Shockwave Therapy

Shockwave Therapy, also known as Extracorporeal Shock Wave Therapy (ESWT), is a non-invasive treatment that delivers high-energy acoustic pressure waves to injured or degenerated tissue. These waves stimulate the body's natural healing processes at a cellular level, accelerating tissue repair, reducing chronic inflammation, and breaking down calcifications that block recovery. Originally developed to disintegrate kidney stones, shockwave technology has been refined over decades into one of the most effective tools available for musculoskeletal rehabilitation.

Two primary forms are used in clinical practice:

Radial Shockwave Therapy: Pressure waves radiate outward from the point of application, making it ideal for treating larger surface areas and superficial soft tissue conditions such as plantar fasciitis, Achilles tendinopathy, and shoulder tendinitis.

Focused Shockwave Therapy: Energy is concentrated precisely at a targeted depth within the tissue, allowing treatment of deeper structures such as hip tendons, calcific deposits, and chronic insertional tendinopathies where superficial treatment alone is insufficient.

Shockwave Therapy works through several overlapping biological mechanisms that together create an environment conducive to healing in tissue that has otherwise stalled in a chronic, non-healing state.

• Neovascularization: Shockwave stimulates the formation of new blood vessels in treated tissue, restoring circulation to areas that have become poorly perfused due to chronic degeneration. Improved blood supply delivers the oxygen and nutrients necessary for tissue regeneration.
• Cellular Stimulation: The acoustic waves activate fibroblasts, the cells responsible for producing collagen, and stimulate tenocytes within tendon tissue. This triggers a renewed healing response in tissue that had previously become dormant or degenerative.
• Calcification Breakdown: In conditions such as calcific tendinitis of the shoulder, shockwave therapy mechanically disrupts calcium deposits, allowing the body to reabsorb them naturally over the weeks following treatment.
• Pain Reduction: Shockwave therapy reduces the concentration of Substance P, a neuropeptide associated with chronic pain signaling, and promotes the release of endorphins. This produces both immediate and sustained reductions in pain independent of anti-inflammatory medication.
• Collagen Remodeling: By stimulating new collagen synthesis and promoting proper fiber alignment, shockwave therapy helps restore the structural integrity of damaged tendons and ligaments over time.

• Plantar Fasciitis – One of the most common and frustrating causes of heel pain, plantar fasciitis involves chronic degeneration of the plantar fascia at its calcaneal insertion. Shockwave therapy is one of the most well-supported non-surgical treatments for this condition, particularly in cases that have persisted beyond six months despite stretching, orthotics, and other conservative care.
• Achilles Tendinopathy – Both mid-portion and insertional Achilles tendinopathy respond well to shockwave therapy. By stimulating collagen remodeling and neovascularization within the degenerated tendon, shockwave accelerates recovery in patients who have struggled with persistent Achilles pain despite physical therapy and activity modification.
• Calcific Shoulder Tendinitis – Calcium deposits within the rotator cuff tendons can cause severe, activity-limiting shoulder pain. Shockwave therapy is particularly effective for this condition, mechanically disrupting the calcific deposit while simultaneously stimulating the surrounding tissue to heal.
• Lateral Epicondylitis (Tennis Elbow) – Chronic degeneration of the common extensor tendon at the lateral elbow is a notoriously slow-healing condition. Shockwave therapy restimulates the body's healing response in this tissue, providing meaningful relief for patients who have not responded to rest, bracing, or corticosteroid injections.
• Medial Epicondylitis (Golfer's Elbow) – Similar in mechanism to tennis elbow but affecting the medial aspect of the elbow, golfer's elbow also responds well to shockwave-driven collagen remodeling and cellular stimulation.
• Patellar Tendinopathy – Also known as jumper's knee, patellar tendinopathy is common in athletes and active individuals. Shockwave therapy promotes structural repair within the patellar tendon and reduces pain that limits training and daily function.
• Rotator Cuff Tendinopathy – Chronic rotator cuff degeneration without full-thickness tear can be effectively managed with shockwave therapy, stimulating repair of the involved tendon tissue and reducing the impingement-related pain that limits shoulder range of motion.
• Greater Trochanteric Pain Syndrome – Pain at the lateral hip arising from gluteal tendinopathy and bursitis is increasingly well-supported by shockwave research. Treatment targets the insertional tendon tissue at the greater trochanter, stimulating healing in a notoriously difficult-to-treat location.
• Shin Splints and Stress Reactions – In athletes with medial tibial stress syndrome or early stress reactions, shockwave therapy can accelerate periosteal healing and reduce the downtime associated with these overuse injuries.

A systematic review published in the Journal of Orthopaedic Surgery and Research found that extracorporeal shockwave therapy produced statistically significant improvements in pain and function for patients with plantar fasciitis, with outcomes superior to placebo at both short- and long-term follow-up (Thomson et al., 2005). Research published in the American Journal of Sports Medicine demonstrated that shockwave therapy was significantly more effective than corticosteroid injection for calcific shoulder tendinitis at twelve-month follow-up, with the shockwave group showing greater rates of calcification resorption and pain reduction (Gerdesmeyer et al., 2003). Additionally, a randomized controlled trial in the British Journal of Sports Medicine found that shockwave therapy combined with eccentric exercise produced superior outcomes compared to eccentric exercise alone in patients with chronic Achilles tendinopathy (Rompe et al., 2007).

Shockwave therapy has accumulated one of the strongest evidence bases of any physical medicine modality over the past two decades, with hundreds of peer-reviewed studies supporting its use across a wide range of musculoskeletal conditions.

For patients who have been offered corticosteroid injections or surgical debridement as their next step, shockwave therapy represents a compelling alternative. Unlike corticosteroid injections, which suppress inflammation temporarily but can weaken tendon tissue with repeated use and do not address underlying degeneration, shockwave therapy stimulates actual tissue repair. Unlike surgery, it requires no incisions, no anesthesia, no hospitalization, and no significant recovery period. Most patients resume normal daily activities immediately following treatment. A typical course of shockwave therapy involves three to six sessions spaced one week apart, making it a time-efficient option compared to prolonged surgical recovery.

Each shockwave session at Grieb Chiropractic Clinic begins with a focused assessment to identify the precise area of involvement. A coupling gel is applied to the skin overlying the treatment area, and the shockwave handpiece is positioned against the tissue. Patients typically feel a rhythmic pressure sensation during treatment, which can range from mildly uncomfortable to temporarily intense depending on the tissue being treated and the energy level used. Some patients experience temporary soreness in the treated area for one to two days following treatment, which is a normal part of the healing response. Significant improvement is often noticeable after the second or third session, with continued gains over the six to twelve weeks following the completion of the treatment course.

Shockwave therapy is appropriate for a broad range of patients with chronic tendon and soft tissue conditions, particularly those who have not responded adequately to rest, physical therapy, stretching, or injections. During your consultation at Grieb Chiropractic Clinic, Dr. Eric Grieb or Dr. Rowan Grieb will evaluate your history, examination findings, and imaging to determine whether shockwave therapy is the right fit for your condition.