| How We Treat
Radial Shockwave Therapy
A way of restarting a repair your body began months ago and quietly gave up on.
What the radial device does to tissue, which conditions it genuinely helps and which it doesn’t, exactly where NICE stands — and why you shouldn’t judge it at the end of the course.
Overview
What Radial Shockwave Is
Some tendons stop trying.
Months into a problem, the tissue is no longer inflamed and no longer healing. It has settled into a stalemate — disorganised, poorly supplied with blood, quietly failing to finish a repair it started long ago.
Radial shockwave therapy is a way of restarting that argument. It doesn’t fix the tendon. It re-opens the biological conversation so that loading can.
The idea came out of kidney stone treatment. At energies far below those needed to break up a stone, acoustic pressure waves turned out to change how soft tissue behaves. What followed was three decades of research — and an evidence base that is genuinely strong for some conditions and genuinely weak for others.
This page is about the radial device, which is the one we use, and it tells you which conditions it genuinely helps — because on this treatment more than any other, clinics tend to blur that line.
The Machine
Two Different Machines Share One Name
This is worth two minutes of your time, because the distinction is almost never explained — and it decides which evidence actually applies to you.
Radial pressure wave — what we use
Compressed air fires a small projectile into an applicator held against your skin. Energy is greatest at the surface and spreads outward from there. The right tool for structures you can feel through the skin.
Focused shockwave — what we don’t
A true shock wave converged onto a point several centimetres inside the body. High energy, deep target, physician-delivered. A different machine for different problems.
“Isn’t the radial one just a fancy massager?”
No. High-speed imaging at 300,000 frames per second shows radial devices generate a negative pressure phase and produce cavitation bubbles within 10 microseconds — bubbles whose collapse was energetic enough to perforate X-ray film. A vibrating massage device produced none at all.1
Everything below this point is about the radial device. Where a claim rests on focused-shockwave research instead, we say so.
The Mechanism
What It Does to Tissue
The principle is simple, even if the word isn’t: your cells can feel mechanical force, and they answer it by changing what they build. Scientists call it mechanotransduction. A radial pressure wave is a way of shouting it at a tendon that has stopped listening.
Tap through what that actually sets off.
An honest caveat
Almost all of the above comes from cell cultures and animal studies. It is reproducible and biologically coherent — but a convincing mechanism is not proof of clinical benefit, and the human picture below is considerably more mixed than the laboratory story implies.
One recent review of the field concluded plainly that most dosing parameters “remain empirically derived rather than systematically validated.” Anyone telling you shockwave regenerates human tendon is going beyond the evidence.
Much of the laboratory work above also used focused devices. The biology is likely shared, but you should know that the mechanism evidence and the radial clinical evidence are not always the same body of research.
The Evidence
Which Conditions It Genuinely Helps
Sorted honestly, strongest first.
Every row states which device the underlying trials used. Rows marked radial are directly about the treatment you would receive here; rows marked pooled mix radial and focused studies, so read those more cautiously.
| Condition | Evidence base | Evidence | What it actually says |
|---|---|---|---|
| Plantar heel pain | Radial | Strong | 245 people, 3 radial sessions vs placebo: 61% success vs 42% at 12 weeks, and more convincing again at 12 months. The best-supported use of the device we own, and consistent with best-practice guidance for plantar heel pain.6,7 |
| Gluteal tendon / hip pain | Radial | Moderate | 68% success at 4 months and 74% at 15 in the radial trial — but home exercise alone reached 80%.8 |
| Shin splints | Radial | Low–moderate | 76% vs 37% success at 4 months. Radial, but a single non-blinded cohort study rather than an RCT. |
| Achilles tendinopathy | Pooled | Weak | Downgraded on review. Pooled analysis found no clinically meaningful benefit over placebo for either midportion or insertional problems.12 |
| Patellar tendinopathy | Pooled | Weak | Safe, but no demonstrated superiority. The trials disagree with each other almost completely. |
| Tennis elbow | Pooled | Weakest | Cochrane found little or no benefit. Loading is first-line. |
| Your tendon, specifically | Individual | Case by case | Every row above is an average. A treatment that shows no benefit across a group can still help individuals within it — and where a tendon has been stubbornly persistent, there is coherent biological reason to think it might. See below. |
Where the table stops and you begin
Averages are the right way to decide what to offer first. They are a poor way to decide what to do when the first thing hasn’t worked.
If a tendon has been painful for a long time and a genuinely well-executed loading programme has stalled, the situation the biology describes is exactly the one radial shockwave is meant for: a stalled repair, a poor blood supply, a tissue that has stopped responding to the signal it’s being given. Trying it there is reasoned, not desperate — even on a page that has just told you the group-level evidence for that tendon is weak.
What stops that being wishful thinking is measuring it. So if we do try it, we agree in advance:
- a baseline score before the first session
- a defined trial — usually three sessions, then judged at twelve weeks, not at the end of the course
- a stop rule: if the number hasn’t moved, we stop and say so, rather than selling you another block
“It might work for you” is only an honest thing to say if you’re willing to find out.
Two things you may read about that we do not offer
Calcific shoulder tendinopathy and fractures that fail to unite. Both have a real evidence base — high-energy focused treatment for calcific shoulder,13 and a 73% union rate pooled across 1,200 long-bone non-unions.14 But that is a focused shockwave evidence base, generated with physician-delivered equipment. Neither has been established with the radial device, and we would be misrepresenting the research to imply otherwise.
If your problem is one of those, the honest answer is a referral, not a course of treatment here.
The most instructive trial in the field
229 people with gluteal tendon pain were randomised to home exercise, a steroid injection, or shockwave.
At one month the injection was streets ahead — 75% success versus 13% for shockwave.
At four months shockwave had overtaken it, 68% to 51%.
At fifteen months the injection group had fallen to 48%, while shockwave sat at 74% and home exercise at 80%.8
The fastest treatment and the best treatment were not the same treatment. Worth remembering when something offers immediate relief.
What Next
What to Expect, Week by Week
This is the part people get wrong. Drag the slider.
This treatment works on a clock you can’t feel, in a tissue you can’t see. Judge it at three months — not at the end of the course.
A course, practically
Three to five sessions, one to two weeks apart
Most of the positive trials used three, which also matches international society guidance on dosing.2 Each session takes five to ten minutes of actual treatment.
The intensity is set by you
Dose is pain-adapted — turned up to what you can tolerate rather than fixed by a protocol. Most people describe it as uncomfortable but manageable, settling within minutes of stopping. Adherence in trials runs at 92–94%.
No local anaesthetic
Not stoicism — evidence. Numbing the area appears to block the effect on the very nerve endings the treatment works through. One of the better explanations for why some large trials of shockwave came out negative is precisely that they used local anaesthesia, while the positive ones didn’t.10 If we numb it, we may waste it.
It runs alongside loading, never instead of it
In the Achilles evidence, shockwave added to a loading programme beat the programme alone at four months — 82% versus 56% — but the difference had washed out by twelve.11 Shockwave speeds the journey. Loading decides the destination.
Before You Consent
Where NICE Stands
You should know this before you agree to it, and we would rather you read it here than find it later.
NICE has reviewed shockwave for four musculoskeletal conditions and reached essentially the same verdict each time: no major safety concerns, but evidence on efficacy that is “inconsistent” or “limited in quality and quantity.” Its guidance therefore says the procedure should be used only with special arrangements for clinical governance, consent and audit — for plantar fasciitis, tennis elbow, gluteal tendon pain and Achilles tendinopathy. For calcific shoulder tendinopathy it goes further, saying efficacy is inadequate and the procedure should be used only in research.9
What that means we owe you
Those “special arrangements” require two things of us: that you get clear written information about the uncertainty, and that we audit our outcomes.
So we do both. You’ll get a baseline outcome measure before your first session, and the same measure at the end of the course, at three months and at twelve. If it isn’t working for you, we’ll both know — with a number, rather than a guess.
When to Seek Help
⚠ We won’t treat, or will stop, if
- Absolute: a tumour in the treatment area, pregnancy with the uterus in the field, or a pacemaker in the field
- Infected or broken skin, active lymphoedema, or an acute fracture at the site
- Bleeding disorders or anticoagulation — with caution and case-by-case judgement
- Recent corticosteroid injection into the same tendon. The documented tendon ruptures in the literature occurred after repeated cortisone injections
- Serious pathology hasn’t been excluded — we investigate first
Seek advice if you develop sudden severe pain, an audible pop, or loss of function in the treated tendon. Tendon rupture after shockwave is rare but real — two Achilles ruptures were documented in the recent focused-shockwave meta-analysis.
Common Questions
Frequently Asked Questions
Does it hurt?
Deep, percussive tapping that builds to something most people describe as uncomfortable but manageable, and which settles within minutes of stopping. Adherence in trials was 92–94%, which tells you most people find it tolerable enough to finish the course.
Afterwards you may get a temporary increase in pain, some skin reddening, bruising, mild swelling, or a patch of numbness that resolves over a few days.
How soon will I know if it’s working?
Not at the end of the course, which is when most people judge it. Expect little in the first two to four weeks. Meaningful change typically arrives between six and twelve weeks and continues to build for four to six months — sometimes beyond.
The plantar fascia trial was more convincing at twelve months than at twelve weeks.7 That trajectory makes biological sense: the new blood vessel response in animal models peaks weeks after the treatment, not during it.
Can I have it instead of doing exercises?
No — and any clinic offering that is selling you something. In every trial where shockwave performed well, it was tested alongside a loading programme or against one.
In the gluteal tendon trial, home exercise alone reached 80% success at fifteen months. Shockwave got people there faster; it didn’t get them further.
Why won’t you numb it first?
Because local anaesthetic appears to reduce the effect. The treatment works partly through stimulating the sensory nerve endings in the tissue — anaesthetise them, and you may be paying for a treatment that can’t do its job.10
The dose is adjusted to your tolerance instead.
Why is my Achilles / tennis elbow listed as weak evidence — are you talking yourself out of a treatment?
We’d rather you heard it from us. A 2026 meta-analysis found no clinically meaningful benefit over sham for Achilles tendinopathy, and Cochrane found little or no benefit for tennis elbow.
That doesn’t mean it’s never worth trying after a well-executed loading programme has stalled — only that you should go in knowing the odds, and that loading comes first.
Is it covered by insurance?
It varies by insurer and by condition — and because NICE classifies it as requiring special arrangements, some policies treat it differently from standard physiotherapy. We’ll tell you what a course would cost before you commit, and check with your insurer if you’d like us to.
The honest summary
For plantar heel pain that hasn’t responded to good conservative care, shockwave has real, well-evidenced value. For gluteal tendon pain and shin splints it’s a reasonable, evidence-informed option.
For Achilles, patellar and elbow tendinopathy, the current evidence doesn’t support it as a routine treatment, and we’d be doing you a disservice to sell it as one.
It is never the whole plan.
Where We Work
Radial shockwave therapy in North Norfolk
Tidal Physiotherapy is based in Wells-next-the-Sea, and radial shockwave therapy is available both at the clinic and on home visits across North Norfolk — including Fakenham, Holt, Burnham Market, Walsingham and Blakeney.
Appointments are with Brandon Dobson MSc, MCSP, HCPC registered. You do not need a GP referral, and we will tell you honestly at your assessment whether radial shockwave therapy is the right tool for your problem — or whether something else on this list is.
Not Sure If This Is Right for You?
Nothing on this page is a plan until it’s pointed at your goal. An assessment is where we work out which of these tools — if any — belongs in yours. If you have a scan report you don’t understand, bring it with you.
Book Your AssessmentOther Treatment Modalities:
References
- Császár NBM, Angstman NB, Milz S, et al. Radial shock wave devices generate cavitation. PLOS ONE, 2015;10(10):e0140541.
- International Society for Medical Shockwave Treatment. ISMST Guidelines for ESWT, January 2024; and ISMST Consensus Statement on Indications and Contraindications.
- Zhang L, et al. Biological response of extracorporeal shock wave therapy to tendinopathy in vivo: a review. Frontiers in Veterinary Science, 2022;9:851894.
- Hausdorf J, Lemmens MAM, Kaplan S, et al. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Research, 2008; and Ohtori S, et al. Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neuroscience Letters, 2001.
- Wang C-J. Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research, 2012;7:11.
- Morrissey D, Cotchett M, Said J’Bari A, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine, 2021;55(19):1106–1118.
- Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis. American Journal of Sports Medicine, 2008;36(11):2100–2109.
- Rompe JD, Segal NA, Cacchio A, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine, 2009;37(10):1981–1990.
- National Institute for Health and Care Excellence. Interventional procedures guidance IPG311 (plantar fasciitis), IPG313 (tennis elbow), IPG376 (greater trochanteric pain syndrome), IPG571 (Achilles tendinopathy) and IPG742 (calcific tendinopathy of the shoulder).
- Rompe JD, Meurer A, Nafe B, et al. Repetitive low-energy shock wave application without local anesthesia is more efficient than with local anesthesia in chronic plantar fasciitis. Journal of Orthopaedic Research, 2005;23(4):931–941; and Rompe JD, Furia J, Maffulli N. Journal of Orthopaedic Surgery and Research, 2013;8:31.
- Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion chronic Achilles tendinopathy. American Journal of Sports Medicine, 2009;37(3):463–470.
- Korakakis V, Kotsifaki R, Sotiralis Y, Malliaras P. Shockwave therapy for midportion and insertional Achilles tendinopathy: a systematic review with meta-analysis. JOSPT, 2026.
- Bannuru RR, Flavin NE, Vaysbrot E, et al. 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.
- Martinelli N, et al. Extracorporeal shock wave therapy for the treatment of long bone non-union: a systematic review and meta-analysis. Journal of Clinical Medicine, 2022;11(7):1977.