Shockwave therapy for
chronic tendon and muscle pain
Radial shockwave sends quick pressure pulses from an air-driven applicator into a sore area. We use it for pain that has lasted months, always alongside exercise-based rehab, never on its own. Available at our Petaluma office.
Understanding the Treatment
What is shockwave therapy?
Shockwave therapy (extracorporeal shockwave therapy, or ESWT) sends short pressure pulses into a sore area from outside the body. Ours is radial: compressed air fires a small projectile against an applicator head on your skin, and each strike sends a pulse into the tissue beneath. The pulse spreads out from the head, so it's strongest near the skin and weaker deeper down; focused devices, a different kind, are built to aim at a point deeper in.
How shockwave helps isn't fully worked out. In cell and animal studies, mostly with focused devices, cells responded to the pulses by changing how they signal, divide and make collagen, and in rabbits, treated tendons grew new small blood vessels over the following weeks. In people, one study found that a single radial session raised inflammation signals around the tendon for at least four hours.
What the trials show depends on the problem. Support is strongest for calcium deposits in a shoulder tendon and for long-lasting heel pain. For chronic low back pain and for neck and upper-back trigger points, small trials found modest relief, mostly in the short term. For tennis elbow and for shoulder pain without calcium deposits, the larger trials found it no better than a sham. No trial has tested shockwave after a car crash or for whiplash.
We use shockwave for chronic cases, pain that has lasted months, and only rarely in the weeks after a crash. With Ryan Lloyd, DC, QME, it's always one part of an exercise-based rehab plan, never a treatment on its own. We track your progress with your pain level and a standard questionnaire, the Neck Disability Index or the Bournemouth Questionnaire.
Radial Pressure Waves
An air-driven applicator sends quick pulses into the sore area. They spread out from the head, strongest near the skin and weaker with depth.
For Long-Lasting Pain
We use shockwave for chronic cases, rarely after a recent crash. Trials enrolled people whose pain had lasted three months or more, and none studied people after car crashes.
Part of Your Rehab
Always paired with exercise-based rehab, never used on its own. Prescribed from your exam, not as a general wellness treatment.
Progress You Can Track
Your pain level and a standard questionnaire, the Neck Disability Index or the Bournemouth Questionnaire, show how you're doing across the course.
Inside one pulse
From air to tissue
One pulse is over in millionths of a second. Scroll to slow it down.
Air
It starts with compressed air
Our shockwave device is air-driven, the kind called radial shockwave. Inside the handpiece, a burst of compressed air fires a small projectile down a short tube.
Strike
The projectile hits the applicator
The projectile strikes the metal applicator head, which rests on your skin over the sore area. The impact sends a pressure wave through the metal and on into the tissue beneath.
Depth
Into the skin, weaker with depth
The pulse spreads out from the head rather than focusing on one spot, so it's strongest near the skin and weaker the deeper it goes. Measured in water on other radial devices, peak pressure 20 millimeters from the head was less than half its value at 1 millimeter. In animal tissue tested in a lab, the pressure was about half the water reading at the same depth.
Pulse
One pulse, millionths of a second
Measured in water just in front of the head, each pulse is a sharp push and then a weaker pull, over in about 15 to 25 millionths of a second. It rises too slowly to count as a true shock wave in physics, so researchers call it a radial pressure wave; "radial shockwave" is the treatment's everyday name.
Visit
Pulse after pulse, 2,500 a visit
A visit here is 2,500 pulses, one after another. We start gently and raise the intensity step by step to what you can tolerate. Most trials gave about 2,000 pulses a session, and 2,500 is well within the range they used.
Tissue
What researchers have seen in tissue
How shockwave helps isn't fully worked out. In one study of people's tendons, a single radial session raised inflammation signals around the tendon for at least four hours. In rabbits, treated tendons grew new small blood vessels over the following weeks; whether that happens in people hasn't been shown.
Clinical Application
How we use shockwave
Where shockwave fits in your care: what one trial saw over a course of visits, why it's always paired with exercise, what's known about scar tissue, and when it isn't used.
The Course of Visits
In one small trial of 40 adults with chronic low back pain, everyone did stabilizing exercises, and half also had ten radial shockwave sessions, twice a week, while the other half had a sham (pretend) treatment. Right after the course, the sham group had less pain; by three months, the shockwave group had less pain and lower disability scores. Across 12 small trials of chronic low back pain, shockwave eased pain by about 1 point out of 10 more than the comparison treatments at 4 and 12 weeks.
Alongside Exercise
Shockwave is always one part of an exercise-based rehab plan here, never a treatment on its own. Most trials added it to exercise as well: in some, the add-on helped, and in others it made no difference. See our rehabilitation exercises.
Scar Tissue: The Evidence
Whether shockwave changes scar tissue or adhesions in muscles, tendons or ligaments hasn't been studied in people. The only scar trials in people are of skin scars after burns, with mixed results. In animal studies, too much energy disorganized or damaged healthy tendon.
When It Isn't Used
Guidelines advise against shockwave over the lungs, during pregnancy, over a tumor or an infection, for people with clotting problems or on blood thinners, or soon after a steroid injection at the same spot, and caution with children and teens, whose tissue is still growing. Trials didn't report serious harm in back, neck or shoulder patients.
Conditions
Conditions we treat with shockwave
We use shockwave only for long-lasting cases. Here's what trials found for each, including where the evidence is weak. None of these trials studied people after car crashes.
Shoulder Pain
Calcium deposits in a rotator cuff tendon have the most support: in one radial trial of four weekly sessions, deposits disappeared completely in 86.6% of treated patients and in none of the comparison group. For rotator cuff pain without calcium, trials found little or no benefit over a sham. Frozen shoulder: one trial was encouraging, but the evidence is very weak.
Back Pain
Across 12 small trials of chronic low back pain, shockwave eased pain by about 1 point out of 10 more than comparison treatments at 4 and 12 weeks. Results varied: in one trial the extra relief appeared one to three months after the course; in another, the edge was gone a month after it.
Neck Pain
For long-lasting neck and upper-back muscle pain with trigger points, trials found pain relief about equal to dry needling or lidocaine injections, mostly in the short term. One careful trial of six weekly radial sessions, kept at one low setting, found no benefit over a sham.
Your Visit
What to expect during treatment
From your exam to your last visit: what a session feels like, what can follow, and how we track progress.
Assessment
Ryan Lloyd, DC, QME, examines you and reviews your history. Shockwave is for pain that has lasted months, not a first step after a crash.
Treatment Session
The applicator rests on your skin over the sore area and delivers 2,500 quick pulses. You'll feel pressure and some discomfort; we start low and raise the intensity step by step to what you can tolerate. A session takes about 20 minutes. We don't numb the area first: in heel pain trials, numbing could make shockwave work less well.
Afterwards
Some people are sore, red or slightly bruised for a short time afterward; in trials these effects were usually minor and short-lived. Soreness isn't a sign that it's working; no study has linked the two.
Treatment Course
Usually 6 visits, sometimes 12 at twice a week, alongside your rehabilitation exercises. That's our schedule, not a research finding: trials most often used three or four sessions about a week apart.
Tracking Progress
We recheck your pain level and your Neck Disability Index or Bournemouth Questionnaire score across the course. At 3100 Lakeville Highway, off Highway 101 in Petaluma.
For Your Case
Why this matters for your case
If you have a claim, clear records help your doctors and your attorney. Ours say what was done and how your pain and daily function changed on standard questionnaires.
- ✓ Pain and daily function tracked with the Neck Disability Index or the Bournemouth Questionnaire
- ✓ Shockwave used only for long-lasting cases, and always alongside exercise-based rehab
- ✓ Reports from our office explain the clinical reasons for each treatment, written by Ryan Lloyd, DC, QME
- ✓ Serving the Highway 101 corridor from Novato to Rohnert Park, with same-week appointments
Start your recovery
Same-week appointments. Lien-based care. Serving Petaluma, Rohnert Park, Novato, and Sonoma County.
3100 Lakeville Hwy, Ste D, Petaluma, CA 94954