Mississauga Pain Clinic offering chiropractic, physiotherapy, massage therapy and orthotic services to residents of Churchill Meadows InMississauga
Mississauga Pain Clinic offering chiropractic, physiotherapy, massage therapy and orthotic services to residents of Churchill Meadows InMississauga
Extracorporeal Shockwave Therapy (ESWT) has become one of the most researched non-invasive treatments for chronic tendon pain, soft-tissue injuries, and postoperative rehabilitation. Once used mainly for kidney stones, it is now a trusted therapy in physiotherapy, chiropractic care, orthopedics, and sports medicine. Recent clinical trials and systematic reviews published between 2020 and 2024—including new evidence from BMC Musculoskeletal Disorders, Scientific Reports, and the Annals of Physical and Rehabilitation Medicine—show strong and growing support for shockwave therapy as part of modern rehabilitation. At the Muscle and Joint Clinic, we provide both radial (r-ESWT) shockwave treatments using medical-grade technology to help patients recover faster and more effectively.
Shockwave therapy delivers high-energy acoustic waves into injured tissues. These waves stimulate a controlled mechanical and biological response that promotes healing. Research shows that shockwave therapy increases blood flow, stimulates collagen production, promotes new blood vessel growth, reduces inflammation, and affects pain-processing nerve fibers. By improving tissue regeneration and decreasing local sensitivity, ESWT helps restore function in tendons, fascia, muscles, and joint structures—especially in chronic or treatment-resistant cases.
A 2024 meta-analysis in BMC Musculoskeletal Disorders examined 18 randomized controlled trials involving over 1,000 patients with rotator cuff tendinopathy. Results showed that shockwave therapy significantly improved pain, shoulder function, and external rotation. Patients had better scores on multiple functional scales, including the Constant-Murley Score, ASES, UCLA Shoulder Score, and overall treatment effectiveness. Importantly, both radial and focused shockwave were effective, and benefits appeared regardless of energy level used.
Further evidence from the Annals of Physical and Rehabilitation Medicine (2023) adds an important insight: radial shockwave therapy can also improve tendon healing after rotator cuff repair surgery. In this randomized clinical trial, patients received either advanced rehabilitation alone or rehabilitation plus 2000 pulses of radial ESWT weekly for five weeks. After six months, the ESWT group showed significantly lower pain, higher ASES scores, and—most notably—better healing at the tendon’s suture anchor site based on MRI signal-to-noise quotient (SNQ) analysis. This study supports ESWT as a safe way to enhance postoperative tendon healing and reduce early pain during recovery.
The 2024 Scientific Reports randomized trial compared shockwave therapy with ultrasound and deep friction massage for tennis elbow. Shockwave therapy demonstrated faster and larger improvements in pain and function. By week seven, PRTEE scores in the ESWT group improved dramatically compared to controls, showing substantial reductions in pain and disability and better grip function. These findings are consistent with multiple systematic reviews showing that ESWT is one of the most effective non-surgical treatments for chronic tennis elbow.
Plantar fasciitis remains the condition with the strongest evidence for ESWT. Multiple reviews and clinical trials confirm that shockwave therapy produces significant improvements in pain and walking tolerance, often outperforming corticosteroid injections, ultrasound therapy, and standard conservative care. Shockwave therapy helps break down scar tissue, stimulates tissue regeneration, and is especially effective in cases lasting more than six weeks.
For Achilles tendinopathy, research shows mixed but generally positive results when shockwave is combined with structured rehabilitation. ESWT appears particularly helpful for chronic mid-portion Achilles pain where natural healing is slow. Patellar tendinopathy results are more variable, with some trials showing limited benefit compared to exercise alone; however, shockwave may still help in stubborn cases that have not responded to strengthening programs, load management, and biomechanical correction.
Shockwave therapy has strong support for treating calcific tendonitis of the shoulder. High-energy focused shockwave has been shown to dissolve calcium deposits, reduce inflammation, and restore shoulder mobility. Patients frequently experience rapid improvements in pain and function, avoiding the need for injections or surgical removal of calcifications.
The 2023 RCT published in Annals of Physical and Rehabilitation Medicine provides groundbreaking evidence for using shockwave therapy after rotator cuff repair:
– ESWT significantly reduced pain at six months post-surgery
– ASES scores improved more than rehabilitation alone
– MRI showed better tendon remodeling near the suture anchor (lower SNQ)
– No complications were reported
This study highlights shockwave therapy as a promising tool for supporting recovery after shoulder surgery, particularly during the vulnerable tendon remodeling phase between three and six months.
Research consistently shows that ESWT is effective because it stimulates tendon healing and improves microcirculation, helping damaged tissues receive more blood flow and nutrients. It also breaks down calcifications and scar tissue that can restrict movement, while reducing local nerve sensitivity to decrease pain. Shockwave therapy activates important anti-inflammatory pathways, including the release of nitric oxide, which further supports healing. In addition, ESWT enhances collagen organization and strengthens tendons, improving their ability to tolerate daily stresses. By preparing tissues to accept load more effectively, it also complements exercise-based rehabilitation. Together, these effects make ESWT particularly valuable for chronic injuries where healing has plateaued or stalled.
At the Muscle and Joint Clinic, shockwave therapy is delivered using treatment settings tailored to the patient’s condition, tissue sensitivity, and stage of recovery. Protocols follow current clinical research and generally involve 2000–4000 pulses per session, pressures in the range of approximately 1.8–5.0 Bar, and frequencies between 8 and 15 Hz, administered once or twice weekly for a period of 4–6 weeks. Shockwave is not usually used as a standalone intervention; it is consistently combined with hands-on manual therapy, targeted rehabilitative exercises, and personalized education to support long-term healing. Many patients begin noticing meaningful improvements in pain and function within just 3–5 sessions, particularly when they remain engaged in their home exercise program.
Extensive modern research supports shockwave therapy as an effective, non-invasive treatment for a wide variety of tendon and soft-tissue conditions, including shoulder tendinopathy, post–rotator cuff repair recovery, tennis elbow, plantar fasciitis, and chronic Achilles or patellar tendon injuries. At the Muscle and Joint Clinic, shockwave therapy is integrated into a comprehensive, evidence-based rehabilitation approach designed to relieve pain, restore mobility, and help patients return to work, sport, and everyday activities with greater comfort and confidence. For individuals experiencing persistent pain that has not improved with traditional treatments, shockwave therapy may offer an important and much-needed step forward in their recovery.
Abo Al-Khair, M. A., El Khouly, R. M., Khodair, S. A., Al Sattar Elsergany, M. A., Hussein, M. I., & Eldin Mowafy, M. E. (2021). Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy. The Physician and Sportsmedicine, 49(4), 480–487.
Cacchio, A., Paoloni, M., Barile, A., et al. (2006). Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: Single-blind, randomized clinical study. Physical Therapy, 86(5), 672–682.
Galasso, O., Amelio, E., Riccelli, D. A., & Gasparini, G. (2012). Short-term outcomes of extracorporeal shock wave therapy for chronic non-calcific tendinopathy of the supraspinatus. BMC Musculoskeletal Disorders, 13, 86.
Li, H., Chen, Y., & Chen, S. (2019). Postoperative residual pain and MRI-based tendon signal intensity after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy, 27(12), 4014–4020.
Shao, H., Zhang, S., Chen, J., et al. (2023). Radial extracorporeal shockwave therapy reduces pain and promotes proximal tendon healing after rotator cuff repair: A randomized clinical trial. Annals of Physical and Rehabilitation Medicine, 66, 101730. https://doi.org/10.1016/j.rehab.2023.101730
Scientific Reports. (2024). Randomized clinical trial comparing shockwave therapy versus ultrasound and friction massage in lateral epicondylitis.
Wang, C. J. (2012). Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research, 7, 11.
Zhao, Y., et al. (2024). Shockwave therapy for rotator cuff tendinopathy: A systematic review and meta-analysis. BMC Musculoskeletal Disorders.