Disclaimer: General educational purposes only. Always consult a qualified health professional. © 2026 Better Physiotherapy Bundoora.
If you have a chronic tendon problem that has not responded to standard physiotherapy, stretching, or cortisone injection — shockwave therapy may be the missing piece. It is one of the most evidence-backed treatments for chronic tendinopathy and is increasingly used in Australian physiotherapy clinics.
How Shockwave Therapy Works
Extracorporeal shockwave therapy (ESWT) delivers high-energy acoustic pulses to targeted tissue through the skin using a handheld applicator. These pulses work through multiple mechanisms:
- Tissue repair stimulation: Shockwaves trigger growth factor release and stimulate new blood vessel formation (angiogenesis), reversing the degenerative changes in chronic tendons
- Calcium dissolution: Acoustic energy breaks down calcific deposits in calcific tendinitis of the shoulder
- Pain modulation: Shockwaves temporarily desensitise pain fibres (substance P depletion), producing immediate pain relief
- Collagen production: Stimulates fibroblast activity and collagen synthesis, strengthening the degenerative tendon tissue
Conditions Treated with Shockwave Therapy
| Condition | Evidence strength |
|---|---|
| Chronic plantar fasciitis | Strong (Level 1) |
| Calcific shoulder tendinitis | Strong (Level 1) |
| Mid-portion Achilles tendinopathy | Strong (Level 1) |
| Chronic patellar tendinopathy | Moderate (Level 2) |
| Lateral epicondylalgia (tennis elbow) | Moderate (Level 2) |
| Greater trochanteric pain syndrome | Moderate (Level 2) |
| Tibial stress reaction | Emerging evidence |
When Is Shockwave Appropriate?
Shockwave therapy is most appropriate when a tendinopathy has been present for more than 3–6 months and has not fully responded to a properly conducted physiotherapy program. It is not a substitute for rehabilitation — it is used alongside progressive loading to accelerate tissue repair in stubborn chronic cases.
Shockwave vs Cortisone
Multiple randomised trials comparing shockwave to cortisone injection show that while cortisone provides faster initial relief, shockwave produces significantly better outcomes at 6 and 12 months. Cortisone weakens tendon tissue and is associated with higher recurrence rates. For chronic tendinopathy, shockwave is the superior long-term choice.
Frequently Asked Questions
What is shockwave therapy?
Extracorporeal shockwave therapy (ESWT) delivers focused acoustic energy pulses to targeted tissue through the skin. These pulses stimulate tissue repair, increase blood flow, disrupt pain signals, and dissolve calcium deposits. It is a non-invasive procedure performed in a physiotherapy clinic without anaesthesia.
What conditions does shockwave treat best?
The strongest evidence is for chronic plantar fasciitis, mid-portion Achilles tendinopathy, calcific shoulder tendinitis, and chronic patellar tendinopathy. It is also used for tennis elbow, gluteal tendinopathy, and tibial stress reactions that have not responded to other treatments.
Is shockwave therapy covered by private health insurance?
Most Australian private health extras policies cover shockwave therapy when performed by a registered physiotherapist. Check your specific policy for physiotherapy inclusion. It is not currently covered by Medicare.
What should I expect after a shockwave session?
Mild soreness in the treated area for 24–48 hours after each session is normal and indicates the treatment is stimulating the healing response. Anti-inflammatory medication should be avoided for 48 hours after treatment as it may blunt the therapeutic effect.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora