Shockwave Therapy
SHOCKWAVE THERAPY FOR TENNIS ELBOW
At a glance
Shockwave therapy (ESWT) is an effective non-invasive treatment for tennis elbow (lateral epicondylitis) that has not responded to conservative care. A 2024 meta-analysis found that ESWT outperforms corticosteroid injections at three and six months for pain, grip strength and elbow function. Radial ESWT, the type we use at our practice, was specifically highlighted as effective. A typical course is 3 to 5 weekly sessions.
Tennis elbow is one of the most common and stubborn tendon conditions we treat. Despite the name, fewer than 10% of cases come from tennis. Repetitive gripping, typing, mouse work and manual tasks are far more common triggers. The underlying problem is degeneration of the common extensor tendon where it attaches to the outer elbow. The tissue breaks down faster than it repairs, and once the cycle is established it can persist for months.
For many patients, progressive loading exercises, manual therapy and activity modification are enough to turn the corner. But when elbow pain persists beyond 6 to 8 weeks of consistent conservative care, shockwave therapy is a well-supported next step. It is particularly useful for cases where the tendon has stopped healing on its own and needs a stimulus to restart the repair process.
A 2024 systematic review compared shockwave to corticosteroid injections across 6 randomised trials for chronic tennis elbow. At one month, cortisone provided faster initial relief. But at three months, shockwave was significantly better for pain, grip strength and function. At six months, the advantage of shockwave over cortisone was even larger. This matches a pattern seen across tendon conditions: cortisone suppresses symptoms quickly but the effects wear off, while shockwave stimulates tissue repair that builds over time.
A separate 2024 meta-analysis of 18 randomised trials of shockwave for upper limb tendon conditions, including tennis elbow, found that shockwave was effective for pain relief with results surpassing placebo at three and six months. Radial shockwave specifically was highlighted as effective, and the rate of side effects was low.
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 tennis elbow is rarely just an elbow problem. Neck and shoulder problems frequently refer pain to the elbow, and thoracic spine stiffness can alter how forces are distributed down the arm. Addressing these alongside the local tendon gives the best results.
WHEN TO CONSIDER SHOCKWAVE FOR TENNIS ELBOW
Shockwave therapy may be appropriate for tennis elbow when:
- Elbow pain has persisted for more than 6 to 8 weeks despite rest, bracing and exercises
- Grip strength is reduced and daily tasks like lifting a kettle or turning a door handle are painful
- Cortisone injections have provided only temporary relief or you want to avoid them
- The pain is limiting your ability to work, train or play sport
- You want a non-invasive treatment that targets the tendon itself rather than just managing the pain
- Previous treatment including physiotherapy or manual therapy has stalled
WHAT TO EXPECT FROM A COURSE OF SHOCKWAVE
Treatment follows a structured protocol:
- A thorough assessment at your first visit to confirm that shockwave is appropriate for your elbow pain
- 3 to 5 sessions delivered once a week, each lasting about 15 minutes of shockwave treatment
- Each visit also includes a chiropractic assessment, elbow and thoracic mobilisation and rehabilitation exercises
- Many patients notice improved grip strength and reduced pain after the first or second session
- Mild tenderness or warmth in the elbow 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
- Tissue remodelling continues for 6 to 12 weeks after the course ends, with ongoing improvement
- Progress is tracked through pain levels and grip strength at each visit, with the treatment plan adjusted as you respond
If conservative care has not resolved your tennis elbow, shockwave therapy is a well-supported next step with stronger mid-term outcomes than cortisone injections. Read more about the condition and how we treat it on our elbow pain page.
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 elbow before booking.
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Frequently Asked Questions
Yes. A 2024 meta-analysis of 18 randomised trials found that ESWT is effective for pain relief in lateral epicondylitis, with results surpassing placebo at three and six months. Radial shockwave specifically was highlighted as effective. A separate meta-analysis found that ESWT outperforms corticosteroid injections at three and six months on pain, grip strength and elbow function.
At mid-term follow-up, yes. A 2024 meta-analysis of 6 randomised trials found that cortisone injections provided faster relief at one month, but ESWT produced significantly better outcomes at three and six months for pain, grip strength and function. Cortisone also carries the risk of tendon weakening with repeated use, while shockwave stimulates tissue repair.
Most published trials use 3 to 5 sessions delivered once a week. Many patients notice meaningful improvement in grip strength and pain after the first or second session. The tissue remodelling triggered by treatment continues for 6 to 12 weeks after the course ends.
Tennis elbow involves degeneration of the common extensor tendon at the outer elbow. The tissue has stopped healing on its own. Shockwave delivers acoustic pressure waves into the damaged tendon, increasing blood flow, stimulating new blood vessel growth and triggering a healing response. It also reduces Substance P, a neurotransmitter involved in pain signalling.
Shockwave is a good option when tennis elbow has not responded to rest, bracing, exercises or other conservative measures over 6 to 8 weeks. It is also worth considering if you want to avoid cortisone injections or have had injections that provided only temporary relief.
The treatment feels like rapid mechanical tapping over the outer elbow. Over the tender area of the tendon 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.
In most cases, yes. You may need to modify how you do repetitive tasks temporarily, particularly heavy gripping or prolonged typing. Your chiropractor can advise on adjustments to your workstation or training that reduce the load on the tendon while it heals.
Yes. Golfer's elbow (medial epicondylalgia) is a similar overuse tendinopathy on the inner elbow. The same meta-analysis of upper limb tendonitis found that ESWT is effective for pain relief across elbow tendon conditions. The treatment protocol and expected response are similar to tennis elbow.
References
- Zhang L, Zhang X, Pang L, Wang Z, Jiang J. Extracorporeal shock wave therapy versus local corticosteroid injection for chronic lateral epicondylitis: a systematic review with meta-analysis of randomized controlled trials. Orthopaedic Surgery. 2024;16(11):2598-2607.
- Xiong Y, Wen T, Jin S, et al. Efficacy and safety of extracorporeal shock wave therapy for upper limb tendonitis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine. 2024;11:1394268.