- Chronic tendon pain is usually stalled healing rather than ongoing damage, which is why anti-inflammatories so often fail to resolve it.
- Shockwave provokes a controlled repair response — stimulating new blood vessel growth, breaking down calcification and reducing pain signalling.
- The evidence for plantar fasciitis and calcific tendinopathy is genuinely strong, with multiple randomised trials and inclusion in clinical guidelines.
- A discovery session first, then a course of ten. We check the tissue responds before proposing the course, and the effect builds over the weeks following treatment rather than during it.
- No drugs, no needles, no downtime — you walk out and carry on with your day.
How shockwave actually works
The name sounds more dramatic than the experience. These are acoustic pressure waves, not electrical shocks.
A handheld applicator delivers high-energy acoustic waves through the skin into the target tissue. What happens there is several things at once.
Neovascularisation. The mechanical stress triggers release of growth factors that stimulate new blood vessel formation. In tendon and fascia — tissue with famously poor blood supply — this addresses the actual limitation on healing.
Breakdown of calcification. In calcific tendinopathy, the deposits that form in chronically inflamed tendon are physically disrupted, which is why the evidence in calcific shoulder tendinopathy is among the strongest in the field.
Reduced pain signalling. Shockwave appears to reduce substance P, a neurotransmitter involved in pain transmission, and to affect the small nerve endings that have proliferated into chronically painful tissue.
A restarted inflammatory cascade. This is the counterintuitive part. Chronic tendinopathy is frequently characterised by an absence of active healing rather than an excess of inflammation. Provoking a fresh, acute, self-limiting inflammatory response is what restarts the repair sequence.
Why a stalled tendon needs provoking
This is why anti-inflammatories so often fail here. The problem is usually too little active healing rather than too much inflammation.
What the evidence actually shows
This is one of the better-evidenced therapies we offer, and the strength varies meaningfully by indication.
Plantar fasciitis has the most consistent support. Multiple randomised controlled trials and systematic reviews show meaningful improvement in pain and function, and shockwave appears in clinical practice guidelines for the condition.
Calcific shoulder tendinopathy is arguably where the evidence is strongest of all — high-energy shockwave produces both symptom improvement and radiographic resolution of calcium deposits in a substantial proportion of patients.
Tennis elbow, Achilles tendinopathy and patellar tendinopathy all have positive trial evidence, though with more heterogeneity between studies — largely because energy levels, session counts and protocols vary considerably.
Erectile dysfunction of vascular origin has a developing and reasonably positive evidence base, working through the same neovascularisation mechanism applied to penile vasculature.
What varies most between clinics is energy level and protocol. Under-dosed treatment is one of the more common reasons a patient reports that shockwave did not work for them.
What a session actually involves
Straightforward, brief, and uncomfortable in a specific and tolerable way.
- We locate the target precisely. Often by palpation, because the tender point tells us where the problem is. Gel is applied for acoustic coupling.
- The applicator is placed and energy delivered. Five to fifteen minutes depending on the area. It is uncomfortable rather than painful — a deep percussive sensation — and the energy is titrated to what you can tolerate.
- You get up and walk out. No downtime. We ask you to avoid anti-inflammatories for a few days afterwards, because they would suppress the exact healing response we just provoked.
- You return weekly. A course of ten is standard here, and the benefit continues building for several weeks after the final one.
The ten conditions we treat with shockwave
Ranked by strength of evidence and how reliably they respond.
Plantar Fasciitis
The strongest indication and the most common reason patients come. Multiple randomised trials, inclusion in clinical guidelines, and a condition that is notoriously resistant to almost everything else.
What the evidence showsExtracorporeal shockwave therapy has randomised controlled trial evidence for plantar fasciitis, with meta-analyses supporting pain reduction and functional improvement in chronic cases.Calcific Shoulder Tendinopathy
Arguably where shockwave performs best of all. High-energy treatment produces both symptom relief and actual radiographic resolution of the calcium deposit in a substantial share of patients.
What the evidence showsShockwaves induce mechanotransduction, converting mechanical stimulus into biochemical signalling that upregulates growth factors including VEGF and stimulates angiogenesis.Tennis and Golfer's Elbow
Chronic lateral and medial epicondylitis are classic stalled-healing problems. Positive trial evidence, and a condition where patients have usually tried rest, braces and anti-inflammatories without resolution.
What the evidence showsChronic tendinopathy is characterised by failed healing rather than active inflammation — a degenerative rather than inflammatory process, which is why anti-inflammatory approaches disappoint.Achilles Tendinopathy
Both mid-portion and insertional respond, with mid-portion generally doing better. Combining shockwave with eccentric loading exercise outperforms either alone, and that combination is what we use.
What the evidence showsCalcific tendinopathy of the shoulder responds to shockwave with documented reduction in calcific deposits on imaging alongside symptom improvement in randomised trials.Patellar Tendinopathy
Jumper's knee, common in athletes and frustrating to treat conservatively. Responds well, and the timing within a training season matters for how the protocol is structured.
What the evidence showsShockwave has trial evidence for lateral epicondylitis, though results have been more variable than for plantar fasciitis and calcific shoulder conditions.Erectile Dysfunction of Vascular Origin
Low-intensity shockwave applied to penile vasculature to stimulate new blood vessel formation. A developing and reasonably positive evidence base, and a genuinely different proposition from medication that works only when taken.
What the evidence showsTreatment stimulates recruitment of mesenchymal cells to the treated area, contributing to the repair response documented histologically in animal models.Hip and Gluteal Tendinopathy
Greater trochanteric pain syndrome is extremely common, frequently misdiagnosed as bursitis, and responds to shockwave when the underlying tendinopathy is properly identified.
What the evidence showsShockwave for erectile dysfunction of vascular origin has randomised trial support, with the proposed mechanism being angiogenesis and improved penile blood flow.Shin Splints and Stress-Related Bone Pain
Medial tibial stress syndrome responds, and shockwave has been used to accelerate healing in stress fractures and delayed unions where the bone healing process has stalled.
What the evidence showsBone healing applications including delayed union and non-union have documented response to shockwave, with the mechanism involving osteoblast stimulation and local vascularisation.Chronic Muscle Trigger Points
Less evidenced than the tendon indications, but useful clinically for persistent myofascial pain that has not responded to manual therapy.
What the evidence showsThe therapy requires no anaesthesia, incision or downtime, and adverse events are limited to transient local discomfort and occasional bruising.Cellulite and Skin Tightening
A cosmetic application with a genuine mechanism — collagen remodelling and improved local circulation. Real but modest, and we would rather set that expectation than oversell it.
What the evidence showsTreatment courses typically run three to six sessions at weekly intervals, with maximal benefit generally assessed at twelve weeks because tissue remodelling continues after the final session.What patients commonly experience under our care
When patients receive the proper guidance, here is what they commonly experience under our care.
- The first 48 hours — sometimes more sore. A brief increase in soreness after the first session or two is common and is part of the mechanism. We ask patients not to reach for anti-inflammatories, because those would suppress the response we just created.
- Sessions 2–3 — the first real change. Most patients notice a meaningful reduction in pain around the second or third session. Morning pain with plantar fasciitis is usually the first thing to shift.
- Sessions 4–6 — function returns. This is where walking distance, training capacity and daily activity improve. The tissue is genuinely remodelling rather than the pain simply being masked.
- Weeks 6–12 after the course — it keeps improving. This is the part patients find surprising. The benefit continues accumulating for weeks after the final session, because what was started is a biological process rather than a temporary effect.
If you have a tendon or a heel that has hurt for months and rest, braces and anti-inflammatories have not resolved it, that problem is almost certainly stalled rather than permanent. Schedule a consultation and let my team assess it properly and tell you honestly whether shockwave will help. We will not stop until the root cause of every one of your health issues has been found and addressed.
A proper assessment of what is actually happening in the tissue, and an honest answer about whether shockwave is the right tool.
Common questions
Does shockwave therapy hurt?
It is uncomfortable rather than painful — a deep percussive sensation, and the energy is titrated to what you can tolerate. Most patients describe it as very manageable, and it lasts five to fifteen minutes. Some soreness for a day or two afterwards is common and is part of the mechanism.
How many shockwave sessions do I need?
We start with a single discovery session to see whether the tissue responds. If it does, we propose a course of ten, typically one a week. The important thing to understand is that the benefit continues building for weeks after the final session, because shockwave initiates a biological healing process rather than producing a temporary effect.
What does shockwave therapy treat?
Chronic tendon and fascia problems primarily — plantar fasciitis, calcific shoulder tendinopathy, tennis and golfer's elbow, Achilles and patellar tendinopathy, and gluteal tendinopathy. Also erectile dysfunction of vascular origin, and stalled bone healing in stress fractures and delayed unions.
Why should I avoid anti-inflammatories after shockwave?
Because the mechanism is a deliberately provoked acute healing response. Anti-inflammatory medication would suppress the exact process the treatment was designed to create. We generally ask patients to avoid them for a few days after each session.
Where can I get shockwave therapy near Nashville?
At our clinic in Franklin, Tennessee, about twenty minutes south of downtown Nashville and minutes from Brentwood and Cool Springs. We assess the tissue properly first, and we combine shockwave with red light or loading exercise where the combination outperforms either alone.
- Sun J, Gao F, Wang Y, et al. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Medicine. 2017;96(15):e6621. PMC5403085
- Bannuru RR, Flavin NE, Vaysbrot E, et al. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder. Annals of Internal Medicine. 2014;160(8):542–549.
- Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research. 2012;7:11. PMC3342893
- Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis. Journal of Sexual Medicine. 2017;14(1):27–35.
This article is educational and reflects the published literature as of August 2026. It is not a diagnosis or a treatment recommendation for any individual, and any decision about your care belongs in a conversation with a licensed practitioner who has seen your history and your labs.