Extracorporeal Shockwave Therapy’s Role in Treating Grumpy Tendons

Extracorporeal Shockwave Therapy, commonly called “Shockwave Therapy” or ESWT, is commonly used to accelerate or improve healing in tendon and other soft-tissue conditions. Have you ever had a tendon injury that reoccurs more than you’d like it to? Can you tolerate the pain and decide to run on it anyway? Does it ever get to the point where you can no longer do the activities you want to do (or at the intensity, you’d like to)? If so, ESWT may just be your new best friend. In this blog, I’ll explain Extracorporeal Shock Wave Therapy’s role in treating grumpy tendons. Specifically I will cover: 

  1. How does ESWT work? 
  2. Why is ESWT effective at treating soft tissues like tendon injuries and plantar fascia?

Read more about ESWT HERE  

How does ESWT work?

ESWT is an interesting technology that was originally developed as a non-surgical way to break up kidney stones. It functions via the application of high-intensity sound waves in a narrow pattern or beam (more on it’s development here). However, over the past 30 years, it has been increasingly applied to tendon conditions and other soft-tissue conditions with good results. 

There are 2 main types of ESWT

  1. Radial shockwave therapy (Broad radial beam)
  2. Focused shockwave therapy (Narrow focused beam)

Most commonly for tendon injuries is a “focused” type of ESWT with a narrow beam (this is what we use here at Runners’ Edge!). Promising research supporting “focused” shockwave therapy from a recent study in the British Journal of Sports Medicine, showed that ESWT is superior to conservative care in several conditions including hamstring tendinopathy, greater trochanteric pain syndrome, and Achilles tendinopathy! 

Why is ESWT so effective at treating soft-tissue conditions?

To answer this question, let me geek out on anatomy and physiology real quick…

A recent study covers this topic in-depth but is easily understood when we talk about a few basic principles.

  1. Tissues that are stressed, will change and adapt to these stressors. This is called Wolff’s Law
  2. ESWT uses sound waves to “stress” tissues on a microscopic level, resulting in an adaptive (healing) response.

What does all this mean? Due to Wolff’s law and tissue adaption,  ESWT essentially jump-starts the body’s natural healing and adaptive processes to help you recover from an injury, quicker! If we take a look at what happens to a tendon, we can see this even more clearly.

What does ESWT do to tendons?

In the simplest explanation, ESWT “stresses” the tendon so that it repairs itself. But, I am a PT, so excuse my complex dive into this subject 😉 

  1. Sounds waves stress the tendon using a process called mechanotransduction
  2. The tendon cells, called “tenocytes” respond to the stress by producing more growth factors, turning over collagen, and helping create a more robust tendon.
  3. Other adaptations such as an increase in the number of blood vessels in and around the tendon occurs which may assist with healing.

Additional benefits of ESWT

Many of these changes are not exclusive to tendons, other tissues like the plantar fascia, muscle tissue, and even bone positively respond to ESWT. Tissues like the plantar fascia will generally demonstrate similar responses to ESWT with multiple benefits including:

  • Enhanced protein synthesis
  • Tenocyte proliferation and activation
  • Restoration of tissue mechanical load-to-failure
  • Increasing collagen turnover
  • Restoration of more normal tendon composition
  • Analgesic effect (pain reduction) in the short-term


Extracorporeal shockwave therapy can accelerate and improve your recovery from tendon pain and plantar fasciopathy. 

If you are an athlete that wishes to achieve faster recovery or someone who has tried other options and are still struggling, ESWT might be right for you. 

Give us a call to find out if ESWT can help or schedule a FREE discovery session with me below! 

WhittierLKBurgon 27 scaled


Written By: 
Trevor Staples, PT, DPT, CSCS


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