New Research Explores the Expanding Role of Shockwave Therapy in Musculoskeletal Medicine

Extracorporeal shockwave therapy (ESWT) has become an increasingly studied treatment for musculoskeletal conditions, including chronic tendon injuries and certain types of persistent pain. Now, emerging research is exploring another potential application: using focused shockwaves to help identify the anatomical structures responsible for a patient’s symptoms.

A recent paper published in Bioengineering examines the potential role of ESWT as a diagnostic modality in musculoskeletal medicine, exploring how targeted acoustic energy might help clinicians identify specific pain-generating structures.

The research highlights an important challenge in musculoskeletal care: identifying the source of pain is not always as straightforward as identifying an abnormality on an MRI or ultrasound.

For patients experiencing persistent pain, understanding which structures are contributing to their symptoms is an important step toward developing an appropriate treatment plan.

At Sampson Regen in Los Angeles, extracorporeal shockwave therapy is part of a broader approach to evaluating and treating musculoskeletal conditions using targeted, nonsurgical technologies.

Could Shockwave Therapy Help Identify the Source of Pain?

Musculoskeletal pain can originate from a variety of structures, including tendons, ligaments, muscles, joints, and other tissues. Although diagnostic imaging can reveal structural changes, those findings do not always explain a patient’s symptoms.

For example, an MRI may show degenerative changes or tendon abnormalities that are also present in people who have no pain. Determining whether a particular finding is responsible for a patient’s symptoms requires a broader clinical assessment.

The recent Bioengineering paper explores whether focused ESWT could provide additional diagnostic information by delivering a controlled mechanical stimulus to a suspected pain-generating structure.

The concept involves several steps:

1. Identify a potential pain source. The physician evaluates the patient’s medical history, symptoms, physical examination, and imaging findings.
2. Precisely target the structure. Focused shockwave technology can concentrate acoustic energy within a defined area of tissue.
3. Evaluate the patient’s response. The clinician assesses whether stimulation reproduces the patient’s familiar pain and interprets that response alongside other clinical findings.

The underlying hypothesis is that a response to targeted stimulation could provide additional information about the relationship between a particular anatomical structure and a patient’s symptoms.

However, this remains an emerging diagnostic application. Further research is needed to establish its accuracy, reliability, and role in clinical decision-making. Reproducing pain alone does not confirm a diagnosis.

The study nevertheless underscores an important principle in musculoskeletal medicine: understanding the source of pain is essential when determining the most appropriate treatment.

How Sampson Regen Uses Extracorporeal Shockwave Therapy

While researchers continue to investigate new applications for shockwave technology, ESWT is already used in the treatment of selected musculoskeletal conditions.

At Sampson Regen, Dr. Steve Sampson incorporates shockwave therapy into individualized treatment plans for patients with musculoskeletal pain and injuries. The approach emphasizes understanding the patient’s condition, identifying appropriate treatment targets, and selecting therapies based on clinical findings rather than symptoms alone.

Shockwave therapy delivers acoustic pressure waves through the skin to targeted tissues. Depending on the technology and treatment protocol, the mechanical energy may influence pain signaling and biological processes involved in tissue repair.

ESWT is a nonsurgical treatment that does not require an incision. It may be considered for certain chronic tendon disorders and other musculoskeletal conditions, depending on the diagnosis and available clinical evidence.

Importantly, shockwave therapy is not a single, uniform treatment. Different technologies deliver energy in different ways, making it essential to understand which type of device is being used and how it relates to the condition being treated.

Focused Shockwave vs. Radial Pressure Wave Therapy

Two commonly discussed forms of shockwave treatment are focused extracorporeal shockwave therapy and radial pressure wave therapy.

Focused shockwave therapy concentrates acoustic energy within a defined focal zone at a selected depth. This allows the clinician to target specific structures beneath the skin, including certain deeper tissues.

Radial pressure wave therapy delivers energy that is strongest near the applicator and spreads outward through surrounding tissues. It is often used to address more superficial or broadly distributed areas of musculoskeletal pain.

These technologies have different physical characteristics and clinical applications. Treatment selection depends on the patient’s diagnosis, the location of the affected tissue, and the clinical rationale for using a particular modality.

At Sampson Regen, the goal is to match the treatment approach to the patient’s needs.

What Conditions Can Shockwave Therapy Treat?

Depending on the diagnosis and treatment protocol, shockwave therapy may be considered for selected musculoskeletal conditions, including:

• Plantar fasciitis: Persistent heel pain associated with the plantar fascia.
• Achilles tendinopathy: Pain and dysfunction involving the Achilles tendon.
• Tennis elbow and golfer’s elbow: Tendon disorders affecting the outside or inside of the elbow.
• Patellar tendinopathy: Pain involving the tendon connecting the kneecap to the shinbone.
• Certain shoulder tendon conditions: Selected disorders affecting the shoulder’s tendons.
• Selected cases of chronic low back pain: Including some cases in which the lumbar facet joints are suspected to contribute to symptoms.

The strength of the clinical evidence varies by condition. Shockwave therapy is not appropriate for every injury or source of pain, and a thorough evaluation is important before treatment begins.

Exploring Shockwave Therapy for Chronic Low Back Pain

Chronic low back pain is particularly challenging because it can arise from multiple structures, including intervertebral discs, facet joints, muscles, and other tissues.

The lumbar facet joints are located at the back of the spine and help guide movement while providing stability. In selected patients, these joints may contribute to persistent lower back pain.

Research published in Pain Medicine in 2025 investigated focused ESWT for chronic lumbar facet joint pain in a randomized, sham-controlled study. The findings add to the growing body of research exploring the potential role of shockwave therapy in spinal pain management.

This does not mean that all chronic back pain originates in the facet joints or that shockwave therapy is appropriate for every patient. Identifying the likely source of pain remains an important part of treatment planning.

At Sampson Regen, the evaluation of chronic back pain considers the patient’s symptoms, examination findings, relevant imaging, and treatment history to help determine which nonsurgical options may be appropriate.

Integrating Shockwave Therapy into an Individualized Treatment Plan

For some patients, shockwave therapy may be considered as part of a broader treatment strategy that includes rehabilitation, activity modification, or regenerative medicine procedures such as platelet-rich plasma (PRP).

PRP is prepared from a patient’s own blood and contains a concentrated platelets. These platelets release signaling molecules involved in the body’s normal healing processes.

Depending on the condition, a physician may consider shockwave therapy and PRP as complementary components of a treatment plan. The rationale for combining treatments depends on the diagnosis, the available evidence, and the patient’s individual circumstances.

Other aspects of care may include physical rehabilitation to improve strength and mobility, as well as adjustments to activity levels to help manage excessive loading on affected tissues.

Combining treatments does not automatically produce better results. Each component should have a clear clinical rationale, and patients should understand the potential benefits, limitations, and alternatives.

At Sampson Regen, treatment decisions are individualized, with an emphasis on clinical evaluation, appropriate patient selection, and evidence-informed care.

What to Expect from Shockwave Therapy at Sampson Regen

Shockwave therapy is performed in an outpatient clinical setting and does not require surgery.

The process typically begins with a clinical evaluation to determine whether the patient’s condition may respond to ESWT. The physician reviews the patient’s symptoms, medical history, physical examination findings, and relevant imaging.

If treatment is appropriate, the clinician identifies the target area and selects the treatment parameters based on the condition and the technology being used.

A handheld applicator then delivers acoustic energy through the skin to the selected area. Some patients experience discomfort during treatment, and temporary soreness or bruising may occur.

The number of sessions varies according to the condition and the treatment protocol. Progress is evaluated over time to help determine whether the approach should continue or be modified.

As with any medical treatment, results vary, and shockwave therapy is not suitable for every patient.

Advancing Musculoskeletal Care Through Research and Individualized Treatment

Research into extracorporeal shockwave therapy continues to expand our understanding of how acoustic energy may be used in musculoskeletal medicine. While its potential diagnostic applications remain under investigation, ESWT is already an important treatment option for selected musculoskeletal conditions.

For patients with persistent pain, the key is not simply finding a technology that may help. It is understanding the underlying condition and determining which treatment options are most appropriate.

At Sampson Regen, our clinical team takes an individualized approach to musculoskeletal care, considering the patient’s diagnosis, symptoms, functional goals, and available evidence when developing a treatment plan.

Interested in learning whether shockwave therapy may be appropriate for your condition? Contact Sampson Regen in Los Angeles to discuss your symptoms and explore potential nonsurgical treatment options.

Visit Sampson Regen to learn more about the practice and its approach to musculoskeletal care.

Medical disclaimer: This article is intended for educational purposes only and does not constitute medical advice. The potential diagnostic applications of ESWT described in emerging research are not established standalone diagnostic tests. Treatment suitability and outcomes vary, and medical decisions should be made in consultation with a qualified healthcare professional.