Clinical Science
About Shockwave Therapy
Extracorporeal Shockwave Therapy (ESWT) uses high-amplitude acoustic pulses to trigger biological responses in targeted tissue. Originally developed in the 1980s for lithotripsy, it has evolved into a versatile regenerative treatment.
Two physical principles, one therapeutic effect
Shockwaves are single-pulse acoustic waves with a steep pressure rise (≤10 ns) followed by a short tensile phase. Two devices dominate clinical use:
Focused Shockwaves (fESWT)
Generated electrohydraulically, electromagnetically, or piezoelectrically. Penetrate up to 12 cm with a focused energy zone — ideal for deep musculoskeletal targets, calcifications, and erectile dysfunction protocols.
Radial Pressure Waves (rPW)
Pneumatically generated, dispersing radially from the applicator. Lower peak pressure but broader treatment area — best suited for superficial tendinopathies and trigger-point work.
Biological mechanisms
The therapeutic effect of ESWT is multifactorial. Key mechanisms include:
- Mechanotransduction — acoustic energy converts to biochemical signals via integrin and ion-channel activation.
- Neovascularisation — upregulation of VEGF, eNOS, and PCNA promotes new capillary formation.
- Anti-inflammatory cascade — modulation of NF-κB and TNF-α reduces chronic inflammation.
- Stem-cell recruitment — mobilisation and differentiation of mesenchymal stem cells in treated tissue.
- Cavitation effects — microbubble collapse generates secondary shear forces that disrupt calcific deposits.
- Pain modulation — hyperstimulation analgesia and substance-P depletion in nociceptive fibres.
Clinical evidence
ESWT is supported by Level I evidence for plantar fasciitis, calcific rotator-cuff tendinopathy, lateral epicondylitis, and chronic non-healing wounds. Emerging high-quality data supports its use in low-intensity protocols for erectile dysfunction, ischaemic heart disease, and bone non-unions. International societies (ISMST, DIGEST) publish regularly updated recommendations.
Safety profile
ESWT is non-invasive and well tolerated. Transient side effects include mild erythema, petechiae, and short-term post-treatment pain. Contraindications include pregnancy, malignancy in the treatment field, coagulopathies, and acute infection. Treatment over growth plates, lung tissue, and major nerves should be avoided.