Shockwave Therapy
SHOCKWAVE THERAPY FOR CALCIFIC TENDINOPATHY
At a glance
Shockwave therapy (ESWT) is a non-invasive treatment for calcific tendinopathy of the shoulder. It delivers acoustic pressure waves into the affected tendon to promote calcium resorption and stimulate healing. A systematic review of 28 randomised trials found that ESWT significantly improves pain, shoulder function and calcification resolution. A 2023 meta-analysis concluded that it is reasonable to trial ESWT before considering surgery. A typical course is 4 to 5 weekly sessions.
Calcific tendinopathy is one of the most painful shoulder conditions we treat. A calcium deposit forms inside a rotator cuff tendon, most often the supraspinatus, and when the body tries to reabsorb it the result is sudden, intense shoulder pain that can make it impossible to lift your arm, sleep on that side or reach behind your back.
The treatment options for persistent calcific tendinopathy range from conservative care through to ultrasound-guided needling (barbotage) and arthroscopic surgery. Shockwave therapy sits between these as a non-invasive treatment that actively targets the deposit. A systematic review of 28 randomised trials found that shockwave significantly improved pain, function and calcification resolution compared to placebo, concluding that the treatment may be underutilised for a condition that can be difficult to manage.
Shockwave works on calcific tendinopathy by delivering acoustic pressure waves into the affected area of the tendon. This increases local blood flow, stimulates the growth of new blood vessels and activates an inflammatory response that helps the body break down and clear the calcium deposit. The structural changes triggered by treatment continue to develop for weeks after the course ends.
A 2024 meta-analysis of 21 randomised trials found that shockwave significantly reduces pain and improves function in calcific tendinopathy compared to sham treatment. The same review found no significant difference in outcomes between radial and focused shockwave devices, which means radial shockwave, the type we use at our practice, performs equivalently to focused devices for this condition.
A separate meta-analysis compared surgical and non-surgical approaches for calcific tendinopathy. Both produced meaningful improvements. Surgery showed greater functional gains, but shockwave still produced significant improvements in both pain and function while avoiding the risks, costs and recovery time of an operation. The researchers concluded that it is reasonable to try non-invasive options including shockwave before considering surgery.
At our Sandton practice we deliver shockwave using the EMS Swiss DolorClast Smart20, the most extensively researched radial shockwave system in clinical use. We combine shockwave with chiropractic care because the shoulder does not exist in isolation. Thoracic spine stiffness, poor scapular control and compensatory movement patterns all affect how the rotator cuff loads. Restoring normal mechanics through the shoulder, thoracic spine and neck, alongside targeted rehabilitation, gives the tendon the best environment to heal.
WHEN TO CONSIDER SHOCKWAVE FOR CALCIFIC TENDINOPATHY
Shockwave therapy may be appropriate for calcific tendinopathy when:
- Shoulder pain has persisted for more than 6 to 8 weeks despite rest and conservative treatment
- Imaging (X-ray or ultrasound) has confirmed a calcium deposit in a rotator cuff tendon
- Pain is severe enough to disrupt sleep, work or daily activities
- You want to explore a non-invasive option before considering needling or surgery
- Cortisone injections have provided only temporary relief or no relief
- You have been told the deposit is unlikely to resolve on its own in a reasonable timeframe
WHAT TO EXPECT FROM A COURSE OF SHOCKWAVE
Treatment follows a structured protocol:
- A thorough shoulder assessment at your first visit to confirm that shockwave is appropriate for your condition
- 4 to 5 sessions delivered once a week, each lasting about 15 minutes of shockwave treatment
- Each visit also includes a chiropractic adjustment, manual therapy and rehabilitation exercises tailored to your shoulder
- Pain relief is often noticeable after the first or second session
- Mild tenderness or warmth in the shoulder for 24 to 48 hours after each session is normal and expected
- Avoid anti-inflammatory medication during the course where possible, as it can slow the healing response shockwave is designed to trigger
- Structural changes including calcium resorption continue to develop for 6 to 12 weeks after the course ends
- Progress is tracked through pain levels and shoulder function at each visit, with the treatment plan adjusted as you respond
If conservative care alone has not resolved your calcific tendinopathy, shockwave therapy is a reasonable next step that targets the deposit non-invasively. If the deposit does not respond adequately, we can discuss and arrange referral for ultrasound-guided needling or surgical opinion. Read more about the condition, its stages and what drives it in our detailed calcific tendonitis article.
Located on Rivonia Road in Morningside, we serve patients from Sandton, Bryanston, Fourways, Randburg, Sunninghill, Rivonia and surrounding areas of Johannesburg.
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 shoulder before booking.
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Frequently Asked Questions
Yes. A systematic review of 28 randomised trials found that shockwave significantly improved pain, shoulder function and calcium clearance compared to placebo. A 2024 meta-analysis of 21 trials confirmed these findings and reported that radial and focused shockwave produce equivalent results.
Shockwave delivers acoustic pressure waves into the calcified area of the tendon. This increases local blood flow, stimulates new blood vessel growth and activates an inflammatory response that drives the body's own resorption process to break down and clear the calcium. These structural changes continue for weeks after the treatment course ends.
Most published trials use 3 to 5 sessions delivered once a week. Calcific tendinopathy typically needs 4 to 5 sessions, though some patients notice meaningful pain relief after the first or second session. The deeper structural changes, including calcium clearance, continue for 6 to 12 weeks after the course.
A 2023 meta-analysis found that both shockwave and surgery produce meaningful improvements. Surgery showed greater functional gains, but it also carries the risks of anaesthesia, surgical complications and a longer recovery period. The researchers concluded that it is reasonable to try shockwave and other non-invasive options before considering surgery.
Shockwave has been shown to help the body break down and clear calcium deposits. The degree of clearance varies between patients: some achieve complete resolution, while others see partial reduction. Even when the deposit is not fully cleared, most patients experience meaningful improvement in pain and function.
The treatment feels like rapid mechanical tapping over the shoulder. Over the calcified area it can be intense for the first 30 to 60 seconds before the pain-modulating effect kicks in. Most patients describe the discomfort as a 3 to 5 out of 10 and entirely manageable. We adjust the energy level to your tolerance.
You may feel mild tenderness or warmth in the shoulder for 24 to 48 hours afterwards. This is the healing response and is expected. We ask patients to avoid anti-inflammatory medication during the course where possible, as it can blunt the very response shockwave is trying to provoke. Normal activities can continue between sessions.
A 2023 meta-analysis concluded that it is reasonable to try non-invasive treatments including shockwave before considering surgery for calcific tendinopathy. Shockwave produces meaningful improvements in pain and function while avoiding the risks and recovery time of an operation. If the deposit does not respond, surgery and ultrasound-guided needling remain available as next steps.
References
- Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, McAlindon T. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Annals of Internal Medicine. 2014;160(8):542-549.
- Brindisino F, Marruganti S, Lorusso D, Cavaggion C, Ristori D. The effectiveness of extracorporeal shock wave therapy for rotator cuff calcific tendinopathy: a systematic review with meta-analysis. Physiotherapy Research International. 2024;29(3):e2106.
- Angileri HS, Gohal C, Comeau-Gauthier M, et al. Chronic calcific tendonitis of the rotator cuff: a systematic review and meta-analysis of randomized controlled trials comparing operative and nonoperative interventions. Journal of Shoulder and Elbow Surgery. 2023;32(8):1746-1760.