If you’ve been dealing with stubborn heel, Achilles, knee, elbow, or shoulder tendon pain, you’ve probably tried the usual advice of rest, stretching, “taking it easy,” maybe even a brace, orthotic, or new shoes. And sometimes… it still doesn’t change.

That’s usually when people start asking about shockwave therapy, also known as Extracorporeal Shockwave Therapy (ESWT).

In this post, I’ll explain what ESWT is (and what it isn’t), who it tends to help, and what to expect if we decide it fits your case here in Hillsboro, OR.

ESWT is a non-invasive treatment that uses acoustic pressure waves to stimulate tissue healing in slow-to-recover tissues. It’s most commonly used for tendon and soft-tissue pain that hasn’t responded fully to progressive rehab.

The key point: ESWT isn’t a magic fix. Think of it as a way to stimulate the healing process when the tissue is acting “stuck.”

If you want the full overview and expectations, see our ESWT page here → Learn more about ESWT in Hillsboro

The treatment employs two main approaches: focused shockwave therapy (FSWT), which targets specific deeper areas with nanosecond pulses, and radial shockwave therapy (RSWT), which treats more superficial conditions with microsecond pulses. Radial shockwave therapy is often referred to as radial pressure wave therapy (RPWT), as it isn’t a true shockwave. During a session, a gel is applied to the skin, and a handheld device delivers acoustic waves that penetrate tissues to varying depths depending on whether radial or focused shockwave therapy is used. RPWT's typical treatment range is from 3-6 centimeters (~1.2” to 2.3”), while FSWT can reach 13-14 centimeters (~5.1” to 5.5”).

The therapy essentially "wakes up" the body's healing mechanisms by creating a controlled inflammatory response. This breaks down scar tissue, reduces chronic inflammation, and stimulates the repair process that may have stalled in chronic conditions.

Shockwave therapy addresses a wide range of musculoskeletal conditions, including:

• Plantar fasciitis

• Achilles tendinopathy

• Tennis elbow (outer elbow pain)

• Golfer's elbow (inner elbow pain)

• Rotator cuff injuries

• Frozen shoulder

• Jumper's knee/Runner’s knee

• Shin splints

• Carpal tunnel syndrome

• Calcific tendonitis

• Trigger points

• And other various tendon, ligament, and muscle injuries

Sessions typically last 5-10 minutes, but may reach up to 20 minutes depending on the area treated and whether FSWT, RSWT, or both are used. Patients may experience discomfort during treatment, particularly when the device passes over irritated tissue, often described as a thumping sensation or a deep ache. Providers generally aim for a maximum discomfort level of 5-7 out of 10 on the pain scale, which can be adjusted based on patient feedback. Some temporary soreness, tenderness, redness, or bruising may occur for up to a few days after treatment, representing the body's inflammatory healing response.

Most patients require 3-6 sessions for optimal results, with sessions scheduled 48 hours to 1 week apart. Some individuals might notice minor improvements after the first treatment, such as reduced average pain levels and improved mobility within 24-48 hours, depending on their tissue’s response. However, completing the full course of treatment, which includes structured physical rehab, is important for maximal benefit, which typically occurs within 8-12 weeks, but can take longer depending on the diagnosis and chronicity.

Most insurance plans do not currently cover shockwave therapy for musculoskeletal conditions, making it primarily an out-of-pocket expense. However, when combined with physical therapy, the physical therapy component may be eligible for insurance reimbursement, whereas the shockwave component remains out-of-pocket.

Coverage may depend on the specific insurance plan, the condition being treated, and whether the provider obtains prior authorization. Patients should verify coverage with their insurance company before beginning treatment. Many clinics accept Health Savings Account ( HSA ) or Flexible Spending Account ( FSA ) funds and may offer payment plans or financing options.

Clinical studies show success rates of 72-80% for various conditions. The therapy offers several advantages: it's non-invasive with no need for anesthesia, has minimal side effects compared to surgery, requires no recovery downtime (patients can resume normal activities immediately), works faster than traditional physical therapy, treats the underlying cause rather than just symptoms, and can help patients avoid more invasive and expensive surgical procedures.

Shockwave therapy is contraindicated for patients with blood-clotting disorders, those taking anticoagulants, individuals with active infections or tumors in the treatment area, pregnant women, people with polyneuropathy from diabetes, and children with open growth plates.

This treatment represents an evidence-based option for patients struggling with chronic pain who haven't responded to conventional therapies, offering a middle ground between conservative treatments and surgery.

If you’ve been dealing with persistent tendon or soft-tissue pain that hasn’t responded to rest, stretching, or traditional rehab, Extracorporeal Shockwave Therapy (ESWT) may be an option.

At Tualatin Valley Physical Therapy, we currently offer both Focused and Radial Shockwave Therapy as a self-pay service in our Regenerative Performance Programs with no insurance games, and no surprise bills. Interested? Click here to apply for a Regenerative Performance Evaluation online.

ESWT is not covered by Medicare or most health insurance.

• What is shockwave therapy (SWT)?

  Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a noninvasive treatment that uses acoustic pressure waves to stimulate healing in injured tendons and soft tissues.

• What is the difference between focused and radial shockwave therapy?

  Focused shockwave therapy delivers energy with greater precision and can reach deeper tissue structures. Radial shockwave therapy disperses energy over a broader, more superficial area. The best option depends on the condition, tissue depth, and treatment goals.

• What conditions are treated with shockwave therapy?

  Shockwave therapy is commonly used for plantar fasciitis, Achilles tendinopathy, patellar tendon pain, tennis elbow, golfer’s elbow, and certain shoulder tendon conditions. It may also be used for other chronic tendon and soft-tissue issues, depending on the evaluation.

• Is ESWT a replacement for physical therapy?

  ESWT is not a replacement for physical therapy. It is most effective when combined with appropriate strengthening, loading, and movement-based rehabilitation.

• Is shockwave therapy covered by insurance?

  Most insurance plans do not cover shockwave therapy for musculoskeletal conditions. At our clinic, ESWT is offered as a self-pay service with transparent pricing. Shockwave therapy is not covered by Medicare