Published May 2026. Written by the Upwell Health Collective clinical team. Clinically reviewed May 2026. Next review November 2026. For educational purposes only — please consult a qualified podiatrist, physiotherapist, or GP before commencing shockwave therapy. Upwell offers shockwave (ESWT) at our Camberwell clinic.
Related reading from Upwell Health:
• Podiatry Camberwell — Award-Winning Podiatrist Near You
• The Tendinopathy Ultimate Guide 2026
• The Diabetic Foot Care Master Guide 2026
• Perimenopause & Menopause Thrive Guide 2026
• Pain Is Not Damage
If you've been told you might benefit from shockwave therapy — or you're considering it for chronic heel pain, Achilles tendinopathy, tennis elbow, or another stubborn musculoskeletal condition — five things to know before anything else:
1/ Shockwave therapy (ESWT) is real, evidence-based, and approved for specific conditions. Extracorporeal Shockwave Therapy (ESWT) has been used clinically for over 30 years, has FDA, TGA, and CE-mark approvals for specific musculoskeletal indications, and is supported by Cochrane reviews, systematic reviews in the British Journal of Sports Medicine, and clinical practice guidelines from multiple international podiatry and sports medicine bodies. It is not snake oil, it is not laser, and it is not ultrasound. It is a distinct, well-studied modality.
2/ It works best for specific conditions — not everything. The strongest evidence is for chronic plantar fasciopathy (plantar fasciitis), calcific rotator cuff tendinopathy, lateral elbow tendinopathy (tennis elbow), greater trochanteric pain syndrome (gluteal tendinopathy), and chronic Achilles tendinopathy. The evidence is good but slightly less strong for patellar tendinopathy, Osgood-Schlatter disease, and chronic plantar heel pain in athletes. It is not effective for all musculoskeletal pain — and any clinic that markets it as a cure-all is misleading you.
3/ Timing matters — shockwave is a chronic condition tool. The strongest evidence base is for conditions that have persisted beyond 6 weeks to 3 months of conservative care — typically meaning you've done the loading work, the manual therapy, the footwear modifications, the orthotics, and you're still stuck. Shockwave is not a first-line treatment. It's a powerful second or third-line tool when you're at the wall.
4/ Two main types exist — and they're not interchangeable. Focal Shockwave Therapy (fESWT) and Radial Pulse Therapy (rPT — often marketed as "radial shockwave") are different modalities with different evidence bases, different generators, and different ideal indications. Most clinics offer one or the other (not both), and you may not know which you're getting. The right modality for your condition matters.
5/ Loading is still essential. The single biggest mistake patients make is treating shockwave as a passive cure that replaces exercise. The strongest evidence shows shockwave + structured loading + progressive rehabilitation produces dramatically better outcomes than shockwave alone. If your provider doesn't pair shockwave with structured loading rehabilitation, you're getting half the treatment.
This guide is the most comprehensive evidence-based shockwave resource we've produced. It covers the science, the modalities, the conditions, the protocols, the evidence base, the contraindications, what to expect, the cost, and the role of shockwave in the modern multi-disciplinary care that resolves stubborn musculoskeletal conditions. It sits at around 10,000 words.
The phrase "shockwave therapy" sounds dramatic. The reality is more nuanced. Shockwave therapy is the controlled, clinical application of high-pressure acoustic waves to musculoskeletal tissue — delivering precisely targeted mechanical energy that triggers a biological cascade of cellular and tissue responses.
The technology was originally developed in the 1980s for breaking up kidney stones (lithotripsy). Researchers noticed that surrounding musculoskeletal tissue showed unusual healing responses to the same acoustic energy — and over the following decade, dedicated musculoskeletal shockwave devices were developed for orthopaedic and sports medicine use. Today, extracorporeal shockwave therapy (ESWT) is one of the most-studied non-pharmacological interventions in chronic musculoskeletal medicine, with hundreds of randomised controlled trials and dozens of systematic reviews supporting its use for specific indications.
The biological mechanisms of shockwave therapy are still being fully characterised, but the current consensus involves multiple synergistic pathways:
1/ Mechanotransduction. The high-pressure acoustic waves create mechanical stress on cells, which the cells convert into biochemical signals. This stimulates dormant tenocytes (tendon cells), fibroblasts, and other connective tissue cells to begin active repair processes.
2/ Neovascularisation. Shockwave triggers the release of vascular endothelial growth factor (VEGF), nitric oxide synthase, and other angiogenic factors that promote the formation of new blood vessels in chronic tendinopathy tissue. This addresses one of the core issues in chronic tendinopathy — the relative avascularity of degenerative tendon tissue.
3/ Modulation of inflammation and analgesia. Shockwave appears to modulate inflammatory cytokines and reduce substance P (a key pain neurotransmitter) in treated tissue. This is part of why patients often experience an analgesic effect within days of treatment, before structural tissue changes have time to occur.
4/ Release of growth factors. Shockwave triggers release of platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and insulin-like growth factor (IGF-1) in treated tissue — the same growth factors that drive tissue remodelling in normal healing.
5/ Disruption of pathological tissue. In conditions with calcific deposits (calcific rotator cuff tendinopathy, calcific Achilles insertional tendinopathy), shockwave can mechanically disrupt and fragment the calcium deposits, allowing the body to reabsorb them.
6/ Stem cell mobilisation. Emerging evidence suggests shockwave may mobilise mesenchymal stem cells to treated areas, contributing to longer-term tissue regeneration.
7/ Reduced central sensitisation. In chronic conditions where pain has become amplified by nervous system changes (central sensitisation — see our Central Sensitisation guide), shockwave appears to reduce both peripheral nociceptive input and central pain modulation, contributing to the analgesic effect.
This combination of mechanisms is part of why shockwave produces effects that simpler interventions (heat, ice, massage, NSAIDs) cannot replicate. It is genuinely tissue-modifying, not just symptom-managing.
Here's where most patient confusion happens — and where some clinics intentionally blur the distinction. "Shockwave therapy" is an umbrella term that covers two genuinely different modalities. They are not the same thing.
Focal shockwave generates a true acoustic shockwave — a high-amplitude pressure pulse with a near-instant rise time — that can be precisely focused at depth in tissue. The energy is delivered as a tight beam that converges on a specific anatomical target several centimetres beneath the skin.
Three sub-types of focal shockwave generators exist:
Electrohydraulic. The original technology. A spark gap generates a shockwave that is focused by a parabolic reflector. Highest energy delivery, often most painful, used in some specialist applications.
Electromagnetic. A coil generates a magnetic field that produces a shockwave through a flexible membrane. Precise, well-controlled, common in clinical devices.
Piezoelectric. Piezoelectric crystals generate the shockwave, focused by their geometric arrangement. Highly precise, often gentler, used in newer devices.
Focal shockwave is the gold standard for:
• Calcific rotator cuff tendinopathy (deep target requiring precise focus).
• Insertional Achilles tendinopathy with calcification.
• Deep tendon and bone-tendon junction conditions.
• Stress fracture and bone marrow oedema treatment in some specialist applications.
• Conditions where energy needs to be delivered precisely at depth.
Radial pulse therapy (often marketed as "radial shockwave" or "radial extracorporeal shockwave therapy") generates a different waveform. Instead of a true focused shockwave, rPT generates ballistic pressure waves — a projectile (typically a metal bullet) is accelerated inside a hand-piece by compressed air, striking an applicator that transmits the kinetic energy into the tissue.
The energy spreads radially outward from the application point, with maximum intensity at the skin surface and progressively diminishing intensity with depth. Penetration depth is typically 2–3cm — sufficient for superficial tendons and fasciae but inadequate for deeper structures.
Radial pulse therapy is the gold standard for:
• Plantar fasciopathy (plantar fasciitis).
• Lateral elbow tendinopathy (tennis elbow).
• Greater trochanteric pain syndrome (gluteal tendinopathy).
• Mid-portion Achilles tendinopathy.
• Patellar tendinopathy.
• Conditions with superficial or moderate-depth targets.
The clinical evidence base differentiates the modalities by indication. Some conditions respond well to either. Others respond better to one specifically. The decision is based on:
• The depth of the target tissue.
• The presence or absence of calcific deposits.
• The specific anatomy and pathology.
• The available evidence for that specific indication.
A well-equipped shockwave clinic ideally offers both modalities and selects based on the patient's condition. A clinic with only one modality may not be able to optimally treat all indications. Ask which type of shockwave device a clinic uses before booking.
This is the practical core. The evidence for shockwave is condition-specific, not blanket. Here's what the 2023–2026 evidence base tells us for each major indication.
The evidence: Strong. Multiple Cochrane reviews and meta-analyses (Sun et al, Yin et al, Speed et al) support shockwave — particularly radial — for chronic plantar fasciopathy that has failed conservative treatment for 6–12 weeks.
What the trials show: Significant reduction in plantar heel pain at 12 weeks and 12 months compared to placebo. Effect size moderate to large. Number-needed-to-treat approximately 3 — meaning for every 3 patients treated, 1 achieves a clinically meaningful improvement they wouldn't have achieved with placebo.
Typical protocol: 3–6 sessions, 1–2 weeks apart. Radial shockwave at moderate energy (1.5–2.5 bar typically). Combined with structured calf and plantar fascia loading.
When to consider it: Plantar heel pain that has not responded adequately to 6–12 weeks of structured loading (the Rathleff heel-raise protocol, calf stretching, footwear modification, taping, orthotics if indicated).
For deeper detail on the broader plantar fasciopathy picture, see our Plantar Fasciitis Runner's Guide and our Tendinopathy Ultimate Guide 2026.
The evidence: Good. Multiple RCTs support shockwave (focal or radial) as an adjunct to loading for chronic mid-portion Achilles tendinopathy that has failed initial loading-based rehabilitation.
What the trials show: Comparable or superior outcomes to eccentric loading alone when used in combination. Particularly useful in patients who have already done extensive loading but plateaued.
Typical protocol: 3–5 sessions, 1–2 weeks apart. Combined with continued heavy slow resistance (HSR) loading.
When to consider it: Mid-portion Achilles tendinopathy that has plateaued at 12+ weeks of structured loading.
The evidence: Strong, particularly when calcific changes are present at the insertion. Focal shockwave is typically preferred over radial for deeper insertional pathology.
What the trials show: Significant improvement in pain and function. Effect size moderate. Particularly effective in cases with retrocalcaneal bursitis or Haglund's deformity.
Typical protocol: 3–6 sessions of focal shockwave. Combined with modified loading (avoiding deep dorsiflexion early), heel lift inserts where appropriate, and gradual progression to standard heavy slow resistance.
The evidence: Very strong. This is probably the single strongest indication for shockwave — ahead of any other musculoskeletal application. Focal shockwave has consistently outperformed sham, conservative care, and (in some trials) injection therapies in well-conducted RCTs.
What the trials show: Dissolution or fragmentation of calcific deposits in 60–70% of cases. Substantial pain reduction. Improved shoulder function. Some patients avoid surgery they would otherwise have needed.
Typical protocol: 3 sessions of focal shockwave, 1 week apart. Higher energy required than for soft tissue applications. Combined with progressive rotator cuff loading.
For broader context on rotator cuff and shoulder pathology, see our Shoulder Pain Master Guide 2026.
The evidence: Modest. Shockwave shows some benefit in non-calcific rotator cuff related shoulder pain, but the effect size is smaller than for calcific cases. Loading and exercise remain first-line.
When to consider it: Chronic shoulder pain that has plateaued at 12+ weeks of structured loading and exercise.
The evidence: Good. Multiple RCTs and a 2023 systematic review support shockwave as effective for chronic lateral elbow tendinopathy that has failed conservative treatment.
What the trials show: Significant pain reduction and functional improvement, particularly at 12 weeks and 6 months. Effect size moderate. Outcomes better than corticosteroid injection at long-term follow-up.
Typical protocol: 3–5 sessions of radial shockwave, 1–2 weeks apart. Combined with eccentric and HSR loading of wrist extensors.
When to consider it: Lateral elbow pain that has not responded to 8–12 weeks of structured wrist extensor loading.
The evidence: Moderate to good. Several RCTs support shockwave for gluteal tendinopathy, particularly chronic cases. The 2018 LEAP trial established education plus exercise as first-line — shockwave is positioned as a second-line tool for cases that have not responded adequately.
What the trials show: Significant pain reduction. Effect size moderate. Particularly useful in patients with multiple simultaneous tendinopathies (perimenopausal women with MSM — see our Perimenopause & Menopause Thrive Guide 2026).
Typical protocol: 3–5 sessions of radial shockwave. Combined with progressive hip abductor loading and avoidance of compressive positions.
The evidence: Moderate. Shockwave shows benefit in chronic patellar tendinopathy that has failed conservative care. Often combined with the Kongsgaard heavy slow resistance protocol.
What the trials show: Significant pain reduction and improved VISA-P scores. Effect size moderate.
Typical protocol: 3–5 sessions of focal or radial shockwave. Combined with HSR loading.
The evidence: Limited but emerging. Small trials show benefit. Larger evidence base needed. Many specialist clinics use shockwave as part of multi-modal management for stubborn proximal hamstring cases.
The evidence: Strong where calcific deposits are present. Focal shockwave can fragment calcium deposits and dramatically improve symptoms.
Stress fracture and delayed union. Limited but emerging evidence for shockwave in delayed bone healing, stress reactions, and certain non-union fractures. Specialist application.
Bone marrow oedema syndrome. Emerging evidence in transient bone marrow oedema and avascular necrosis. Specialist application, often requires focal shockwave at high energy.
Equally important to be honest about: shockwave does NOT have strong evidence for:
• Acute injuries (within 6 weeks of onset).
• Most low back pain (not first-line, weak evidence).
• Generic neck pain.
• Knee osteoarthritis pain (limited evidence in selected cases only).
• Most fibromyalgia presentations.
• Generic muscle soreness.
• Pelvic floor conditions (unless specifically trained pelvic shockwave provider).
• Most headache presentations.
• Bursitis without underlying tendinopathy.
A clinic that markets shockwave for everything is overselling. The science is condition-specific.
If you've never had shockwave therapy before, knowing what to expect makes it easier. Here's what a typical shockwave session at Upwell looks like:
Your first session typically includes a thorough assessment of your condition — history, examination, palpation of the affected area, and review of any imaging. The clinician confirms shockwave is appropriate, identifies the specific target tissue, and explains the treatment plan. You'll be educated about what to expect during and after the treatment.
You'll be positioned for access to the treatment area. Ultrasound gel is applied to the skin where the shockwave applicator will be placed — this couples the applicator to the skin for effective energy transmission.
The shockwave applicator is placed against the target area. The clinician begins delivering shocks at a low energy and frequency, gradually increasing both as you adapt to the sensation. The clinician moves the applicator around the target area to deliver shocks across the affected tissue.
Typical session parameters:
• Duration: 10–20 minutes depending on condition and area treated.
• Number of shocks: 2,000–4,000 per session.
• Frequency: 5–20 Hz (5–20 shocks per second).
• Energy: Adjusted to patient tolerance, typically progressively increased.
Most patients describe shockwave as uncomfortable but tolerable. The sensation is often described as a strong tapping or thumping at the application site. Some areas (over bony prominences, near insertions) are more uncomfortable than others. Calcific deposits can be particularly sensitive when first treated.
The discomfort is part of the therapy, not a sign of injury. Clinicians adjust energy to your tolerance. If a setting is genuinely intolerable, the energy is reduced.
Most patients experience an immediate analgesic effect — a temporary reduction in pain that can last hours to days. This is followed by a treatment soreness response (similar to delayed-onset muscle soreness) that typically lasts 24–72 hours. Many patients report the original pain feels different (often improved) in the days following treatment.
Activity guidance after shockwave:
• Avoid icing the treated area for the first 24–48 hours (you want the inflammatory response that shockwave triggers).
• Avoid anti-inflammatory medications (NSAIDs like ibuprofen) for 48 hours after treatment — NSAIDs may blunt the healing response shockwave triggers.
• Continue your normal activity, but avoid pushing into high-intensity loading of the treated area for 24–48 hours.
• Continue your prescribed exercise and loading program — the shockwave + loading combination is what drives the best outcomes.
Most conditions are treated with 3–6 sessions, scheduled 1–2 weeks apart. Each session builds on the previous one, with progressive energy and progressively more shocks delivered as tolerance improves and the tissue responds.
Symptom improvement typically begins 2–4 weeks after the first session and continues for 8–12 weeks after the final session. The full effect is usually assessed at 12 weeks post-treatment. Some patients respond rapidly. Others have a slower but ultimately equivalent response. A small minority don't respond well to shockwave — typically those with very chronic, complex, or multi-factor presentations.
Shockwave is generally safe with minimal side effects, but it's not appropriate for everyone. Honest discussion of contraindications:
Shockwave should NOT be used in:
• Pregnancy (over or near the uterus).
• Active malignancy in the treatment area.
• Open wounds at the treatment site.
• Active infection at the treatment site.
• Treatment over major blood vessels, nerves, or organs.
• Acute haematomas in the treatment area.
• Patients on anticoagulant medication at therapeutic levels (relative contraindication — case-by-case).
• Children with open growth plates near the treatment area (relative contraindication).
• Patients with implanted cardiac devices in the treatment field (case-by-case, generally avoid focal shockwave near devices).
• Bleeding disorders without medical clearance.
• Recent (within 6 weeks) corticosteroid injection at the treatment site (delay shockwave).
• Diabetic neuropathy in the treatment area — reduced sensation requires careful energy titration.
• Severe peripheral vascular disease.
• Recent fracture in the treatment area (most evidence supports delaying shockwave until early healing is established).
• Acute injuries within 6 weeks of onset.
• Severe osteoporosis (focal shockwave at high energy).
Most patients experience some combination of:
• Treatment-site discomfort during the session.
• Skin redness or minor bruising at the application site.
• Treatment soreness in the 24–72 hours after.
• Temporary symptom flare in some cases.
• Transient skin numbness.
Serious adverse events are very rare in musculoskeletal shockwave when delivered by trained clinicians using appropriate parameters.
This is the single most important practical principle in modern shockwave therapy:
Shockwave is most effective when paired with structured progressive loading.
The strongest evidence in chronic tendinopathy and plantar fasciopathy consistently shows that shockwave + structured loading rehabilitation outperforms shockwave alone, loading alone, or either compared to passive treatments. The two modalities work synergistically:
• Shockwave provides the biological stimulus for tissue remodelling.
• Loading provides the mechanical stimulus that directs that remodelling.
• Together they produce structural and functional change that neither produces alone.
This is why the Upwell approach to shockwave always integrates with the broader rehabilitation framework. We don't deliver shockwave in isolation — we deliver it as part of a multi-modal program that includes:
• Comprehensive assessment of the condition.
• Structured progressive loading appropriate to the tendon or fascia involved (the Kongsgaard HSR protocols, the Rathleff plantar fascia protocol, etc).
• Movement and biomechanical assessment.
• Footwear and orthotic advice where appropriate.
• Manual therapy as adjunct symptom management.
• Patient education on load management and graduated return to activity.
• Return-to-sport progression where applicable.
For the comprehensive evidence base on tendinopathy loading, see our Tendinopathy Ultimate Guide 2026. For the broader context on chronic pain and loading, see our Why Rest Makes It Worse guide.
Honest patient selection matters. The patients who benefit most from shockwave at our Camberwell clinic share a common profile:
1/ Chronic, not acute. The condition has been present for at least 6 weeks (typically 3+ months).
2/ Failed conservative care. They've genuinely tried structured loading rehabilitation, footwear modification, manual therapy, and other appropriate first-line interventions — not for 2 weeks but for 8–12+ weeks.
3/ Clear pathology fitting the indication. Their condition matches one of the well-supported indications (plantar fasciopathy, calcific rotator cuff tendinopathy, lateral elbow tendinopathy, gluteal tendinopathy, Achilles tendinopathy, etc).
4/ Willing to engage with the full program. They understand shockwave is one part of a multi-modal program — not a passive cure — and are willing to continue progressive loading throughout treatment.
5/ Realistic expectations. They understand that shockwave is most effective at the 8–12 week post-treatment mark, and that full structural remodelling can take months. They're not seeking instant fixes.
6/ Appropriate clinical context. No absolute contraindications, no recent corticosteroid injections, no other interventions that would preclude shockwave use.
The patients who often disappoint with shockwave share inverse characteristics: acute injuries, very short conservative care history, unclear pathology, unwillingness to engage with loading, unrealistic expectations, or significant comorbidities.
Women in their 40s, 50s, and 60s frequently present with multiple simultaneous tendinopathies and fascial pain — the musculoskeletal syndrome of menopause (MSM). Shockwave can play a substantial role in management when paired with appropriate loading, hormone health considerations, and the broader Upwell Whole Person Pain™ framework. See our Perimenopause & Menopause Thrive Guide 2026 for the full picture.
Shockwave is safe and effective in older adults with appropriate clinical contexts. Energy parameters are titrated to tolerance. The same indications apply. Loading rehabilitation continues to be essential — see our discussion of older-adult exercise capacity in the Tendinopathy guide.
Shockwave is particularly useful in athletes with chronic tendinopathy or plantar fasciopathy who need to maintain training while resolving their condition. In-season athletes often benefit from the analgesic effect alongside ongoing loading. Off-season athletes can engage with more intensive shockwave + loading protocols.
Diabetic patients with peripheral neuropathy require careful clinical judgement before shockwave treatment. The reduced sensation in neuropathic feet means energy parameters need to be titrated based on tissue response rather than patient pain feedback. Patients with active diabetic foot disease (ulcers, Charcot foot, critical ischaemia) should not have shockwave to the affected foot. For comprehensive coverage of diabetic foot care, see our Diabetic Foot Care Master Guide 2026.
Shockwave therapy can be incorporated into NDIS-funded podiatry and physiotherapy plans for participants with eligible disabilities and qualifying musculoskeletal conditions. Upwell is a registered NDIS provider — our team can discuss how shockwave fits into your plan.
Shockwave is generally avoided in children with open growth plates near the treatment area. Specific applications (Sever's disease, Osgood-Schlatter) have some emerging evidence but are typically managed without shockwave in the first instance.
Honest discussion of cost matters. Shockwave is not a Medicare-rebated standalone service in Australia, but the consultation in which it is delivered may be subject to standard Medicare rebates under chronic disease management plans, NDIS funding, DVA coverage, or private health insurance extras.
Private patients. Standard consultation rates apply, with shockwave delivered as part of the consultation. Most major health funds will cover the consultation under podiatry or physiotherapy extras cover.
Medicare CDM (EPC) plans. Eligible chronic disease management patients can access up to 5 podiatry or physiotherapy sessions per calendar year under Medicare. Shockwave delivered in these sessions is included at the standard Medicare rebate (~$60 per session).
NDIS participants. Shockwave delivered as part of NDIS-funded podiatry or physiotherapy is funded through the participant's plan.
DVA Gold Card and eligible White Card holders. Bulk-billed for eligible services including shockwave-inclusive consultations.
For specific pricing at Upwell, call our reception team on (03) 8849 9096. We're transparent about costs and never surprise patients with hidden fees.
Multiple trials across multiple tendinopathies have shown corticosteroid injection produces short-term symptom relief (4–6 weeks) but worse long-term outcomes (12+ months) compared to shockwave or structured loading. Corticosteroid is rarely a first-line treatment for chronic tendinopathy in current best practice. Shockwave is the better long-term tool. The Coombes 2010 Lancet trial established this picture in chronic tendinopathy generally.
Both interventions target the biological response in chronic tendon tissue. PRP has stronger evidence in lateral elbow tendinopathy and limited evidence in other conditions. Shockwave has a broader evidence base across more indications. Both are typically considered second or third-line tools after structured loading. In some specialist settings, they are combined sequentially.
Surgical referral for chronic tendinopathy is reserved for cases failing 6–12+ months of well-delivered conservative care. Shockwave is one of the key tools in that conservative care window. Patients who respond well to shockwave often avoid the surgery they would otherwise have needed. For cases that ultimately progress to surgery, shockwave is not detrimental — it sits in the conservative care continuum.
Therapeutic ultrasound and low-level laser therapy have substantially weaker evidence in chronic tendinopathy than shockwave. Shockwave should not be confused with these modalities — the mechanisms, energy delivery, and evidence bases are different.
Loading alone has strong evidence as first-line treatment for most tendinopathies. Shockwave is positioned as an adjunct to loading, particularly in cases that have plateaued. The combination outperforms either alone in most studies.
At Upwell Health Collective in Camberwell, shockwave therapy is delivered as part of an integrated, evidence-based, multi-disciplinary approach. Our process:
Every shockwave-considered patient begins with a 45–60 minute consultation with a podiatrist or physiotherapist. We assess your condition thoroughly, review your history, examine the affected area, review any relevant imaging, and determine whether shockwave is appropriate for your specific situation.
If shockwave isn't the right tool for you, we'll tell you. We don't push treatments on patients who don't need them. The conditions that respond well to shockwave are specific — we apply it where the evidence supports it.
Where shockwave is appropriate, we integrate it into a multi-modal treatment plan that includes:
• Structured progressive loading rehabilitation specific to your condition.
• Footwear and orthotic advice where applicable.
• Manual therapy as adjunct support.
• Education on load management and the recovery trajectory.
• Coordination with our broader multi-disciplinary team where relevant — physiotherapy, exercise physiology, clinical Pilates, podiatry.
• Return-to-activity planning.
The specific shockwave protocol — number of sessions, frequency, energy parameters, focal vs radial selection — is matched to your specific condition based on the strongest available evidence. We don't apply a one-size-fits-all approach.
Validated outcome measures (VISA-A for Achilles, VISA-P for patellar, VISA-G for gluteal, NRS for pain, FAAM for foot and ankle, etc) help us track your progress objectively. We re-assess at appropriate intervals to ensure the treatment is working.
If shockwave isn't producing the expected response, we'll tell you. If your condition needs escalation to a sports medicine GP, surgeon, or other specialist, we'll facilitate that referral. We're not invested in keeping you in our clinic if your condition needs care elsewhere.
Most patients receiving shockwave at Upwell also work with our physiotherapy, exercise physiology, or clinical Pilates teams throughout treatment. The combination delivers far better outcomes than shockwave alone.
Most patients describe shockwave as uncomfortable but tolerable. The sensation is typically a strong tapping or thumping at the treatment site. Energy is titrated to your tolerance, and the discomfort is part of the therapeutic effect. Most patients say the discomfort is manageable and worthwhile given the outcomes.
Most musculoskeletal conditions are treated with 3–6 sessions, scheduled 1–2 weeks apart. The exact number depends on your specific condition, severity, and response to early sessions.
Many patients experience an immediate analgesic effect after each session. The full therapeutic effect typically begins 2–4 weeks after the first session and continues for 8–12 weeks after the final session. Full structural remodelling can take 3–6 months.
No. They are completely different modalities. Ultrasound therapy uses continuous low-energy sound waves with limited tissue effects. Shockwave uses high-energy acoustic pulses that produce genuine biological tissue effects. The evidence base for shockwave in chronic tendinopathy is dramatically stronger.
No referral is required for private fee-for-service. For Medicare CDM rebates, your GP will need to prepare the chronic disease management plan first.
Yes — and you should continue your prescribed loading program. Avoid high-intensity loading of the treated area for 24–48 hours after each session, but maintain general activity and your structured loading rehabilitation.
Avoid icing for the first 24–48 hours after treatment — you want the inflammatory response shockwave triggers to do its job.
Avoid NSAIDs (ibuprofen, naproxen) for 48 hours after each session, as they may blunt the healing response. Paracetamol is generally fine if needed.
Highly condition-specific. For calcific rotator cuff tendinopathy, success rates exceed 70–80%. For plantar fasciopathy, approximately 65–75% of patients achieve clinically meaningful improvement. For lateral elbow tendinopathy, success rates approximate 65–70%. For chronic Achilles tendinopathy, 60–70% when combined with structured loading.
A small minority of patients don't respond well to shockwave. In those cases, we reassess your diagnosis, consider whether escalation to PRP, surgical consultation, or other specialist intervention is appropriate, and continue to support you through alternative pathways.
Yes, in most cases. The consultation in which shockwave is delivered is typically covered under podiatry or physiotherapy extras cover. Check your specific health fund and policy. HICAPS is available at Upwell for instant gap payment.
Yes, where clinically indicated as part of NDIS-funded podiatry or physiotherapy, or for eligible DVA Gold Card and White Card holders.
Case-by-case. Many patients on antiplatelet therapy (low-dose aspirin) can have shockwave safely. Patients on therapeutic anticoagulation (warfarin, DOACs) require medical discussion before shockwave. Tell your clinician about all medications.
Yes — there's no anaesthesia, no sedation, and no recovery period required.
Call (03) 8849 9096 or book online at upwellhealth.com.au. Mention shockwave when booking so we can allocate appropriate appointment time and the right clinician for your condition.
Shockwave therapy, delivered well, is one of the most useful tools in modern musculoskeletal medicine for specific chronic conditions. The evidence is mature. The mechanisms are increasingly well-understood. The protocols are refined. Outcomes are good when patient selection is appropriate and treatment is integrated with structured loading.
The barriers to good outcomes are not the technology. They are:
• Inappropriate patient selection (treating acute conditions, treating non-responsive conditions, treating without conservative care first).
• Inadequate loading rehabilitation alongside shockwave.
• Single-modality clinics that don't offer the broader supportive care.
• Wrong modality for the condition (radial when focal is indicated or vice versa).
• Insufficient session number, inappropriate energy, or poor technique.
• Unrealistic patient expectations about timeline and outcomes.
If you have a chronic tendinopathy, plantar fasciopathy, calcific rotator cuff tendinopathy, lateral elbow tendinopathy, gluteal tendinopathy, or another well-supported indication that hasn't responded to 6–12+ weeks of structured loading rehabilitation, shockwave is worth seriously considering.
At Upwell Health Collective in Camberwell, we deliver shockwave the right way — thorough assessment, appropriate patient selection, evidence-based protocols, integrated with our broader multi-disciplinary care, with honest communication about expected outcomes and timelines. We're not the right clinic for everyone, but for patients who fit the appropriate clinical profile, we deliver excellent outcomes.
To book a consultation, visit our Podiatry Camberwell page, call our Camberwell clinic on (03) 8849 9096, or book online at upwellhealth.com.au. We see patients privately, on Medicare CDM plans, NDIS plans, DVA, and through TAC.
1. Speed C. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. British Journal of Sports Medicine. 2014;48(21):1538-1542 (foundational systematic review).
2. Sun J, Gao F, Wang Y, Sun W, Jiang B, Li Z. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs. Medicine (Baltimore). 2017;96(15):e6621.
3. Yin MC, Ye J, Yao M, et al. Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Archives of Physical Medicine and Rehabilitation. 2014;95(8):1585-1593.
4. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles, Ligaments and Tendons Journal. 2012;2(1):33-37 (foundational mechanism review).
5. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research. 2012;7:11.
6. Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, McAlindon T. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Annals of Internal Medicine. 2014;160(8):542-549.
7. Ioppolo F, Tattoli M, Di Sante L, et al. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Physical Therapy. 2012;92(11):1376-1385.
8. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet. 2010;376(9754):1751-1767 (foundational comparative evidence).
9. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. American Journal of Sports Medicine. 2009;37(3):463-470.
10. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for chronic insertional Achilles tendinopathy. American Journal of Sports Medicine. 2006;34(5):733-740.
11. Rasmussen S, Christensen M, Mathiesen I, Simonson O. Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthopaedica. 2008;79(2):249-256.
12. Vahdatpour B, Dehghan F, Bakhtiary AH, et al. Effects of extracorporeal shockwave therapy on the treatment of patients with chronic plantar fasciitis. Journal of Research in Medical Sciences. 2012;17(9):834-838.
13. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288(11):1364-1372 (foundational).
14. Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clinical Orthopaedics and Related Research. 2013;471(11):3645-3652.
15. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow. BMJ. 2006;333(7575):939.
16. Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. Journal of Bone and Joint Surgery. 2005;87(6):1297-1304.
17. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial (LEAP). BMJ. 2018;361:k1662 (foundational).
18. Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. American Journal of Sports Medicine. 2009;37(9):1806-1813.
19. Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. Extracorporeal shockwave for chronic patellar tendinopathy. American Journal of Sports Medicine. 2007;35(6):972-978.
20. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine. 2009;43(6):409-416 (foundational tendinopathy framework).
21. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Practice & Research Clinical Rheumatology. 2019;33(1):122-140.
22. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine & Science in Sports. 2009;19(6):790-802.
23. Beyer R, Kongsgaard M, Hougs Kjær B, et al. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. American Journal of Sports Medicine. 2015;43(7):1704-1711.
24. Rathleff MS, Moløgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine & Science in Sports. 2015;25(3):e292-e300 (foundational plantar fascia loading).
25. van der Worp H, van den Akker-Scheek I, van Schie H, Zwerver J. ESWT for tendinopathy: technology and clinical implications. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(6):1451-1458.
26. International Society for Medical Shockwave Treatment (ISMST). Consensus statement on the use of shockwave therapy. Accessed 2026.
27. d'Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. International Journal of Surgery. 2015;24(Pt B):147-153.
28. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. American Journal of Sports Medicine. 2015;43(3):752-761.
29. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. British Journal of Sports Medicine. 2018;52(6):387-407.
30. Schmitz C, Csaszar NB, Milz S, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British Medical Bulletin. 2015;116(1):115-138.
31. Liao CD, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for lower-limb tendinopathy: A meta-analysis of randomized controlled trials. American Journal of Physical Medicine & Rehabilitation. 2018;97(8):605-619.
32. Australian Physiotherapy Association. Position statement on shockwave therapy. 2024.
33. Australian Podiatry Association. Clinical practice guidance on shockwave therapy. Accessed 2026.
34. Lou J, Wang S, Liu S, Xing G. Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar fasciitis: A meta-analysis of randomized controlled trials. American Journal of Physical Medicine & Rehabilitation. 2017;96(8):529-534.
35. Carlisi E, Cecini M, Di Natali G, Manzoni F, Tinelli C, Lisi C. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clinical Rehabilitation. 2019;33(4):670-680.
36. Vincent AJ, Wright A, et al. The musculoskeletal syndrome of menopause. Climacteric. 2024 (referenced for broader Upwell content context).
37. Surace SJ, Deitch J, Johnston RV, Buchbinder R. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database of Systematic Reviews. 2020;3:CD008962 (foundational).
38. Verstraelen FU, In den Kleef NJ, Jansen L, Morrenhof JW. High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. Clinical Orthopaedics and Related Research. 2014;472(9):2816-2825.
39. Notarnicola A, Quagliarella L, Sasanelli N, et al. Extracorporeal shockwave therapy in plantar fasciitis: A long-term follow-up observational study. Acta Bio-Medica. 2018;89(2):209-214.
40. La Trobe Sport and Exercise Medicine Research Centre. Shockwave research portfolio. Accessed 2026.
A note from Team Upwell
This guide is the most comprehensive evidence-based shockwave therapy resource we've produced. It integrates research from 2023–2026 across mechanisms, indications, modalities, and clinical protocols. We've built it to be useful to patients considering shockwave, clinicians referring for shockwave, and researchers interested in the contemporary evidence base.
If you spot something we've got wrong, or if the evidence has updated since publication, please reach out. We update this guide every six months. Our next scheduled review is November 2026.
Choose evidence. Combine with loading. Trust the timeline. Get connected to a team.
With care,
— Team Upwell, Camberwell