How Does Shockwave Therapy Treat Tendon Injuries?

How Does Shockwave Therapy Treat Tendon Injuries?

Shockwave therapy uses high-energy pressure sound waves delivered through the skin:

• to stimulate healing in stubborn tendon injuries, 
• working by boosting blood flow, 
• encouraging collagen production, 
• and helping break down old scar tissue. 

It's typically used for chronic or persistent cases, such as tennis elbow, Achilles tendinopathy, or plantar fasciitis, where other treatments haven't fully resolved symptoms. ⁽¹⁾ 

Most people need a short course of sessions rather than a single treatment, and it's usually combined with an exercise programme for the best results.

Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that delivers high-energy pressure sound waves to injured tissue through the skin. Despite the name, it doesn't involve an electric shock. The "shockwave" refers to the type of acoustic pulse used, similar in principle to the technology used to break down kidney stones, though at a different intensity.

It's commonly used for tendon injuries that have become chronic or haven't responded well to rest, exercise, or other conservative treatment on their own.

How Does Shockwave Therapy Help Tendons Heal?

Tendons have a relatively limited blood supply compared to muscle, which is part of why tendon injuries can be so slow to heal and so quick to become chronic. Shockwave therapy works by delivering targeted pulses of energy into the affected area, which triggers several helpful responses in the tissue:

• Increased blood flow, bringing more oxygen and nutrients to support repair
• Stimulated collagen production, which is essential for rebuilding tendon strength
• Breakdown of scar tissue and calcific deposits, which can restrict movement and prolong pain
• Reduced pain sensitivity in the treated area over the course of treatment

Essentially, it's designed to "restart" the healing process in tissue that has stalled, prompting the body to treat the area as a fresh injury again rather than an ongoing, low-grade irritation.

What Tendon Injuries Can Shockwave Therapy Treat?

Shockwave therapy is commonly used for a range of tendon and soft tissue conditions, including:

• Tennis elbow and golfer's elbow
• Achilles tendinopathy
• Plantar fasciitis
• Patellar tendinopathy (jumper's knee)
• Shoulder tendinopathy, including calcific tendinitis
• Hip-related tendon pain

It's particularly useful for conditions that have persisted for several months, where the tissue has become thickened or degenerative rather than simply inflamed. ⁽²⁾

What Does a Shockwave Therapy Session Involve?

A typical session is quick, usually taking around 10–15 minutes. A water-based gel is applied to the skin, and a handheld device delivers pulses of energy directly to the affected area. Most people describe the sensation as a strong tapping or pulsing feeling, which can be uncomfortable but is generally well tolerated.

Some soreness or mild bruising in the treated area is common for a day or two afterwards. Most treatment plans involve a short course of sessions, often weekly, over several weeks (depending upon the type of injury and the site of injury), rather than a single visit, as the healing response builds gradually over the course of treatment.

Is Shockwave Therapy Used Alone, or Alongside Other Treatment?

Shockwave therapy tends to work best as part of a wider rehabilitation plan rather than as a standalone fix. It creates favourable conditions for healing, but the tendon still needs to be gradually strengthened and loaded correctly to fully recover and reduce the risk of the injury returning.

For this reason, it's usually combined with a structured physiotherapy programme involving progressive strengthening exercises, alongside advice on activity modification and load management.

Who Is a Good Candidate for Shockwave Therapy?

Shockwave therapy is generally considered for people with:

• Tendon pain that has lasted longer than a few weeks without improving
• Longstanding or recurring sports injuries that haven't responded to rest or exercise alone
• Persistent tendon issues linked to repetitive movement at work
• A preference to avoid or delay more invasive treatment options ⁽³⁾

It's not suitable for everyone, so a proper assessment is important to confirm it's the right option for your specific condition before starting treatment.

Get Expert Shockwave Therapy in Chester

If you're dealing with a stubborn tendon injury that hasn't improved with rest or basic treatment, shockwave therapy could be a helpful next step. At Relive Physiotherapy in Chester, treatment is combined with a tailored rehabilitation plan to give your tendon the best chance of a full, lasting recovery.

Struggling with ongoing tendon pain? Book an assessment with Relive Physiotherapy today to find out if shockwave therapy is right for you.

Frequently Asked Questions

Does shockwave therapy hurt?

It can feel uncomfortable, often described as a strong tapping or pulsing sensation, but it's generally well tolerated. Some mild soreness or bruising afterwards is common and usually settles within a day or two.

How many shockwave therapy sessions do I need?

Most treatment plans involve a short course of sessions, often delivered weekly over several weeks, rather than a single treatment, as the healing response builds gradually.

What tendon injuries respond well to shockwave therapy?

It's commonly used for chronic conditions like tennis elbow, Achilles tendinopathy, plantar fasciitis, and patellar tendinopathy, particularly where symptoms have persisted for several months.

Does shockwave therapy replace the need for exercise or physiotherapy?

No. It tends to work best combined with a structured exercise programme, as the tendon still needs to be progressively strengthened to fully recover and reduce the risk of recurrence.

Is shockwave therapy suitable for everyone with tendon pain?

Not necessarily. It's generally most effective for chronic, persistent tendon injuries rather than acute ones, and a proper assessment is needed to confirm it's the right treatment for your specific condition.

References: 

1.https://pmc.ncbi.nlm.nih.gov/articles/PMC12734210/ 

2.https://pmc.ncbi.nlm.nih.gov/articles/PMC6029898/ 

3.https://pmc.ncbi.nlm.nih.gov/articles/PMC7275282/

About the Author: 

Raj Gandhi

Lead Physiotherapist & Independent Non-Medical Prescriber

Raj Gandhi is a Chartered Physiotherapist and co-founder of Relive Physiotherapy, with over 20 years' specialist experience in Orthopaedics, Sports Injuries, and Musculoskeletal Medicine.

He holds a Master's degree in Sports Physiotherapy, a Postgraduate Diploma in Orthopaedic Medicine and Injection Therapy, and a Postgraduate Certificate in Independent Prescribing. Raj has a particular interest in treating back and neck pain, along with a wide range of sports injuries, and has worked as a Physiotherapist for the Commonwealth Games team. He spent over 10 years in the NHS before leaving to establish Relive Physiotherapy and is widely respected among colleagues for his expertise in Injection Therapy and his hands-on, manual approach to treatment.

Raj is a member of the Association of Chartered Physiotherapists in Orthopaedic Medicine and Injection Therapy (ACPOMIT), the Acupuncture Association of Chartered Physiotherapists (AACP), and the Association of Chartered Physiotherapists in Sports Medicine (ACPSEM). He also mentors the physiotherapy team at Relive, regularly leading training and supporting their ongoing development.

Outside the clinic, Raj is a father to two girls and enjoys playing tennis, listening to audiobooks, and photography.