How Shockwave Therapy (ESWT) Works
A powerful, evidence-guided tool — only used when it truly makes sense
Get WISE - Get WELL - Get ON
Shockwave therapy is often described as a treatment that “breaks down scar tissue” or “stimulates healing”.
Those descriptions are partly true, but they oversimplify what is actually happening. Shockwave therapy works by delivering high-energy acoustic waves into injured tissue. These waves create a mechanical stimulus that triggers biological responses within the cells of the tendon, ligament, or muscle.
In other words, shockwave therapy does not repair tissue instantly. Instead, it stimulates the body’s own healing processes, helping damaged tissue restart repair mechanisms that may have stalled in long-standing injuries.
This is why shockwave therapy is most often used for chronic tendon problems, such as Achilles tendinopathy, plantar fasciitis, or tennis elbow.
This page explains:
-
Where Shockwave Therapy Came From
-
What Shockwave Therapy Actually Is
-
How Shockwave Therapy Works
-
What Happens Inside the Tissue
-
Why It’s Used for Chronic Injuries
-
Why Multiple Sessions Are Needed
-
Why It Can Feel Uncomfortable
-
Shockwave Is Not a Stand-Alone Treatment
-
Can I have shockwave therapy after a steroid injection?
-
Summary
-
Shockwave Therapy FAQ's
Where Shockwave Therapy Came From
Shockwave therapy was not originally developed as a treatment for tendon injuries.
The technology was first explored in the 1960s and 1970s when researchers studying the effects of high-energy pressure waves on aircraft materials noticed that similar waves could travel through solid structures without immediately destroying them.
This observation eventually led to the development of medical devices capable of generating controlled shockwaves.
In the early 1980s, these waves were first used in medicine for a completely different purpose — breaking down kidney stones in a procedure known as lithotripsy. By directing shockwaves at a kidney stone, doctors could fragment the stone without surgery.
As the technology evolved, researchers began investigating whether lower-energy shockwaves might also have biological effects on human tissue.
Over time, studies showed that controlled shockwaves could stimulate blood flow, influence cellular activity, and promote tissue repair. This led to the development of extracorporeal shockwave therapy (ESWT), which is now widely used to treat certain chronic musculoskeletal conditions.
Today, shockwave therapy is commonly used in physiotherapy and sports medicine for persistent tendon problems such as Supraspinatus Tendinopathy, Patella Tendinopathy and tennis elbow.
What Shockwave Therapy Actually Is
Shockwave therapy is a treatment known medically as extracorporeal shockwave therapy (ESWT).
“Extracorporeal” simply means that the energy is generated outside the body, then delivered through the skin into the injured tissue.
The shockwaves themselves are very fast pressure waves that travel through the tissues. When these waves reach the target area, they deliver mechanical energy into the cells and surrounding structures.
Unlike electrical stimulation treatments, shockwave therapy does not work through electrical signals. It works through mechanical energy interacting with biological tissue.
This mechanical stimulus is what triggers the healing responses that make shockwave therapy useful for certain persistent injuries.
How Shockwave Therapy Works
Shockwave therapy works by delivering high-energy acoustic pressure waves into injured tissue.
These waves travel through the skin and underlying structures until they reach the targeted area, such as a damaged tendon or ligament. When the waves interact with the tissue, they deliver mechanical energy that stimulates biological activity within the cells.
This process is known as mechanotransduction — the conversion of mechanical forces into biochemical signals inside the body’s cells. These signals trigger a series of biological responses associated with tissue repair and regeneration.
Several important effects have been observed in response to shockwave therapy.
Increased blood flow and neovascularisation
Tendons and ligaments have a relatively limited blood supply, which is one reason these structures often heal slowly.
Shockwave therapy has been shown to stimulate neovascularisation, the formation of new small blood vessels within the affected tissue. Increased circulation improves the delivery of oxygen, nutrients, and growth factors that support tissue repair.
Activation of cellular repair processes
The mechanical stimulus produced by shockwaves can activate specialised repair cells within the tissue, including fibroblasts and tenocytes.
These cells are responsible for producing collagen, the structural protein that provides tendons and ligaments with their strength and resilience. By stimulating these cells, shockwave therapy may help promote the gradual remodelling and repair of damaged tissue.
Release of growth factors
Shockwave therapy has also been shown to stimulate the release of various growth factors, which play an important role in tissue regeneration.
These biological signals help regulate cellular activity, encourage tissue repair, and support the rebuilding of damaged structures.
Modulation of pain signalling
Shockwave therapy can also influence the way pain signals are transmitted within the treated area.
Research suggests that the treatment may reduce the sensitivity of pain receptors and alter the activity of certain nerve fibres. This may help explain why many patients experience a gradual reduction in pain following treatment.
Effects on abnormal tissue deposits
In some conditions, particularly calcific tendon disorders, shockwave therapy may also help disrupt or fragment abnormal calcium deposits within the tissue.
This effect is not the primary mechanism in most tendon injuries, but it can contribute to symptom improvement in specific cases.
What Happens Inside the Tissue
When shockwave therapy is applied to injured tissue, the mechanical energy delivered by the acoustic waves stimulates biological activity within the cells.
This process, known as mechanotransduction, occurs when physical forces applied to tissue are converted into biochemical signals within the cells. These signals trigger a range of biological responses associated with tissue repair.
One of the most important effects is an increase in local blood flow. Tendons and ligaments often have a limited blood supply, which partly explains why they can take a long time to heal. Shockwave therapy can stimulate the formation of small new blood vessels, improving circulation and helping deliver oxygen and nutrients to the injured tissue.
Shockwave stimulation can also activate specialised repair cells such as fibroblasts and tenocytes, which are responsible for producing collagen. Collagen is the structural protein that provides tendons and ligaments with their strength and resilience.
Research suggests that shockwave therapy may stimulate the release of several biological growth factors, which help regulate cellular activity and support tissue regeneration.
In some conditions, particularly calcific tendon problems, shockwave therapy may also help disrupt abnormal calcium deposits within the tissue.
Together, these effects can help encourage the body to restart healing processes that may have slowed or stalled in long-standing injuries.
Why It’s Used for Chronic Injuries
Shockwave is never delivered in isolation.
Each session lasts 60 minutes, and includes:
-
reassessment of symptoms and progress
-
hands-on treatment where appropriate
-
shockwave therapy if still indicated
-
adjustment of loading and exercise strategy
A typical course is 4–6 weekly sessions, but I reassess continuously.
If there’s no meaningful change after several treatments, we stop — I don’t persist for the sake of it.
Why Multiple Sessions Are Needed
Shockwave therapy works by stimulating biological responses within the tissue rather than producing an immediate structural change.
The processes involved in tissue repair — including collagen production, cellular activity, and tissue remodelling — occur gradually over time.
For this reason, shockwave therapy is usually delivered as a series of treatments, commonly three to five sessions spaced approximately one week apart.
Each session provides another stimulus to the tissue, encouraging ongoing biological activity that supports the healing process.
Improvements in symptoms often develop gradually over several weeks rather than immediately after treatment.
Why It Can Feel Uncomfortable
Shockwave therapy can sometimes feel uncomfortable during treatment.
This is partly because the acoustic waves are delivered directly to sensitive or injured tissue, which may already be irritated. The sensation is often described as a deep tapping or pulsing feeling within the treated area.
The intensity of treatment can be adjusted depending on the patient’s tolerance, and the aim is to deliver sufficient energy to stimulate the tissue while keeping the treatment manageable.
Most sessions last only a few minutes, and any discomfort usually settles quickly once the treatment has finished.
Shockwave Is Not a Stand-Alone Treatment
Shockwave therapy is a useful tool in the management of certain persistent musculoskeletal conditions, but it is rarely a complete treatment on its own.
For most tendon injuries, the best outcomes occur when shockwave therapy is combined with appropriate rehabilitation, particularly strengthening exercises that help restore the tendon’s ability to tolerate load.
In this way, shockwave therapy may help stimulate the biological healing processes within the tissue, while physiotherapy rehabilitation helps rebuild strength, movement, and function.
Used together, these approaches aim to address both the underlying tissue changes and the mechanical demands placed on the body.
Like many treatments in musculoskeletal medicine, shockwave therapy is most effective when it is used at the right stage of injury and combined with appropriate rehabilitation.
Can I have shockwave therapy after a steroid injection?
In many cases, yes — but the timing matters.
Corticosteroid injections work by reducing inflammation, which can help settle pain in the short term. However, steroids can also temporarily weaken tendon tissue by affecting collagen structure and cellular activity.
Shockwave therapy works in the opposite way. Rather than suppressing inflammation, it aims to stimulate biological activity within the tissue, triggering healing responses that involve a degree of local inflammation.
Because of these differences, it is usually sensible to allow time for the effects of the steroid injection to settle before beginning shockwave therapy. This helps ensure the tendon has recovered from the temporary weakening effect of the injection and that the anti-inflammatory effects of the steroid have largely worn off.
The exact timing can vary depending on the condition and the location of the injection, but clinicians commonly recommend waiting several weeks and sometimes months before introducing shockwave therapy.
A proper clinical assessment is important to determine whether shockwave therapy is appropriate and when it should be introduced as part of an overall treatment plan.
Summary
Shockwave therapy is a treatment that works by delivering controlled acoustic energy into injured tissue. Rather than directly repairing damaged structures, the treatment stimulates biological activity within the tissue, encouraging the body to restart healing processes that may have slowed or stalled in long-standing injuries.
Research suggests that shockwave therapy can increase blood flow, stimulate repair cells, and promote the release of biological signals involved in tissue regeneration. These effects develop gradually, which is why the treatment is typically delivered over several sessions and improvement often occurs over time.
Shockwave therapy is most commonly used for chronic tendon conditions, particularly when symptoms have persisted despite other forms of treatment. When used appropriately and combined with targeted rehabilitation, it can be a useful tool in supporting recovery.
As with many treatments in musculoskeletal medicine, the effectiveness of shockwave therapy depends not only on the technology itself, but on using it at the right stage of injury and as part of a well-structured rehabilitation programme.
Shockwave Therapy FAQ's
1. Does shockwave therapy repair the tendon?
Shockwave therapy does not instantly repair damaged tissue. Instead, it stimulates biological activity within the tendon, encouraging the body to restart healing processes that may have slowed or stalled in long-standing injuries. When combined with appropriate rehabilitation, this stimulation can support gradual tissue repair over time.
2. How long does shockwave therapy take to work?
Many people begin to notice improvement after a few treatment sessions, but the full benefits often develop gradually over several weeks. Because the treatment works by stimulating biological healing processes, improvement usually occurs progressively rather than immediately.
3. Why does shockwave therapy sometimes hurt?
Shockwave therapy is applied directly to injured or sensitive tissue, which can make the treatment uncomfortable during the session. The sensation is often described as a deep tapping or pulsing feeling. The intensity can be adjusted to keep the treatment tolerable, and any discomfort usually settles quickly once the treatment stops.
4. How many shockwave therapy sessions are usually needed?
Most treatment plans involve three to six sessions, typically spaced about one week apart. Each session provides another stimulus to the tissue, encouraging biological responses that support healing.
5. How many physiotherapy sessions will I need?
The number of sessions required varies depending on the nature of the injury and how the body responds to treatment.
Some problems improve quickly with appropriate advice and rehabilitation exercises, while others may require a longer period of recovery. Treatment recommendations are always based on clinical findings rather than a preset treatment schedule.
6. What conditions is shockwave therapy used for?
Shockwave therapy is commonly used to treat persistent tendon conditions such as Achilles tendinopathy, plantar fasciitis, tennis elbow, patellar tendinopathy, and certain shoulder tendon problems. It is usually considered when symptoms have lasted for several months and have not improved with other treatments.
7. Is shockwave therapy safe?
Shockwave therapy is generally considered a safe treatment when applied appropriately. Some temporary soreness or redness may occur after treatment, but serious complications are uncommon. A proper assessment is important to determine whether the treatment is suitable for a particular condition.
8. Does shockwave therapy replace physiotherapy exercises?
No. Shockwave therapy is best viewed as a supportive treatment, rather than a complete solution on its own. For most tendon injuries, the best results occur when shockwave therapy is combined with rehabilitation exercises that help restore strength and load tolerance in the affected tissue.
9. Does shockwave therapy replace physiotherapy exercises?
Shockwave therapy is usually used for chronic injuries rather than recent ones. In the early stages of injury, the body’s natural healing processes are often still active. Shockwave therapy is more commonly considered when symptoms have persisted for several months and recovery has stalled.
10. Can shockwave therapy make symptoms worse before they improve?
Some people experience a temporary increase in soreness for a day or two after treatment. This can occur because the therapy stimulates biological activity within the injured tissue.
In most cases this temporary irritation settles quickly, and symptoms gradually improve as the tissue responds to the treatment.
11. When should shockwave therapy not be used?
Shockwave therapy is not suitable for every condition. It is generally avoided in certain situations, such as over areas with active infection, over malignant tumours, or in patients with certain circulation or clotting disorders.
A proper clinical assessment is important to determine whether shockwave therapy is appropriate for a particular injury.
12. Can I have shockwave therapy after a steroid injection?
Why Should You Choose Chris Heywood Physio
Choosing the right physiotherapist can make a significant difference when dealing with pain, injury, or persistent movement problems. The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 years of experience & proven expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
Longer appointments for better results
No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
-
Thoroughly assess your condition
-
Provide focused, effective treatment
-
Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
Honest advice & support you can trust
I will always tell you what is best for you — even if that means you need fewer sessions, not more. My goal is your recovery and long-term wellbeing, not keeping you coming back unnecessarily.
Because I operate an independent practice with low overheads, I do not work to preset business targets based on a number of sessions per patient. Treatment recommendations are based on clinical need only, not on maximising appointments.
If you are interested in this topic, you can read more in my article “Do You Really Need Weekly Private Physiotherapy Sessions?”
Helping you take control of your recovery
I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
Independent clinical care
Chris Heywood Physio operates as an independent physiotherapy practice rather than a high-volume clinic model.
This allows treatment decisions to focus entirely on what is most appropriate for the patient.
The aim is always to understand the problem properly and provide clear, effective physiotherapy that helps you return to normal activity as quickly and safely as possible.
Contact Me
Alongside private practice, I also work on Mondays and Tuesdays as a First Contact Practitioner (FCP) in Musculoskeletal Primary Care within the NHS, assessing, diagnosing, and triaging patients without the need for a GP appointment.
You’re very welcome to call, but when I’m in clinic my phone is often on silent so I can give my full attention to the patient I am seeing. For this reason, it is usually quicker to reach me via the contact form, email or WhatsApp.
Whichever way you get in touch, I will respond as soon as possible — and during the week that is almost always the same day.
Clinic Information
The Clinic In located in:
Scaldwell Village
Northants
NN6 9LA
** Please note that Home Visits, Online Sessions and Aquatic Therapy can often be arranged outside of normal clinical hours on request.**
Opening Times
Monday & Tuesday: Closed for FCP Work
Wednesday - Friday: 0915 - 1400
Saturday & Sunday: Closed
