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Shockwave therapy: focused and radial treatment, indications and what to expect

Focused shockwave delivers high-energy sound waves into the painful area to relieve pain, calm inflammation, stimulate blood flow and support the tissue’s own repair. It is used for chronic problems such as tennis elbow, plantar fasciitis, frozen shoulder, trigger finger, De Quervain’s tenosynovitis and patellar tendinopathy, helping to ease pain and restore activity. Advanz uses the German PIEZOWAVE focused shockwave system, with treatment depth adjusted to how deep the problem lies.

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What is shockwave therapy?

Shockwaves were first used to break up kidney and urinary stones, and in some cases of poorly healing bone. Later research looked at how a suitable dose can affect tendons and soft tissue: improving local blood flow, changing how pain is felt, and treating chronic or calcific tendinopathy and muscle strain.[1] [2]

It is now widely used for overuse and chronic pain around the neck and shoulder, arm, lower back, hip, knee and ankle. A physiotherapist assesses whether it is suitable before treatment starts.

Focused or radial shockwave?

Focused shockwave can be set to the depth of the injury, with an effective depth of about 125 mm, so it suits deeper soft tissue. Radial shockwave cannot be focused in the same way; most of the energy stays near the skin and suits more superficial tendons. Advanz uses the German PIEZOWAVE focused system.

Focused shockwave gathers energy deeper in the tissue; radial shockwave stays near the skin
Focused shockwave reaches deeper tissue; radial energy stays nearer the surface

Common indications

The original page lists the following. Whether shockwave is used depends on assessment, how long the problem has lasted, and any reasons not to treat.

  • Tennis elbow and golfer’s elbow
  • Plantar fasciitis
  • Trigger finger
  • Frozen shoulder, and chronic or calcific tendinopathy
  • De Quervain’s tenosynovitis (mummy thumb)
  • Piriformis syndrome
  • Patellar tendinopathy

It can also be aimed at muscle trigger points for overuse pain around the neck and shoulder, arm, back, hip, knee or ankle.

Where it is used

Focused shockwave for frozen shoulder to ease pain and support tendon recovery

Shoulder

Used for frozen shoulder or chronic rotator cuff strain, to relieve pain and support tendon recovery.

Focused shockwave for tennis elbow to ease tendon pain and inflammation

Tennis or golfer’s elbow

Aimed at the tendon attachment on the outer or inner elbow, to reduce pain and inflammation and support repair.

Focused shockwave on the sole for plantar fasciitis to ease foot pain and support fascia recovery

Plantar fasciitis

Applied to the sole and heel to ease plantar pain and support fascia recovery.

Focused shockwave for patellar tendinopathy to ease knee tendon pain and support repair

Patellar tendon

Used for patellar tendinopathy, to ease pain below the kneecap and support tendon repair.

What a session involves

The physiotherapist sets the focus depth and intensity, and the time depends on how many areas are treated and how large they are. During treatment the sore spot can feel achy, painful or refer discomfort; aiming off the painful spot usually feels much milder. Each area receives about 2,000 to 4,000 pulses. Sessions are often once to three times a week, with a course of about six to eight sessions.

For one to two days afterwards the area may feel sorer, tighter or slightly swollen. A few people notice mild redness or bruising, which usually settles within about two days. Contact the clinic if redness, numbness or pain keeps getting worse.

Focused shockwave applicator on the outer elbow with coupling gel, to treat tennis elbow pain
The applicator is held against the skin with coupling gel

Common questions

Does it hurt?

The treated spot can feel achy or sore. Intensity is adjusted to what you can tolerate, and treatment should not continue through pain you cannot bear. Brief soreness afterwards is not the same as a new injury.

Should I rest afterwards?

Avoid heavy loading of that area on the day of treatment. Light activity as advised is better than prolonged complete rest as the only plan.

Who should not have it?

Tell your physiotherapist if the area is infected or has an open wound, if there is a known tumour, if you are pregnant and the area is near the abdomen or lower back, if you bleed easily, or if you have had a recent steroid injection there. Suitability is decided individually.[1] [2]

Book shockwave therapy

Call or WhatsApp the clinic nearest you. Appointment times depend on availability and a professional assessment.

Sources

  1. NICE HTG200: Extracorporeal shockwave therapy for refractory plantar fasciitis. Evidence on how well it works is inconsistent; no major safety concerns are raised.
  2. NICE HTG426: Extracorporeal shockwave therapy for Achilles tendinopathy.