Is Shockwave Therapy Worth the Cost for Tendon Pain?

A couple of weeks ago, we explored the potential healing effects of injecting peptides derived from gastric juices, commonly known as BPC-157, into injured areas.

If that doesn’t work, I’ve got another option… heavy metal.

Extracorporeal Shockwave Therapy (ESWT) was first used in the 1980s to break apart kidney stones with sound waves. Interestingly, it also appeared to increase bone density, prompting experiments to investigate the use of these sound waves for treating other ailments.

The evidence suggests it might.

How Does It Work?

First off, shockwave therapy is not the same as ultrasound.

The machines may look similar, but the mechanisms are very different.

Ultrasound is basically a mild heat lamp.  Shockwave therapy, on the other hand, delivers sharp bursts of high-pressure sound energy (think loud bangs, not music) targeted at painful tissue.

There are two primary devices:

• Radial shockwave: A gun with a metal “bullet” that rapidly slams into a plate pressed against the skin, creating a lower-energy wave that covers a broader area.  These machines are available on Amazon for around $1,500 online or even as low as $200—I have no clue if they work just as good.
  

• Focused shockwave: Uses pressure waves generated in water that can deliver higher-energy, more concentrated blasts that penetrate deeper. These devices are far pricier, which might make sense if you’re a clinic owner, but it’s not the type of late-night purchase you make on Amazon.

And yes, it hurts. Sensitive tissue often gets sore or even bruised after treatment, but those effects may actually be part of how it works.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7608508/

What’s Happening Inside the Body?

On a cellular level, shockwave therapy may promote healing through several mechanisms:

• Improved blood flow: Stimulates growth factor production and promotes new blood vessel formation, thereby enhancing oxygen and nutrient delivery.
  

• Pain modulation: Dampens pain messengers and “resets” overactive nerve endings.
  

• Tissue regeneration: Activates pathways for cell growth, collagen synthesis, and remodeling—especially valuable for slow-healing tendons and bones.
  

• Breaking down mineral deposits: Particularly in the shoulders, the pulses can help break up calcium buildups so the body can reabsorb them.

Slam Dunk!?

It all sounds impressive, and studies in smart-sounding medical journals support it. 

It seems to especially make sense for calcific tendinopathy, where shockwave is consistently more effective than placebo.  Which makes sense considering its effectiveness in breaking up kidney stones.

But zooming out, the bigger picture is less clear. For many other conditions, the research is mixed, and I still question the clinical significance, which doesn’t always align with the statistical significance. 

By this, I mean the real-world results that patients actually experience.  Think about it this way: if I could make your crummy shoulder feel slightly less crummy three months down the road for $ 1,500, would you spend it?

Additionally, a particularly interesting finding is that shockwave therapy is less effective when combined with a local anesthetic.  That suggests its power may lie in the graded exposure of pushing painful tissue right up to its tolerance, then gradually elevating that threshold over repeated treatments. 

My Verdict

Like most rehab tools, shockwave therapy works best when it’s part of a broader, active plan that emphasizes progressive loading and consistent movement.

I’d be all for it if my clinician included it as one piece of a comprehensive therapy approach, especially without a hefty line item tacked on. And if you’re dealing with tennis elbow or plantar fasciitis, there’s enough evidence to justify seeking out a provider who uses it.

But if you’re considering buying your own device or shelling out hundreds of dollars per session for a standalone “shockwave” treatment, odds are you’ll end up disappointed.

Of course, plenty of 5-star Amazon reviewers will disagree with me—so if you’re determined to try, at least be sure to use my affiliate link.