Shockwave Therapy: How It Works, What It Treats and What to Expect

Looking for a nonsurgical treatment for chronic tendon pain, plantar fasciitis or a sports injury? Shockwave therapy is a noninvasive treatment that uses acoustic energy to help manage certain musculoskeletal conditions and support tissue recovery. It is used in sports medicine and orthopedic care for selected tendon injuries, heel pain and other persistent musculoskeletal problems.

At Sampson Regen in Los Angeles, shockwave therapy is offered as part of a personalized approach to nonsurgical orthopedic care. Led by Dr. Steven Sampson, DO, the practice evaluates the underlying cause of pain and determines whether shockwave therapy may be appropriate on its own or alongside other treatments.

In this guide, learn how a shockwave therapy machine works, which conditions it may help treat, what happens during a session, how many treatments may be needed and how shockwave fits into a comprehensive recovery plan.

What Is Shockwave Therapy?

Shockwave therapy, also called extracorporeal shockwave therapy (ESWT), is a treatment that delivers acoustic pressure waves into targeted areas of the body. The word extracorporeal means that the treatment is delivered from outside the body, without surgery or an incision.

A shockwave therapy machine generates these waves and transmits them through a handheld applicator placed against the skin. Depending on the technology, the energy can be directed toward a specific treatment area or delivered over a broader region.

Shockwave therapy is used primarily for certain musculoskeletal conditions, particularly persistent tendon and connective tissue problems that have not responded adequately to initial conservative treatment.

Research suggests that shockwave therapy may help reduce pain and improve function in selected conditions. Its effectiveness varies according to the diagnosis, the type of device used, treatment settings and the individual patient.

Unlike treatments that rely primarily on medication to manage symptoms, shockwave therapy uses mechanical energy to stimulate biological responses in the targeted tissues. However, it is not a cure-all, and results are not guaranteed.

How Does a Shockwave Therapy Machine Work?

A shockwave therapy machine delivers acoustic energy to a selected area of the body. This mechanical stimulation may influence pain signaling and cellular processes involved in tissue repair and remodeling.

The effects depend on the device, the energy delivered and the condition being treated.

Potential effects include:

• Pain modulation: Mechanical stimulation may influence how pain signals are processed in the treated area.
• Changes in local tissue response: Shockwave therapy may stimulate biological responses associated with tissue remodeling.
• Support for tendon recovery: In selected tendinopathies, treatment may help improve pain and function over time.
• Improved functional recovery: When symptoms improve, patients may find it easier to participate in rehabilitation and return to regular activities.

The exact mechanisms are still being investigated, and not all proposed biological effects have been established in clinical studies.

Shockwave therapy does not simply break up scar tissue or instantly repair an injured tendon. Its potential benefits are better understood as part of a treatment process that may help selected tissues recover and function more comfortably.

Focused Shockwave vs. Radial Shockwave Therapy

Not all shockwave therapy machines work in the same way. Two commonly discussed approaches are focused shockwave therapy and radial pressure wave therapy.

Focused Shockwave Therapy

Focused shockwave therapy concentrates acoustic energy at a selected depth within the body. The treatment can be adjusted to target specific structures, depending on the device and clinical indication.

Focused shockwave is used for selected tendon and bone-related conditions, with the appropriate treatment protocol determined by the diagnosis.

Radial Pressure Wave Therapy

Radial pressure wave therapy delivers energy that spreads outward from the applicator. It is commonly used to treat superficial musculoskeletal structures, including certain tendons and areas of soft tissue.

Although radial pressure wave therapy is frequently grouped under the general term “shockwave therapy,” it is technically different from focused shockwave therapy. At Sampson Regen we routinely use both focused shockwave and radial pressure wave on the same patient for optimal benefits with a customized approach.

What About SoftWave Therapy?

Sampson Regen also offers SoftWave therapy through its BioRecovery Lab. SoftWave uses broad focused electrohydraulic shock waves and is a distinct technology from focused shockwave and radial pressure wave systems.

These treatments should not be assumed to be interchangeable. Device technology, treatment protocols, clinical evidence and appropriate indications differ. This technology is often preferred for sensitive tissue or areas where we want to distribute energy to a broad area.

At Sampson Regen, the appropriate modality depends on the patient’s condition, examination findings and treatment goals.

What Conditions Can Shockwave Therapy Treat?

Shockwave therapy is used for several musculoskeletal conditions, particularly selected chronic tendon injuries and plantar fasciitis. The strength of evidence varies by condition, and treatment is not appropriate for every injury.

At Sampson Regen, shockwave therapy may be considered for the following conditions when clinically appropriate.

1. Plantar Fasciitis and Chronic Heel Pain

Plantar fasciitis, also called plantar fasciopathy, is a common cause of pain beneath the heel. It often causes discomfort with the first steps in the morning or after sitting for an extended period.

The plantar fascia is a thick band of connective tissue that supports the arch of the foot. Repeated loading can contribute to persistent pain and changes in the tissue.

Shockwave therapy is one nonsurgical option for selected patients whose plantar fasciitis has not improved sufficiently with initial treatments.

Depending on the individual, care may also include footwear modifications, targeted stretching, strengthening and adjustments to training or activity levels.

2. Achilles Tendinopathy

The Achilles tendon connects the calf muscles to the heel bone and helps power walking, running and jumping.

Achilles tendinopathy can cause pain, stiffness and tenderness at the back of the heel or along the tendon. Symptoms often worsen with running, jumping or other activities that repeatedly load the tendon.

Shockwave therapy may be considered for selected cases of persistent Achilles tendinopathy, alongside an appropriate rehabilitation program.

A clinical evaluation is important to distinguish chronic tendinopathy from an acute or significant Achilles tendon tear, which may require a different treatment approach.

3. Tennis Elbow and Golfer’s Elbow

Tennis elbow, or lateral elbow tendinopathy, causes pain around the outside of the elbow. Golfer’s elbow, or medial elbow tendinopathy, affects the inner side.

Both conditions involve tendons associated with the muscles that control wrist and forearm movement. They can develop from repetitive gripping, lifting, sports or occupational activities.

Shockwave therapy may help some patients with persistent elbow tendinopathy. Treatment selection should consider symptom duration, functional limitations and other possible causes of elbow pain.

4. Patellar Tendinopathy or Jumper’s Knee

Patellar tendinopathy causes pain in the tendon connecting the kneecap to the shinbone. It is often associated with jumping sports and repetitive loading.

Pain may occur below the kneecap during jumping, running, squatting or climbing stairs.

For selected patients, shockwave therapy may be considered alongside progressive strengthening and load management. It is not a substitute for assessing the extent of tendon injury or determining whether another knee condition is contributing to symptoms.

5. Shoulder Tendinopathy and Calcific Tendinitis

Shoulder tendon disorders can cause pain with overhead movement, lifting or sleeping on the affected side.

In selected cases, shockwave therapy may be considered for rotator cuff tendinopathy, particularly calcific tendinopathy, in which calcium deposits develop within a tendon.

The evidence differs between calcific and noncalcific shoulder conditions. A proper evaluation is important to determine whether shockwave therapy is appropriate and whether other treatments should be considered.

6. Chronic Muscle and Soft Tissue Injuries

Some patients experience persistent pain related to muscle injuries or other soft tissue conditions.

Depending on the diagnosis, shockwave therapy may be considered as part of a broader recovery plan. However, evidence and indications vary, and acute muscle tears should be evaluated before treatment.

7. Selected Bone-Related Conditions

Shockwave therapy has also been investigated for certain bone-related problems, including some stress injuries and delayed fracture healing.

These applications require careful diagnosis and selection.

A physician must determine whether treatment is appropriate for the specific condition.

How Is Shockwave Therapy Used at Sampson Regen?

At Sampson Regen, shockwave therapy is part of a broader approach to nonsurgical orthopedic and sports medicine care.

Rather than treating pain as an isolated symptom, the clinical team evaluates the structures contributing to the patient’s symptoms and considers which treatments may best support recovery.

Step 1: Evaluation and Diagnosis

Treatment begins with a review of symptoms, medical history, physical activity and previous treatments. A physical examination helps identify the structures that may be contributing to pain.

Imaging (Dynamic Ultrasound, MRI, X-ray) may be recommended when necessary to clarify the diagnosis or assess the extent of an injury.

This step is important because similar symptoms can have different causes, and shockwave therapy is not appropriate for every source of pain.

Step 2: Selecting the Appropriate Treatment

If shockwave therapy is considered appropriate, the clinician determines the treatment area and selects the modality and settings based on the diagnosis and the patient’s tolerance.

Sampson Regen offers both Storz focused and radial pressure wave EPAT shockwave and SoftWave services. The specific technology and protocol should be selected according to the condition being treated rather than assuming that one approach is best for every patient.

Step 3: Delivering the Treatment

During a typical session, a handheld applicator is placed against the skin over the treatment area, often with a coupling gel to facilitate transmission of the acoustic energy.

The device delivers a series of pulses to the targeted region. Patients may feel tapping, pressure or discomfort during treatment, depending on the location and intensity.

The clinician adjusts the treatment as appropriate to help maintain tolerability.

Shockwave therapy is noninvasive and does not require a surgical incision. Sessions are generally brief, although the duration depends on the condition and treatment protocol.

Step 4: Monitoring Progress and Adjusting Care

Recovery is assessed over time rather than based solely on how the patient feels immediately after a session.

The clinical team may evaluate pain, range of motion, activity tolerance and functional improvement to determine whether the treatment plan should continue or change.

For many tendon conditions, shockwave therapy is used alongside progressive rehabilitation and activity modification rather than as a stand-alone treatment.

How Many Shockwave Therapy Sessions Are Needed?

The number of shockwave therapy sessions depends on the condition, the device used, the treatment protocol and the patient’s response.

For some musculoskeletal conditions, treatment plans commonly involve approximately three to five sessions spaced one or two weeks apart. However, this is not a universal protocol, and the appropriate schedule may differ. Bone injuries and stress conditions may require 2 sessions per week.

Some patients notice a change in symptoms relatively early, while others require more time to assess whether treatment is helping.

Immediate pain relief does not necessarily mean the underlying tissue has healed, and a lack of immediate improvement does not automatically mean treatment has failed.

Your clinician can explain the expected treatment course for your diagnosis and establish appropriate milestones for evaluating progress.

Is Shockwave Therapy Painful?

Shockwave therapy is performed without an incision or general anesthesia. Patients may experience pressure, tapping or temporary discomfort when the acoustic energy is delivered, especially over a sensitive tendon or injured area.

The sensation varies according to the treatment site, energy level and individual pain sensitivity. Treatment intensity can often be adjusted to improve tolerability.

Temporary soreness, redness, swelling or bruising may occur. Your clinician should review the potential risks and determine whether any precautions apply to you.

What Are the Benefits of Shockwave Therapy?

For appropriately selected patients, potential benefits include:

• A nonsurgical treatment option for certain persistent musculoskeletal conditions.
• No incision and generally minimal recovery time.
• The possibility of reducing pain and improving function.
• An approach that can complement rehabilitation and other conservative treatments.
• The ability to continue many daily activities, depending on the condition and the clinician’s recommendations.

Results vary, and not every patient responds. Shockwave therapy is best viewed as one component of an individualized treatment plan rather than a guaranteed solution.

Are There Risks or Contraindications to Shockwave Therapy?

Shockwave therapy is generally well tolerated when appropriately administered, but it is not suitable for everyone.

Potential side effects include temporary discomfort, skin redness, swelling, bruising or increased soreness in the treatment area.

Certain medical conditions, medications and treatment locations may increase risk or make shockwave therapy inappropriate. These may include specific bleeding disorders, some blood-thinning medications, pregnancy, implanted electronic devices such as pacemakers or defibrillators, active infection or malignancy at the treatment site, and certain nerve or vascular conditions.

Precautions vary by device, treatment site and clinical circumstances. Your physician should review your medical history and the manufacturer’s guidance before proceeding.

Patients with a suspected fracture, acute tendon rupture or another significant injury should receive an appropriate evaluation before considering shockwave therapy.

Shockwave Therapy in Los Angeles at Sampson Regen

Persistent tendon pain and musculoskeletal injuries can interfere with exercise, work and everyday activities. When initial treatments have not provided adequate relief, it may be worth exploring whether shockwave therapy is an appropriate option.

At Sampson Regen in Los Angeles, Dr. Steven Sampson and the clinical team provide individualized nonsurgical orthopedic and sports medicine care. The practice offers shockwave and SoftWave services as part of its BioRecovery Lab, alongside other treatment options selected according to each patient’s condition and goals.

The first step is determining what is causing the pain and whether shockwave therapy is likely to be useful for that specific diagnosis.

If you are experiencing persistent heel pain, plantar fasciitis, Achilles tendon pain, tennis elbow or another musculoskeletal condition, contact Sampson Regen to discuss an evaluation and your treatment options.

Medical disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. The suitability and effectiveness of shockwave therapy vary by condition and individual patient.