What Is Focused Shockwave Therapy?

A shockwave is a type of sound wave: a very short pulse of high pressure that travels through the body the way sound travels through water. "Extracorporeal" just means the pulse starts outside the body. There are no needles and no incisions. The pulses pass through the skin from an applicator that rests on it.

In focused shockwave, the device shapes the pulses so that they come together at a particular depth below the skin, called the focus, where the pressure is highest. That is the main difference from radial devices, whose pressure is strongest right at the skin. See focused vs. radial shockwave for a side-by-side comparison.

Shockwaves were first used in medicine in the early 1980s for lithotripsy, a procedure that breaks up kidney stones from outside the body. Researchers later began studying lower-energy shockwaves for problems in bones, tendons and other soft tissue.

The two uses are different. In lithotripsy, the goal is to break a stone into pieces. In musculoskeletal care, the pulses are not meant to break tissue apart. Researchers describe them instead as a mechanical stimulus to the area.

Most research on focused shockwave involves tendon and soft-tissue pain that has lasted months and has not settled with standard care such as rest, stretching, physical therapy, supportive footwear or bracing. Shockwave has been studied for:

Being studied for a condition is not the same as working for everyone who has it. Your provider decides whether shockwave is appropriate for you, often alongside other care such as physical therapy.

The evidence is mixed. Some randomized trials have found that people with long-lasting heel pain who had shockwave reported more pain reduction on average than people who had a sham (placebo) treatment. In one multicenter trial of 250 people, heel pain fell by an average of 69.2% after focused shockwave versus 34.5% after placebo. Other trials have found little or no difference.

The UK's National Institute for Health and Care Excellence (NICE) reviewed shockwave for stubborn plantar fasciitis and for tennis elbow. In both reviews it found no major safety concerns, but called the evidence on whether it works inconsistent, and noted a substantial placebo response in the studies. A review of shockwave for patellar tendon pain also found conflicting results.

One reason is that studies used different devices, energy levels, numbers of sessions and comparison treatments, which makes them hard to compare. The practical message: results vary, and not everyone responds.

Researchers do not know exactly how shockwave works. NICE describes the mechanism as unknown. Ideas that have been proposed, mostly from laboratory and animal studies, include:

These are theories under study, not promises about what will happen in your body.

The device at Innovare Tx is a focused shockwave device. Before any session, a provider (Charles Ortega, PA-C, or Rowena Calleja, PT, a Texas-licensed physical therapist) evaluates your pain, checks for reasons you should not have shockwave, and decides whether it fits your situation. If it does, the provider sets the plan, and trained medical staff perform the sessions. Atendemos a nuestros pacientes en español.

Shockwave is self-pay, and most insurance plans do not cover it. It is available through our Wellness Memberships. See cost and memberships, or read what to expect at a session.