the anti-inflammatory effect of NSAIDs without the side effects. At the same time it allows scleraxis expression, a key tendon-lineage signal that helps restore healthy collagen architecture in damaged tendons.

Activation of the body’s healing mechanisms. Shockwave drives angiogenesis, the growth of new microvessels into the treated area, and improves local blood circulation. This in turn stimulates regeneration of muscle, tendon, cartilage and bone through cellular repair, helping damaged fibres remodel and reactivating the healing response in chronic tissue that had stopped progressing.

For conditions like calcific tendonitis of the shoulder, the mechanical pulses also help fragment calcium deposits and stimulate your body’s own resorption processes to clear them.

The combined effect is fast pain relief and faster, more complete healing across a wide range of muscle, tendon and soft tissue conditions.

Conditions we treat with shockwave

Shockwave is effective across a broad range of musculoskeletal conditions. The list below covers the indications with the strongest evidence base, all of which we treat at our Sandton practice. It works on both recent injuries (to speed up healing) and longer-standing pain (to reactivate stalled recovery).

Muscle pain, knots and trigger points

A surprising amount of everyday musculoskeletal pain comes from muscle rather than tendon or joint. Chronic neck pain, shoulder tightness, headaches, persistent low back tension and recurring “knots” between the shoulder blades are very often driven by myofascial trigger points: tight, hyperirritable bands within the muscle that refer pain locally and along predictable patterns.

Shockwave is one of the most effective treatments available for this kind of pain. The mechanical pulses release contracted muscle bands, increase blood flow to the tissue and reset overactive pain signalling. Speed (2014) and subsequent randomised trials have shown shockwave produces meaningful reductions in pain across myofascial pain syndromes, often with results felt the same day.

In practice we use shockwave for:

Stubborn upper trapezius and levator scapulae tightness from desk work
Quadratus lumborum and gluteal trigger points feeding chronic low back pain
Rhomboid and thoracic muscle pain between the shoulder blades
Calf, hamstring and adductor tightness in runners and athletes
Tension headaches driven by suboccipital and cervical muscles
Chronic muscle tightness that returns within days of every massage

For patients who feel like they are constantly chasing relief from tight, painful muscles, shockwave delivers something stretching, foam rolling and even manual therapy alone often cannot: a deep, targeted, mechanical reset of the affected tissue.

Plantar fasciitis and heel pain

This is the most extensively studied indication for shockwave therapy. A meta-analysis by Aqil and colleagues (2013) pooled data from randomised controlled trials and found shockwave significantly improved pain and function in plantar fasciitis compared with placebo. Lou and colleagues (2017) confirmed the effect across further trials.

Shockwave works at any stage of plantar fasciitis. In recent cases it accelerates healing of the irritated fascia. In long-standing cases it shifts pain that has not responded to stretching, orthotics or anti-inflammatories. It is a non-invasive alternative to corticosteroid injections, with none of the risks of fascia rupture or fat-pad atrophy that injections can carry.

Calcific tendonitis of the shoulder

For calcific tendonitis of the rotator cuff, shockwave breaks down calcium deposits and stimulates resorption. Mouzopoulos and colleagues (2007) reviewed the evidence and concluded shockwave is an effective non-surgical option. A more recent systematic review and meta-analysis by Xue and colleagues (2024) found shockwave produced significant improvements in pain and shoulder function in rotator cuff tendinopathy generally, including non-calcific cases.

This is an important option to consider before progressing to barbotage or surgery.

Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis)

Elbow pain on the outside (tennis elbow) or inside (golfer’s elbow) of the joint involves tendinopathy of the wrist extensor or flexor origin. Whether the injury is recent or has been bothering you for months, the underlying problem is the same: a tendon that needs help to repair properly.

A systematic review by Speed (2014) identified consistent benefits for shockwave in lateral elbow pain when applied at appropriate energy levels and combined with loading rehabilitation. Patients commonly report meaningful pain reduction within the first few sessions and continued improvement over the weeks that follow.

Achilles tendinopathy

For Achilles tendinopathy, shockwave combined with eccentric loading produces better outcomes than eccentric loading alone. Rompe and colleagues (2009) ran a randomised controlled trial showing this combination outperformed exercise on its own at four months. The protocol works for both recent flare-ups and long-standing cases: shockwave activates the repair response, structured loading rebuilds tendon capacity.

Patellar tendinopathy (jumper’s knee)

Patellar tendinopathy, common in jumping and running athletes, responds well to shockwave. Vetrano and colleagues (2013) compared shockwave with platelet-rich plasma in athletes with jumper’s knee and found shockwave produced comparable improvements at 12 months, with the advantage of being non-invasive. It pairs well with progressive heavy slow resistance training, which remains the foundation of knee tendon rehab.

Greater trochanteric pain syndrome (lateral hip pain)

Pain over the outside of the hip, often misnamed “hip bursitis,” is usually a tendinopathy of the gluteus medius and minimus tendons. Furia and colleagues (2009) found shockwave significantly outperformed standard non-operative care for this condition at one and three months, with sustained benefit. We see this commonly in runners and women in their 40s and 50s.

Medial tibial stress syndrome (shin splints)

Persistent shin pain in runners that has not settled with rest and load management can respond to shockwave. Rompe and colleagues (2010) showed shockwave combined with a running programme produced faster return to sport than the running programme alone.

Acute soft tissue injuries

Shockwave is increasingly used in the early phase of muscle strains and sprains, particularly hamstring, calf, quad and adductor injuries in athletes. By stimulating local blood flow and activating repair signals from the outset, it can shorten return-to-sport timelines compared with rehab alone. We use it routinely with the active patients in our practice who want to come back from injury as fast as possible.

Other conditions where shockwave is effective

Hamstring tendinopathy (proximal and mid-substance)
IT band friction syndrome and lateral knee pain
Subacromial, trochanteric and ischial bursitis
Adductor-related groin pain and chronic groin tightness
Wrist and hand tendinopathies, including De Quervain’s
Scar tissue and adhesions from old injuries or post-surgical sites
Chronic joint pain where surrounding muscle and tendon are contributing

What does it actually feel like?

The sensation is a rapid mechanical tapping or thudding against the skin. Over a tender tendon it can feel intense for the first 30 to 60 seconds before the pain-modulating effects kick in and the area starts to numb. Most patients describe the discomfort as a 3 to 5 out of 10 and entirely tolerable. We adjust the energy level to your tolerance and the area being treated, and most people are surprised by how manageable it is.

You may feel mild tenderness or warmth in the treated area for 24 to 48 hours afterwards. This is the healing response getting going and is exactly what you want.

What you should expect from a course of treatment

The course length depends on what we are treating, but the dosing across published trials is consistent enough to set realistic expectations. Plantar fasciitis and tennis elbow typically respond within 3 to 4 weekly sessions. Calcific tendonitis usually needs 4 to 5 sessions for the deposit to break down properly. Achilles and patellar tendinopathy are most commonly studied with 3 weekly sessions paired with progressive loading rehabilitation. Greater trochanteric pain syndrome and shin splints often respond in 3 sessions. We re-assess at every visit and adjust the plan based on how you are responding rather than committing you to a fixed number up front.

Many patients notice a meaningful change in pain after the first or second session, but the deeper structural changes (new blood vessels, collagen remodelling, calcium resorption) continue to develop for 6 to 12 weeks after the course ends. The biggest gains often come in the weeks after treatment is finished, as the tissue continues to repair.

Shockwave is most effective when paired with the right rehabilitation. The pulses activate the healing response, and the right loading gives the new tissue the stimulus it needs to rebuild as strong, capable tendon. For tendinopathies we prescribe a structured progressive loading programme alongside the shockwave course; for muscle and trigger point cases it may be a few targeted home exercises or stretches. The point is the same: shockwave wakes the tissue up, the home work helps it remodel.

We will also ask you to avoid anti-inflammatories (ibuprofen, diclofenac and similar) for the duration of the course where possible, as they can blunt the very response shockwave is trying to provoke. Paracetamol is fine if you need pain relief.

How a shockwave appointment works at our practice

Every patient starts with a full assessment. We work out what is actually driving your pain, identify any biomechanical contributors further up the chain (the lower back, hip, knee or ankle that may be feeding the problem) and confirm shockwave is the right tool for your specific injury.

From there, treatment usually combines:

Targeted shockwave to the affected tendon, fascia or muscle, delivered with the EMS Swiss DolorClast Smart20.
Manual therapy and soft tissue work to address joint restrictions and adjacent muscle tension that contribute to the load on the injured tissue.
Appropriate home exercises or stretches, scaled to your case: a structured progressive loading programme for tendinopathies, or a few targeted exercises for muscle and trigger point cases.
Onward referral for imaging or specialist input if your case calls for it.

This combined approach consistently outperforms shockwave alone in the published evidence and is what we have built our protocols around.

Why patients choose shockwave

The appeal of shockwave is straightforward:

It is non-invasive. No needles, no injections, no anaesthetic.
It treats a wide range of conditions: muscle pain, trigger points, tendon injuries, heel pain, joint pain and chronic tightness.
It works on both new injuries and long-standing pain.
It actively accelerates healing rather than just managing pain.
Many patients feel meaningful relief within the first one or two sessions.
The evidence base is large, consistent and growing.
It avoids the risks associated with corticosteroid injections.

Book a shockwave assessment in Sandton

Whether you are dealing with chronic muscle tightness, persistent trigger points, a stubborn tendon, heel pain or a sports injury you want healed faster, shockwave therapy is one of the most effective non-invasive options available. We will assess what is driving your pain, explain how shockwave fits into your treatment and start treatment in the same visit if it is the right fit.

Shockwave therapy at our practice is offered by Dr Matthew Proctor. Book a shockwave appointment directly with him, or get in touch to discuss your case before booking.

References

SHOCKWAVE THERAPY: HOW IT WORKS AND THE CONDITIONS IT TREATS