Shockwave therapy has emerged as one of the most effective treatments for chronic tendon conditions that haven’t responded to standard physiotherapy. At Burwood Physio, we use radial shockwave therapy to treat conditions including Achilles tendinopathy, plantar fasciitis, calcific tendinitis, lateral elbow tendinopathy, and patellar tendinopathy. This article explains how it works, what the evidence says, and what you can expect from a session.
What Is Shockwave Therapy?
Shockwave therapy (also called Extracorporeal Shockwave Therapy or ESWT) delivers high-energy acoustic waves to injured tissue. The two main types are radial shockwave (pressure waves that disperse radially from the handpiece) and focused shockwave (waves that converge at a specific focal point deep in tissue). At Burwood Physio, we use radial shockwave, which is the most extensively researched type for tendinopathy.
The waves are generated by a pneumatically driven projectile inside the handpiece and transmitted into the tissue through a gel coupling medium. Treatment typically involves 1,500–2,000 impulses delivered over 5–10 minutes, usually weekly for 3–6 sessions.
How Does Shockwave Therapy Work?
The mechanisms are well-studied and multifactorial. Shockwave stimulates tenocyte (tendon cell) proliferation and collagen synthesis, promoting genuine tendon tissue remodelling — not just pain relief. It disrupts calcific deposits in calcific tendinitis, breaking down calcium into a form that can be reabsorbed by the body. It stimulates neovascularisation (new blood vessel formation) in chronically degenerated tendons that have poor vascularity.
Shockwave also has a direct analgesic effect: it overstimulates nociceptors (pain receptors), causing a temporary hyperstimulation analgesia, and may reduce substance P levels in the treated area, decreasing local neurogenic pain signalling.
What Does the Evidence Say?
Shockwave therapy is one of the better-evidenced treatments in physiotherapy for chronic tendinopathy. For plantar fasciitis, a 2018 Cochrane systematic review found moderate-quality evidence that shockwave provides superior pain relief and function compared to sham treatment. For calcific shoulder tendinitis, multiple RCTs show 60–80% success rates in reducing calcium deposits. For lateral elbow tendinopathy, shockwave produces outcomes comparable to corticosteroid injection in the short term but with superior long-term results (injection has a well-documented high recurrence rate at 12 months).
Evidence is somewhat weaker for Achilles tendinopathy and patellar tendinopathy, but clinical experience and high-quality case series consistently show significant benefit in cases that have failed standard loading programmes.
What Conditions Is Shockwave Suitable For?
Shockwave is most appropriate for chronic tendinopathies that have persisted for more than 3 months despite appropriate physiotherapy. We use it for: plantar fasciitis, Achilles tendinopathy (mid-portion and insertional), calcific shoulder tendinitis, lateral elbow tendinopathy (tennis elbow), patellar tendinopathy (jumper’s knee), medial tibial stress syndrome (shin splints), and greater trochanteric pain syndrome (hip bursitis).
It is not suitable for: acute injuries (less than 6 weeks), conditions overlying major blood vessels or nerves, patients on blood thinners, pregnancy, open wounds or skin infections at the treatment site, or malignancy in the treatment area.
What to Expect During a Session
Your physiotherapist will palpate the area to identify the most painful/tender zone within the tendon. Ultrasound gel is applied to the skin, and the shockwave handpiece is placed firmly against the treatment area. The device produces a rhythmic clicking/tapping sensation — the intensity is adjusted so you feel significant pressure and discomfort without unbearable pain (typically 5–7/10 on a pain scale). Sessions last 5–10 minutes.
After treatment, the area typically feels sore for 24–48 hours — this is a normal and expected part of the treatment response (the “stimulation phase”). Anti-inflammatory medications should be avoided in the 24 hours following treatment as they may blunt the biological response. High-impact loading of the treated tendon should be avoided for 48 hours post-treatment.
How Many Sessions Are Needed?
Most protocols involve 3–6 weekly sessions. The majority of patients notice meaningful improvement after sessions 2–3. It is important to complete the full course even if you feel better early, as the underlying tendon remodelling continues for 6–12 weeks after treatment.
Shockwave is always delivered as part of a comprehensive physiotherapy plan — including a progressive tendon loading programme — not as an isolated treatment. Exercise-based rehabilitation remains essential for long-term outcomes.
Book Shockwave Therapy in Burwood
Burwood Physio offers shockwave therapy for chronic tendon conditions as part of our comprehensive physiotherapy services. If you’ve been struggling with heel pain, Achilles pain, elbow pain, or knee pain that hasn’t responded to standard treatment, shockwave may be the next step in your recovery. Same-week appointments, HICAPS on-site. Call 02 8322 9022 or book online today.
Conditions we treat with shockwave therapy: Plantar Fasciitis, Achilles Tendinopathy, Patellar Tendinopathy, and Golfer’s Elbow.
Reviewed by the Burwood Physio Clinical Team
BPhty (Hons) | AHPRA Registered Physiotherapists | Member, Australian Physiotherapy Association
Our clinical team has over 20 years of combined experience in musculoskeletal physiotherapy, sports rehabilitation, and pain management. All content is reviewed for clinical accuracy and updated in line with current evidence-based practice guidelines. Meet our team →
