Whenever "extracorporeal shockwave therapy" comes up for long-term heel, elbow or shoulder pain, many people's first reaction is: "I've heard it really hurts, like being hit with a little hammer. Can I take it?" Others assume "the more it hurts, the better it works".
This article explains what shockwave therapy is, which conditions it is commonly used for, what treatment involves and how many sessions are needed, who should avoid it, and common myths. It is health education and cannot replace an in-person consultation with a registered clinician. Shockwave is not a cure-all, and we do not promise it will "clear things up for good in a few sessions".
What Is Shockwave Therapy?
Extracorporeal shockwave therapy (ESWT) uses a device to send high-energy sound waves through the skin into soft tissues such as tendons and fascia. The sound waves are thought to help trigger local tissue repair and change pain sensitivity; in some cases of calcific tendinitis, they may also help calcium deposits to be gradually reabsorbed.
There are two common types, "radial" and "focused", which differ in energy and depth. Which type to use, and how much energy, depends on where the pain is and the assessment.
Which Conditions Is It Commonly Used For?
Shockwave is mostly used for chronic, recurring tendon or fascia problems, and most of the research evidence concerns these, but results vary from person to person:
- Plantar fasciitis: heel pain that has lasted for some time.
- Calcific tendinitis of the shoulder: shoulder pain caused by calcium deposits in the rotator cuff tendons.
- Tennis elbow: long-term strain of the extensor tendons on the outer elbow (research results are more mixed).
- Other tendinopathies: such as the Achilles tendon, the patellar tendon (below the kneecap) and pain on the outer hip.
Note: frozen shoulder may not be suitable
The main problem in frozen shoulder is a tight shoulder joint capsule and restricted movement, which is different from calcific tendinitis. Identify which type of shoulder pain you have before deciding whether shockwave is suitable.
*Note: the above is not a self-diagnosis tool.
Two Common Myths
Myth 1: "It has to hurt until your eyes water — the more it hurts, the better it works?"
No. Aching, soreness or tingling during treatment is a common reaction, but it should stay within a level you can accept. Pain so strong that your body tenses and your muscles resist does not necessarily add any benefit, and may increase bruising or discomfort. The therapist adjusts the energy step by step according to how it feels for you.
Myth 2: "It's a machine, so it's the same wherever you go?"
The results of shockwave depend on an accurate diagnosis, the treatment site, the energy settings and whether it is followed by exercise. The source of the pain should be confirmed first, for example whether heel pain comes from the plantar fascia, the Achilles tendon or the fat pad, before deciding whether it is suitable.
What Treatment Involves and How Many Sessions
- Before treatment: we review your medical history, medication and where the pain is, and check whether it is suitable.
- During treatment: gel is applied to the area and a probe delivers the sound waves; each session usually takes under about fifteen minutes (depending on the site and area).
- Number of sessions: a common approach is about once a week for several weeks, adjusted to the assessment and your response. Results usually appear gradually over a few weeks rather than immediately.
- After treatment: some people have redness, mild bruising or more aching for a day or two, which usually settles gradually.
Who Should Avoid It or Take Extra Care
Shockwave is generally unsuitable, or needs special assessment by a clinician, in the following situations:
- Pregnancy.
- A clotting problem, or taking blood thinners.
- A tumour, infection or wound at the treatment site.
- Near the growth plates of children or teenagers.
- An implanted device such as a pacemaker (depending on the treatment site).
- A recent steroid injection at the same site (discuss with your clinician first).
Take extra care: give your full medical history before treatment
Please tell us about pregnancy, blood thinners, any history of cancer, implanted devices and recent injections. If swelling and pain keep getting worse after treatment, or you develop numbness or anything else unusual, contact your therapist or see a doctor promptly.
How Ever-Health Usually Arranges Treatment
At Ever-Health (Luen Wo Hui, Fanling), a registered physiotherapist first carries out a physical examination to confirm the source of pain and whether shockwave is suitable; if it is not, we will suggest other options or a referral. Shockwave is usually not used on its own but combined with the following (results vary from person to person and are not guaranteed):
1. Exercise and load management
Tendon and fascia problems need gradual stretching and strength training, along with adjustments to daily load (such as how much you walk, your footwear and work movements), to reduce the chance of recurrence.
2. Acupuncture (depending on the individual)
If needed, a registered Chinese medicine practitioner may use acupuncture, based on pattern differentiation, to ease tightness in the surrounding muscles. Whether and how to combine treatments will be discussed according to the assessment and your wishes.
3. Sensible things you can do day to day
- Avoid strenuous exercise and repeated forceful use of the treated area for a day or two after treatment.
- Whether to use ice or take anti-inflammatory painkillers should follow your therapist's or doctor's advice.
- Keep doing the home exercises your therapist teaches you; don't rely on the machine alone.
When to See a Doctor
If heel, elbow or shoulder pain lasts more than a few weeks or affects walking or work, arrange a professional assessment to find the source of the pain and a suitable plan. If you have severe pain after an injury, obvious swelling or deformity, fever, or numbness and weakness, seek medical help promptly.
Remember: shockwave is one tool among several, and whether it suits you depends on the assessment. Individual cases should be judged at an in-person consultation.
Frequently Asked Questions
Does shockwave therapy hurt a lot?
Aching, soreness or tingling during treatment is a common reaction, but it should stay within a level you can accept. The therapist adjusts the energy to how it feels for you; it does not need to be "the more painful, the better".
How many sessions are needed?
A common approach is about one session a week for several weeks, with the actual number adjusted to the assessment and how your body responds. Results usually appear gradually over a few weeks.
Can shockwave therapy be used for frozen shoulder?
Frozen shoulder is different from calcific tendinitis, and shockwave may not be the first choice. The cause of shoulder pain should be identified first before deciding whether it is suitable.
Who should not have shockwave therapy?
It is generally unsuitable, or needs special assessment, for people who are pregnant, have a clotting problem or take blood thinners, have a tumour or infection at the treatment site, or near the growth plates of children. Please give your full medical history before treatment.
Want to know if shockwave therapy suits you? Get assessed first
If you have long-term heel, elbow or shoulder pain, visit Ever-Health in Luen Wo Hui, Fanling. Our team will carry out a detailed assessment first, then discuss whether shockwave therapy, exercise therapy, acupuncture or another option is suitable. This article is for reference only; individual cases should be judged at an in-person consultation.