Focused Shockwave Therapy
Utilising the latest technological advances to deliver a non-invasive therapeutic Piezowave
What it does: Clinical goal
Focused shockwave aims to reduce pain and improve tendon function by modulating the diseased tendon environment: decreasing nociceptive signalling, altering neovascularisation and ingrowing nerves, whilst stimulating collagen remodelling and tissue repair so patients can progressively load the tendon. It’s used for chronic, activity-limiting tendinopathy that has not responded to ≥3 months of structured loading/physio.
How it works: Mechanisms
Shockwaves produce controlled mechanical stress that activates cellular mechanotransduction pathways in tenocytes and local stem cells, up-regulates growth factors, increases local blood flow, and can disrupt pathological neovessels and associated pain-carrying nerve fibers. These changes promote a shift from degenerative tendon matrix to a more organised, reparative state. Clinical analgesia also occurs through neuromodulatory effects.
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Who is suitable
Patients with chronic (>3 months) mid-portion or insertional tendinopathy who have tried and not improved with progressive loading programs, activity modification and analgesics are typical candidates. It’s generally not the first-line for acute tendon ruptures or for large full-thickness tears that need surgery. A focused exam and imaging (ultrasound) help determine suitability.
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What to expect: Procedure & Recovery
Sessions are performed in clinic: We locate the painful area with ultrasound, apply a coupling gel, and deliver a series of focused shockwaves (energy and count depend on protocol). Each session lasts 5–15 minutes. You may feel sharp but brief discomfort during impulses; local anaesthetic is usually avoided because it can blunt therapeutic effects. Expect transient soreness for 24–72 hours, then gradual improvement over weeks as you start/continue a supervised rehab program. Most protocols use 1–6 sessions spaced weekly.
Outcomes & Evidence
Systematic reviews and meta-analyses show moderate to strong evidence that ESWT (focused and radial types) reduces pain and improve function in many tendinopathies (Plantar fasciitis, Achilles & Patellar tendon, Rotator Cuff) with benefits often apparent by 8–12 weeks and maintained to 6–12 months in many trials; some conditions report durable effects beyond 12 months. Patient selection, energy dosing, and combined rehab are key determinants of success.
Risks
Transient pain during treatment, & rare skin reddening are common.