extracorporeal shockwave therapy
/ eks-truh-kor-POR-ee-ul /
The same shockwave technology once developed to shatter kidney stones without surgery has been adapted, at lower energy, to treat stubborn tendon and soft-tissue pain. Extracorporeal shockwave therapy ('extracorporeal' simply means from outside the body) delivers a series of focused pressure pulses through the skin into a painful area.
A handpiece pressed against the skin generates rapid mechanical pulses — sharp little pressure waves, not electricity or heat — that travel into the tissue. The treatment is usually given in a few weekly sessions and can be moderately uncomfortable. The proposed mechanism is that the controlled mechanical 'stress' provokes a mild, deliberate healing response: stimulating new small blood vessels, stirring up repair activity in tissue that had become chronically stuck, and possibly affecting pain nerves. It is most studied for chronic problems that have stalled, such as plantar fasciitis (stubborn heel pain), calcific tendon problems in the shoulder, and tennis elbow.
Shockwave is one of the passive modalities with relatively better and more interesting evidence: for several chronic tendon conditions that have not responded to simpler measures, it has reasonable support and offers a non-surgical option. That said, it is not a magic fix, the benefit is not guaranteed, it can be painful, and it usually works best alongside a loading-exercise programme. It is avoided over the lungs, large nerves and vessels, growth plates in children, areas of infection or tumour, and in people on blood-thinning medication or with clotting problems.
A runner with stubborn heel pain (plantar fasciitis) that has not improved with stretching and insoles undergoes a course of shockwave sessions, finding it somewhat painful but eventually less sore, used alongside calf-loading exercises.
Better evidence than most modalities for stalled chronic tendon pain — but no magic fix.
Shockwave has relatively good evidence for several stalled chronic tendon problems, but benefit is not guaranteed, it can hurt, and it works best paired with loading exercise — not as a standalone cure.