Extracorporeal shockwave therapy delivers high-energy acoustic waves to damaged tendon tissue, stimulating a healing response in tissue that has become metabolically dormant. For chronic tendinopathies that have failed to respond to physiotherapy, anti-inflammatory medication, and rest, shockwave therapy has a substantial evidence base and a strong safety profile.
How It Works Physiologically
Chronic tendinopathy is not an inflammatory condition in the classic sense. It is a failed healing response in which the tendon tissue undergoes degenerative change, with disorganised collagen, reduced tensile strength, and absent inflammatory cells. Shockwave therapy breaks up this degenerate tissue mechanically, triggers a genuine inflammatory healing cascade, stimulates tenocyte activity, promotes angiogenesis, and appears to desensitise local nociceptors, which accounts for the significant pain reduction often observed within three to four sessions.
The Strongest Evidence For
- Plantar fasciitis and insertional Achilles tendinopathy
- Mid-portion Achilles tendinopathy
- Patellar tendinopathy in active adults
- Calcific shoulder tendinopathy
- Lateral epicondylalgia (tennis elbow) resistant to other treatment
What to Expect
A standard protocol is three to five sessions at weekly intervals. Some patients experience a temporary increase in pain for 24 to 48 hours after each session, which is a normal part of the healing cascade being stimulated. Improvement is typically progressive, with the greatest gains seen at three months post-treatment as collagen remodelling completes. Shockwave therapy is not a substitute for rehabilitation but is most effective when combined with a progressive loading programme for the affected tendon.