Whether you are a physically active or sedentary adult, pains in your shoulder, elbow, and ankle are widespread. Most people will experience these issues at least once in their lives.

Tennis Elbow

For many, shoulder or ankle pain or elbow pain may occur due to repetitive motion of overuse, for example, tennis elbow or golfer’s elbow. However, now studies show that these conditions arise not only due to overuse or stress but also due to a degenerative process.

It means that people living with such pain often have suboptimal healing. That is why some may continue to experience pain even after months of treatment with oral anti-inflammatory drugs, injections, and physiotherapy.

Anti-inflammatory drugs often fail to provide relief from aching shoulder, elbow, wrist joint, and ankle, as these medications may reduce inflammation but are unable to reverse the degenerative processes.

Such degenerative processes are common in both sedentary adults and physically active adults. This constant pain in various joints makes day-to-day activities and sports training highly challenging for them. Often, they are dejected as it appears that nothing might be working for such pain.

Extracorporeal Shockwave Therapy (ESWT) may be able to help with such chronic issues. ESWT is a very safe way of promoting local tissue regeneration. In many cases, it can considerably promote local healing and may even result in complete relief of the pain.

What is impressive is that ESWT is a non-invasive treatment. It uses high-energy shockwaves to promote regenerative processes in the deeper tissues, something not possible through methods like massage therapy. Also, unlike a regular ultrasound, it has a much higher peak pressure.

Studies suggest that it works in many ways – for example, it promotes the formation of local blood vessels, increases blood flow, boosts local protein production, promotes differentiation of various cells, amplifies growth factors, stimulates collagen production, and more1,2.

Indications for ESWT

ESWT is suitable for managing a range of health conditions, though it is more commonly used to treat issues related to the musculoskeletal system. It is particularly useful for managing chronic and difficult-to-treat conditions like tendinopathies, as many of these issues are not merely a result of stress and trauma but persist due to local degenerative changes, and other treatments fail to stimulate local regenerative processes.


  • Shoulder issues like rotator cuff and tendinopathies: Shoulder pains are common and affect about twenty-five percent of adults. They are also among the most difficult-to-treat aches, as multiple factors are involved in shoulder pain. Quite often, doctors struggle to understand the cause of shoulder pain. There are many ways to manage shoulder pain, from pills to physiotherapy. However, ESWT is quite good for chronic issues like tendinopathies, frozen shoulder, and rotator cuff problems, and a few ESWT sessions may even provide complete pain relief3.


  • Elbow conditions, including tennis/golfers’ elbow: These conditions are more likely to occur due to repetitive activities, and thus they occur not only in sports people but also in other professions like carpenters, painters, and so on. In many cases, such people cannot reduce their activity level. However, ESWT may do wonders in such cases. It may even help completely overcome age-old elbow pain. Studies show that ESWT can reduce pain and increase grip strength in those with such issues4.


  • Knee conditions, including pes anserine tendinopathies and patella tendinopathies: The knee is a weight-bearing joint prone to injuries and diseases like osteoarthritis. Knee joint ligaments and tendons are more likely to be injured due to contact injuries like those in sports. Any kind of knee pain is highly debilitating. Studies show that ESWT may promote the healing of various tendinopathies affecting the knee joint, including patella tendinopathies5.


  • Ankle tendinopathies: Ankle tendinopathies are relatively common and occur due to local weaknesses, sports injuries, walking on uneven surfaces, and more. These tendons are pretty robust. However, once severely injured, they are slow to heal, as avoiding stress or immobilizing the ankle is challenging. Studies suggest that ESWT can promote the healing of various tendons and help with Achilles tendinopathies6.


  • Plantar fasciitis: it is a chronic condition causing heel pain. Those living with the condition continue to suffer due to pain for months and even years. Painkillers or other conservative treatments only help moderately in the condition. However, studies show that ESWT can be pretty good for managing plantar fasciitis7.
man gym

ESWT has provided hope for those living with chronic pain. It is especially good for conditions that occur due to a slowdown in regenerative processes. It may even help when prolonged treatment with anti-inflammatory drugs or physiotherapy using other methods like massage therapy fails to help.


Get in touch with your Doctors at Hisential today to find out how ESWT can help you!



  1. Chen YJ, Wang CJ, Yang KD, et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. J Orthop Res. 2004;22(4):854-861. doi:10.1016/j.orthres.2003.10.013
  2. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs. J Foot Ankle Surg. 2002;41(1):16-22. doi:10.1016/s1067-2516(02)80005-9
  3. Murphy RJ, Carr AJ. Shoulder pain. BMJ Clin Evid. 2010;2010:1107.
  4. Yao G, Chen J, Duan Y, Chen X. Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:2064781. doi:10.1155/2020/2064781
  5. Leeuwen MT van, Zwerver J, Akker-Scheek I van den. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature. British Journal of Sports Medicine. 2009;43(3):163-168. doi:10.1136/bjsm.2008.050740
  6. Al-Abbad H, Simon JV. The Effectiveness of Extracorporeal Shock Wave Therapy on Chronic Achilles Tendinopathy: A Systematic Review. Foot Ankle Int. 2013;34(1):33-41. doi:10.1177/1071100712464354
  7. Hossain M, Makwana N. “Not Plantar Fasciitis”: the differential diagnosis and management of heel pain syndrome. Orthopaedics and Trauma. 2011;25(3):198-206. doi:10.1016/j.mporth.2011.02.003

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