Shockwave Therapy for Tendinopathy: What the Evidence Says

The Problem

Why tendon pain is so stubborn

Tendinopathy is what we now call the pain, swelling and loss of function that develops when a tendon is loaded more than it can tolerate. The older term “tendinitis” has largely been retired, because in most long-standing cases the tendon is not simply inflamed — its structure has changed in response to load.

That distinction matters, because it explains why rest alone so rarely fixes it. A tendon that has become intolerant of load does not recover by being avoided; it recovers by being rebuilt, gradually and deliberately. It is also why these problems drag on for months in a way that a simple strain does not.

Shockwave therapy is one of the tools we use when that process stalls.

How It Works

What shockwave therapy actually is

Shockwave therapy delivers pulses of mechanical pressure into the tissue through a handpiece applied to the skin. It is not electrical, and despite the name, nothing is being shocked. The pulses are thought to work by stimulating local blood flow, provoking a healing response in tissue that has become quiet and unresponsive, and altering the way the area signals pain.

There are two distinct types, and the difference is real rather than a marketing one. Focused shockwave converges its energy at a specific depth. Radial shockwave — which is what we use at Workstrong, via the Intelect® RPW 2 — disperses energy outward from the skin surface, making it well suited to tendons that sit relatively superficially.

A 2026 meta-analysis in Scientific Reports comparing the two found no clear superiority of either for pain relief across the conditions studied, while noting that the overall evidence base remains limited and varied (Stania et al., 2026). It is worth knowing which type a clinic uses, because some published research applies to one and not the other.

The Evidence

Where shockwave helps most

Plantar heel pain is the strongest indication. It has the largest and most consistent body of supporting research of any tendon-related use, and it remains the condition we most often reach for shockwave to treat (Lippi et al., European Journal of Physical and Rehabilitation Medicine, 2024).

Tennis elbow (lateral elbow tendinopathy) has moderate supporting evidence. A 2025 umbrella review found shockwave outperformed placebo and ultrasound therapy, and compared favourably with corticosteroid injection over the medium term (Deng et al., Journal of Orthopaedics and Traumatology, 2025).

Gluteal tendinopathy — often described to patients as hip bursitis, and a common cause of pain on the outside of the hip — has a smaller but encouraging evidence base, with benefit shown over the short and medium term.

For mid-portion Achilles tendinopathy, the picture is more mixed. The evidence supports it as an addition to a loading programme rather than as a substitute for one.

Being Straight With You

Where the evidence is less established

We would rather tell you this up front than have you spend money on something unlikely to help.

For insertional Achilles tendinopathy — pain right at the back of the heel where the tendon attaches — a 2024 sham-controlled trial found radial shockwave added no measurable benefit over a placebo treatment (Alsulaimani et al., Clinical Rehabilitation, 2024). For patellar tendinopathy, health technology reviews have rated the evidence insufficient to draw firm conclusions.

That does not mean shockwave can never form part of a plan for these problems. It does mean we will be honest about what to expect, and that loading and rehabilitation should carry most of the weight.

The Most Important Part

Shockwave is an addition, not a replacement

If you take one thing from this article, take this. Across the research, progressive loading — structured, gradually increasing strength work for the affected tendon — is consistently the foundation of tendinopathy treatment. Shockwave has been studied and shown to work best alongside that programme, not instead of it.

Any clinic offering shockwave as a standalone cure, with no exercise plan attached, is not reflecting what the evidence shows. When we use it, it is to reduce pain enough that you can do the loading work that actually rebuilds the tendon.

What to Expect

What a session involves

Treatment is quick. A session typically takes five to ten minutes of actual treatment time, delivering somewhere between 1,500 and 2,500 pulses to the affected area. You will feel a firm tapping sensation, and it can be uncomfortable over a sensitive tendon — we adjust intensity to what you can tolerate, and it should never be more than briefly unpleasant.

Sessions are usually spaced about a week apart, with a course commonly running to three to five treatments. Some people notice a change early; for others it builds over the course and the weeks that follow. Mild soreness or redness afterwards is common and settles quickly.

Shockwave is not suitable for everyone. We avoid it over areas of active infection, in people taking blood-thinning medication or with clotting disorders, over open wounds, during pregnancy, and in some other circumstances — which is why it follows an assessment rather than being booked blind.

Measuring Progress

How we know whether it is working

Tendon pain fluctuates, which makes it genuinely hard to judge progress by memory alone. We use validated outcome measures — short standardised questionnaires such as the VISA-A for Achilles problems or the PRTEE for tennis elbow — so that improvement is tracked with a number rather than an impression.

Those questionnaires are free to complete at myPROMscore, the clinical outcome measures tool we publish. Scoring at your first visit gives us something concrete to compare against later.

Next Steps

Is it worth considering for you?

Shockwave is most worth discussing if your tendon pain has persisted for more than about three months, if you have already tried rest or anti-inflammatories without lasting change, and if you are willing to pair it with a loading programme.

If that sounds like your situation, we are happy to assess it and give you a straight answer about whether it is likely to help — including if the answer is that something else would suit you better.

Read more about shockwave therapy at Workstrong or book an assessment.