Does Shockwave Therapy Work for Tendon Pain?
Shockwave therapy can help certain tendon problems, mainly plantar fasciitis and Achilles tendinopathy, when it is combined with a structured loading exercise programme. The evidence is moderate, not definitive. It is not a fix on its own. It works best when the underlying cause of the tendon overload is found first.
Key points
- Shockwave therapy (ESWT) uses pressure waves to stimulate tendon healing.
- The evidence is strongest for plantar fasciitis and Achilles tendinopathy.
- It works best alongside progressive loading exercises, not on its own.
- Finding out why the tendon is overloaded matters more than treating the pain alone.
- Standing whole-body imaging can show alignment problems that drive tendon strain.
What is shockwave therapy and how does it work?
Shockwave therapy, formally called extracorporeal shockwave therapy (ESWT), sends focused or radial pressure waves through the skin into a painful tendon. These pulses increase blood flow, encourage cell repair and may reduce the nerve signals that carry pain. A clinician holds a handpiece against your skin and delivers the pulses in a short session. A session usually lasts around 10 to 15 minutes.
Radial shockwave spreads outward from the tip of the handpiece. It covers a wider area and is the type most often offered in everyday physiotherapy clinics. It tends to suit tendons closer to the surface, such as the Achilles and the outer elbow.
Focused shockwave concentrates the energy on a smaller, deeper point. It is sometimes used for deeper structures such as the plantar fascia or the greater trochanter. Focused machines are less widely available and are usually found in specialist clinics or hospitals.
What does the evidence say about shockwave therapy?
The evidence is moderate and depends on the condition. Several systematic reviews show that ESWT can reduce pain in plantar fasciitis and Achilles tendinopathy when conservative treatments alone have not been enough. For other tendons the picture is less clear, with smaller studies and mixed results.
Importantly, most positive studies combined shockwave with a structured loading exercise programme. Guidance from NICE in the UK notes that the evidence supports ESWT for certain tendinopathies, but it recommends it as an add-on, not a replacement for rehabilitation. Shockwave on its own, without dealing with why the tendon became overloaded, often leads to the same pain coming back.
- Plantar fasciitis (heel pain lasting more than 6 months)
- Achilles tendinopathy (mid-portion)
- Greater trochanteric pain / trochanteric bursitis
- Lateral elbow tendinopathy (tennis elbow)
- Patellar tendinopathy (jumper's knee)
- Rotator cuff calcific tendinitis (some positive data, still debated)
Which tendon conditions respond best to shockwave therapy?
Plantar fasciitis and Achilles tendinopathy have the most consistent positive results. Both involve weight-bearing tendons that are often overloaded by alignment problems elsewhere in the body.
Stubborn heel pain, especially first thing in the morning. ESWT may help when stretching and insoles have not been enough.
Pain and stiffness in the mid-portion of the Achilles tendon, often linked to tight calves or changes in how the foot moves.
Pain at the outer hip, sometimes called trochanteric bursitis. It is often made worse by an uneven pelvis or a difference in leg length.
In all three cases, the tendon is usually overloaded because of a mechanical problem further up or down the body's kinetic chain. A tilted pelvis, a knee that collapses inward, or a leg-length difference can push extra force onto one tendon for months or years. Treating the tendon alone, whether with shockwave or anything else, may ease the pain for a while. But unless you also deal with the alignment problem driving the overload, the problem is likely to come back.
Does shockwave therapy hurt and what should you expect?
Most people describe the feeling as an intense tapping or mild discomfort during the session. It is usually bearable. The area may feel sore for a day or two afterwards, much like soreness after exercise. Serious side effects are rare, though mild bruising or temporary numbness can happen.
A typical course is three to five sessions, one week apart. Your treating clinician should also give you a loading programme made for you (specific exercises) to follow between sessions. Shockwave combined with progressive loading exercise gives better results than either approach alone.
Wondering about costs? Shockwave therapy prices vary between clinics. ScanAlign does not provide shockwave therapy. We provide the diagnostic imaging that helps your treating clinician decide whether shockwave, loading exercises or another option is right for you. The price of a scan for patients travelling from abroad is confirmed during the free video consultation.
Why does alignment matter before starting shockwave therapy?
Alignment matters because your body is a connected chain from your feet to your head. If one part is out of line, another area makes up for it. That often shows up as tendon pain far from the actual cause. A flat foot might overload the Achilles. A pelvic tilt might strain the hip tendons. A knee that drifts inward might irritate the IT band area and change how force travels through the leg.
Standard imaging, such as an X-ray or MRI taken lying down, relaxes your muscles and can hide these alignment problems. When you stand, gravity compresses the joints, tilts the pelvis and shows the true picture. ScanAlign standing EOS imaging captures a full-length, weight-bearing image of your skeleton in one scan, using about 90% less radiation than a standard X-ray, around ten times less. It shows your specialist exactly how your bones, joints and posture line up under real-world load.
This matters for shockwave therapy. If your clinician knows exactly where the biomechanical problem starts, they can combine targeted treatment with the right rehabilitation programme. Without that information, shockwave risks becoming an expensive way to treat a symptom while the root cause is left alone.
So before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
When MRI is the better tool. EOS shows bones, joints and alignment under load. If your clinician suspects a soft-tissue tear, a disc problem or nerve involvement, MRI is usually the better choice. The two types of imaging answer different questions, and sometimes you need both.
Not sure whether alignment imaging would help in your case? You can book an assessment to discuss your situation with a specialist radiographer at no cost, before you commit to anything or plan travel to London.
Book a free video consultationFrequently asked questions about shockwave therapy
For certain tendon conditions, yes. There is moderate evidence that it can reduce pain and improve function. The strongest results are seen when shockwave is combined with progressive loading exercises. It is not a guaranteed fix, and results vary from person to person.
Most people feel a firm tapping or mild discomfort during the session. It should not be unbearable. The treated area may ache for a day or two afterwards. Your clinician can lower the intensity if it becomes too uncomfortable.
A typical course is three to five sessions, usually one week apart. Some people notice improvement after the first two sessions, while others take longer. Your clinician should check your progress after each session.
Plantar fasciitis is one of the conditions with the most supporting evidence. Shockwave is usually recommended after at least six months of other conservative measures, such as stretching, insoles and changes in footwear, have not fully cleared the symptoms.
There is reasonable evidence for mid-portion Achilles tendinopathy. However, shockwave should be part of a wider plan that includes eccentric loading exercises and, ideally, an assessment of foot and leg alignment to understand why the tendon became overloaded.
Side effects are usually mild. Temporary soreness, redness or light bruising where you were treated are the most common. Serious complications are very rare. If you notice sudden, severe pain, numbness or weakness after a session, contact your treating clinician promptly.
In the UK, costs vary widely depending on the clinic, the type of shockwave machine used and how many sessions are recommended. ScanAlign does not provide shockwave therapy. We provide diagnostic imaging that helps your clinician decide on the right treatment approach. The price of a scan for patients travelling from abroad is confirmed during the free video consultation.
No. You can book yourself, without a referral from your doctor. You start with a free video consultation where a specialist radiographer reviews your history and explains whether standing alignment imaging is likely to help in your situation.
Because tendon pain is often a symptom of a mechanical problem somewhere else. If a pelvic tilt or a leg-length difference is overloading the tendon, shockwave may ease the pain for a while but will not fix the cause. A standing full-body scan shows your clinician exactly where the chain breaks down.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It captures a full-length standing image in a single, low-dose exposure. You can find more details on safety on our website.
Find out what is driving your tendon pain
A free video consultation with a specialist radiographer can help you understand whether standing alignment imaging is a useful next step, before you commit to any treatment or to travelling to London.
Book a free video consultationSources
- NICE Interventional Procedures Guidance IPG313: Extracorporeal shockwave therapy for refractory plantar fasciitis. National Institute for Health and Care Excellence.
- Mani-Babu S, et al. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. The American Journal of Sports Medicine, 2015;43(3):752-761.
- Speed C. A systematic review of shockwave therapies in soft tissue conditions. British Journal of Sports Medicine, 2014;48(21):1538-1542.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.