Jump to content

Extracorporeal Shockwave Therapy

Original Editor - Ayushi Tomer Top Contributors - Angeliki Chorti, Cindy John-Chu, Sue Safadi, Candace Goh, Amanda Ager, Ayushi Tomer, Kim Jackson, Kalyani Yajnanarayan, Vidya Acharya, Carina Therese Magtibay, Rishab Mishra and Alexandra Stead

Introduction

Extracorporeal Shockwave Therapy (ESWT), otherwise referred to as shockwave therapy, is a non-invasive procedure using specific types of sound waves for therapeutic purposes.[1] The first treatment with ESWT is suggested to have taken place in 1980,[2] with the first published clinical paper on its use for the management of urolithiasis reported to be following in 1982.[3] The success of this technology for the treatment of urinary stones quickly made it a first-line, non-invasive, and effective method.[4] Subsequently, ESWT was studied in orthopaedics where it was identified that it could loosen the cement in total hip arthroplasty revisions.[5] Further, animal studies conducted in the 1980s revealed that ESWT could augment the bone-cement interface, enhance osteogenic response and improve fracture healing.[6][7] Nowadays, ESWT therapeutic role has expanded to the rehabilitation of various musculoskeletal conditions.[8]

Types of ESWT

There are two main types of ESWT: focused shockwave therapy (fESWT) and radial shockwave therapy (rESWT). fSWT starts with wide and then proceeds with focused maximal pressure at specific tissue depths whereas in rSWT, pressure is eventually spreading with maximal values being attained at the source (applicator site/skin).[9] Since these ESWT types result in different shockwave speeds and pressures (rSWT is characterised by lower values), some argue that rSWT should be named differently i.e. not "shockwave".[10] Other names commonly found for rSWT include “Radial Shock Wave Therapy", RSWT; “Extracorporeal Pulse Activation Therapy”, EPAT; “Radial Pressure Wave Therapy”.[11] Nevertheless, the physical impact of ESWT and partly, ESWT dosage, are linked with energy per unit area -called energy flux density (EFD, mJ/mm2) or maximal positive pressure (bar).[12]

Physiological Basis of ESWT

ESWT is based on sound waves with distinct physical properties, including non-linearity in pressure, high peak pressure followed by low tensile amplitude, a rapid rise time, and a brief duration of approximately 10 milliseconds.[13] ESWT consists of a single pulse, a broad frequency range, and a high-pressure amplitude.[13][14]

These unique characteristics create both positive and negative (biphasic) phases of the shockwave. The positive phase generates direct mechanical forces on the target tissue, while the negative phase induces cavitation, forming gas bubbles that implode at high velocity.[15] This implosion produces a secondary wave of shockwaves, enhancing the mechanical impact and therapeutic potential of the treatment.

Principles of ESWT

Three different generator methods have been described over time in clinical applications of fESWT: electrohydraulic (EH), electromagnetic (EM), and piezoelectric (PE).[16][9] Despite their different mechanisms, all three methods share the conversion of electric energy into targeted acoustic shockwaves and use a water basis as a medium to transmit them, ensuring effectiveness in energy transfer to the targeted tissues.[9][11] For rESWT, ballistic generator methods apply and refer to pressure waves rather than shockwaves, differing in shape and propangation from fESWT.[11]

Mechanisms of Action

ESWT is often recognised as a valuable tool in the treatment of musculoskeletal conditions because of its suggested ability to promote positive interstitial and extracellular responses and reduce pain.[9][17] The exact mechanism of action of ESWT treatment is not fully elucidated. [18] However, several proposals are found in the published literature about potential biological effects such as the stimulation of tendon neovascularisation and proliferation of tenocytes (dose dependent),[11][19] [20] osteoprogenitor differentiation, [21] immune response activation and modulation,[11] [22] growth factor and protein synthesis promotion for tissue remodelling and regeneration. [23][24]

ESWT and Therapeutic Ultrasound

ESWT and therapeutic ultrasound are non-invasive treatment tools that employ acoustic waves for therapeutic benefits. Both modalities make use of a coupling medium to transmit energy to the tissues being treated. However, the way they deliver results, despite mixed outcomes and low quality evidence in studies, is fundamentally different;[10] [25] therapeutic ultrasound utilises 1-3MHz frequency lower energy sound waves, while ESWT usually utilises lower frequency high-energy waves.[26] In fact, it is supported that the maximal pressure of the shockwave may be 1000 times greater than that of an ultrasound wave.[27] While ultrasound may result in thermal or non-thermal effects, ESWT offers intense, pulsed shockwaves that do not lead to heating of tissues.[28]

Clinical Indications

Extracorporeal Shockwave Therapy for Lateral Epicondyle Tendinopathy.
Extracorporeal Shockwave Therapy for Lateral Epicondyle Tendinopathy.

ESWT has various clinical medical applications, in urology, orthopaedics, cardiology, dermatology, and neurology.[13] In rehabilitation, ESWT is primarily, but not exclusively used in the management of musculoskeletal conditions. Some examples of clinical applications in physiotherapy are listed below.

Contraindications and Precautions

Absolute Contraindications (all energy treatments):
  • Active infection (e.g., osteomyelitis)
  • Malignant tumour
  • Direct application over major blood vessels and nerves
  • Open wounds
  • New thrombosis
  • Acute phase fractures
  • Pregnancy (fetus in the shockwave field)
  • Cardiac pacemakers or other implantable devices (e.g. defibrilator) in the shockwave field
Relative Contraindications (high-energy treatments):
  • Brain or nerve tissue
  • Lung or pleura
  • Skull bones, ribs, vertebral bodies
  • Significant coagulopathy
  • Epiphyseal bone plate / Sites of skeletal immaturity
Important Clinical Considerations:
  • Direct application over joint replacement site
  • Current nonsteroidal anti-inflammatory drug use (in fact, it is suggested that they should be avoided for some time after treatment according to the specific clinical context)
  • Systemic infections
  • Uncontrolled hypertension
  • Severe protein malnutrition (serum albumin <20 g/L)
  • Severe anaemia (hemoglobin <70 g/L)
  • Current anticoagulation therapy
  • Recent corticosteroid injections to treatment area
  • Inability to cooperate or give informed consent

[11][24][42][43]

Potential Side Effects

ESWT is generally considered a safe therapy. However, side effects may occur and these need to be communicated to the patient before treatment. Common, usually temporary, adverse events are listed below.

  • Pain (including headaches, migraines, and tinnitus in sensitive patients)
  • Superficial oedema
  • Erythema
  • Haematoma
  • Local numbness or tingling (nerve irritation)
  • Tendon loosening
  • Rupture or soft tissue damage
  • Hypertension (lithotripsy)

[8][17][24][44]

Training Requirements

ISMST guidelines report that ESWT should be performed by trained, certified and licenced professionals; for physiotherapists, ESWT recommends that treatment should follow medical referral.[11] Several proposals exist on the requirements and core competencies that should be included in ESWT education, but a standard curriculum is missing.[24] For more information and practice ESWT standards, please look at regional regulations, legal framework and professional guidance.

Treatment Procedure and Parameters

As with any other treatment procedure, the patient needs to be informed about the condition, other treatment options, potential risks and side effects, and reported effectiveness. Treatment protocol and procedures are documented and followed throughout sessions. After patient's consent, ESWT is introduced to the skin through an applicator and using a coupling medium (e.g. gel). Analgesia (anesthesia or local anesthesia) for ESWT is usually not recommended. In fact, it is suggested that it may dampen the results of the ESWT in some cases.[45][46] As a result, interruption of the treatment is possible in case of pain at any time. Location of treatment area can be selected based on clinical or imaging findings (e.g. patient reports, ultrasound, X-ray). Treatment parameters, set before and during treatment, need to follow the patient's feedback on perceived pain. Treatment parameters (Table 1) may follow established guidelines on each condition but also need to take account the patient's unique profile (e.g. comorbidities affecting the healing process) and rely on clinical judgement.

[8][11]

Table 1. Treatment parameters for ESWT. (adapted from ISMST[11] & Tenforde et al.[24])
Parameter Description
Device Model, Type
Depth of focus According to target condition
Total number of impulses Pulses/treatment
Impulse frequency Number of shockwaves applied per second
Energy Flux Density (EFD) Energy level/surface area, measured in mJ/mm2
Total energy dose (TED) EFD x total number of impulses = TED
Total number of treatments 3-5 sessions
Time interval between treatments Usually 1-2 weeks
Local anaesthesia Usually none
Guidance Clinical, Imaging for target area


In Table 2, you can find some clinical guidance on ESWT application parameters.

Table 2. Examples of ESWT parameters for musculoskeletal conditions according to the ISMST guidelines. [11]
Condition Relevant information ESWT type Treatment parameters
Calcific Tendinopathy of the Shoulder Risk of tendon rupture in case of previous damage and premature sports load after treatment.

Verify treatment target area (calcific deposit) by ultrasound or imaging

fESWT 0.10-0.32mJ/mm² depending on patient's pain and device used. Up to 5 treatment sessions with an interval of 1- 2 weeks.

2000 to 3000 shock waves, frequency of up to 5Hz are applied per treatment session.

Lateral Epicondyle Tendinopathy Risk of tendon rupture in case of previous damage and premature sports load after treatment.

Both enthesis and affected muscles treated. Control of symptoms > 8-12 weeks

fESWT / rESWT according to possibilities and availability 0.10-0.32mJ/mm² depending on patient's pain and device used.Up to 5 treatment sessions depending on the device, with interval of 1- 2 weeks. Electrohydraulic: 0.015-0.22 mJ/mm², single session. 1500 pulses/session, frequency: 4 Hz; Electromagnetic: 0.09/0.14-1.2 mJ/mm², 3 sessions, 2000 pulses/session, frequency: 4-5 Hz; Radial: 1.4 - 2.5bar, 3-5 sessions, 2000 pulses/session, frequency: up to 8 Hz
Greater trochanteric pain syndrome Target area by patient /ultrasound. Onset of effect>4 weeks. Aftercare: individual sport adaptation, continuation of stretching exercises. Control of symptoms after 4 and 8 weeks fESWT / rESWT fESWT: 0.10-0.35mJ/mm² (pain-adapted dosing). Up to 5 treatment sessions with an interval of 1- 2 weeks. 1500-2500 pulses/session, frequency: up to 5 Hz; rESWT: up to 4 bar (pain-adapted dosing). Up to 5 treatment sessions with an interval of 1- 2 weeks. 2000-3000 pulses/session, frequency: up to 10 Hz
Plantar fasciopathy Target area by patient /ultrasound. Coupling medium ultrasound gel. Apply cryotherapy if necessary. Control of symptoms after 4 and 8 weeks fESWT / rESWT fESWT:0.08-0.35mJ/mm² (pain-adapted dosing). Up to 5 treatment sessions with an interval of 1- 2 weeks. 1500-2500 pulses/session, frequency: up to 5 Hz; rESWT: 4 bar (pain-adapted dosing). Up to 5 treatment sessions with an interval of 1- 2 weeks. 2000-3000 pulses/session, frequency: up to 10 Hz
Achilles tendinopathy Target area by patient, consideration of imaging, co-treatment of myofascial trigger points. Apply cryotherapy if necessary. Load adaptation & sports modification after. Control of symptoms 8-12 weeks fESWT / rESWT fESWT:0.10-0.25mJ/mm² (pain-adapted dosing). Up to 3-5 treatment sessions with an interval of 1- 2 weeks. 1500-2500 pulses/session, frequency: up to 5 Hz. Coupling medium (ultrasound gel); rESWT: 2-4 bar (pain-adapted dosing). Up to 5 treatment sessions with an interval of 1- 2 weeks. 2000-3000 pulses/session, frequency: up to 10 Hz. Coupling medium (ultrasound gel /cave air bubbles)
Osteoarthritis (knee) Target area: at femoral condyle and tibial plateau. Early stages of disease. Free movement, avoidance of overloading after. fESWT 0.25 - 0.6 mJ/mm², 2000 - 4000 pulses/session,
Pseudarthrosis / Delayed Healing of Bone Fractures In long tubular bones, the success rate is lower in fractures with gap > 5mm. Therapy is applied with conduction anesthesia/general anesthesia, and stable limb positioning. Coupling medium: ultrasound gel, if necessary, Vaseline/castor oil. fESWT Electrohydraulic: 0.3 - 0.4 mJ/mm², 3000 (2000 - 4000) pulses, frequency:1- 4 Hz. One-time treatment, after 3 to 6 months, possibility for second or third treatment.

Electromagnetic: 0.4 - 0.7 mJ/mm² (long tubular bones); 0.1 mJ/mm² (navicular bone), 4000 pulses, frequency:1- 4 Hz. 3 to 4 treatments with 3 to 7 days interval.

Evidence Base

Most reviews about the use of ESWT assess its inclusion in the treatment of musculoskeletal (including orthopaedic) pathologies.[8][10][12][18][24][28][29] [32][34][38] Musculoskeletal conditions constitute the majority of approved standard and common empirically tested clinical uses, but there are also exceptional or expert indications, and experimental indications.[12] [11] Overall, ESWT for musculoskeletal pain can be a safe tool and can be applied alone or in combination with other therapies to enhance therapeutic outcomes.[17] However, such statements are often based on evidence of studies assessing many musculoskeletal cases (level of evidence 1-3) that have not been assessed in a systematic way.[17] In fact, some recent systematic reviews may challenge the use of ESWT in some conditions or suggest caution because of study limitations.[25][47] Furthermore, although current trends often favour the use of ESWT in combination with other therapeutic approaches,[17][34] it's still not very clear which combinations work best.

ESWT is often recommended for chronic or resistant musculoskeletal cases, when other conservative therapeutic modalities have failed.[11] This approach has been supported by reviews in some conditions (tendinopathies and plantar fasciopathy).[24][28][32][38]Despite ESWT being more frequently used as a last resort in musculoskeletal practice, its potential in promoting healing at earlier stages for other cases (e.g. bone marrow oedema and osteonecrosis) should not be overlooked.[8]This highlights the need to look at eligibility for ESWT according to condition and clinical circustances-specific suitability.

Current Limitations

Evidence about ESWT is continuously increasing; however, it must be noted that it may present with important challenges in some instances because of the limited and sometimes poor evidence base for some conditions,[8] problems with placebo methodology,[10] the observed variability in treatment administration (e.g. type, parameters) and procedures.[24][43] These problems need to be addressed in future studies, to fully elucidate the potential of ESWT across conditions.

Clinical Guidelines

This section includes the most recent international guidance on ESWT. This guidance aims to ensure effective and safe use for ESWT. For more specific information and guidelines in your area, please consult additionally relevant key regional documents and associated legal framework.

ISMST Guidelines for ESWT (2023 update)

International mDelphi recommendations for ESWT in sports medicine (2025)

Resources

What Is Shockwave Therapy? Uses, Benefits, and What to Expect by Dr. Rob Letizia PT, DPT

YouTube video, which demonstrates ESWT for the management of heel pain:

[48]

References

  1. ↑ d'Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg. 2015 Dec;24(Pt B):147-53.
  2. ↑ Chaussy CG. The History of Shockwave Lithotripsy. In: Patel SR, Moran ME, Nakada SY (eds) The History of Technologic Advancements in Urology. Switzerland. Springer. 2018. p109-21.
  3. ↑ Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol. 1982 Mar;127(3):417-20.
  4. ↑ Argyropoulos AN, Tolley DA. Optimizing shock wave lithotripsy in the 21st century. Eur Urol. 2007 Aug;52(2):344-52.
  5. ↑ Park SH, Park JB, Weinstein JN, Loening S. Application of extracorporeal shock wave lithotripter (ECSWL) in orthopedics. I. Foundations and overview. J Appl Biomater. 1991 Summer;2(2):115-26.
  6. ↑ Weinstein JN, Oster DM, Park JB, Park SH, Loening S. The effect of the extracorporeal shock wave lithotriptor on the bone-cement interface in dogs. Clin Orthop Relat Res. 1988 Oct;(235):261-7.
  7. ↑ Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M. Influence of shock waves on fracture healing. Urology. 1992 Jun; 39(6): 529-32.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Auersperg V, Trieb K. Extracorporeal shock wave therapy: an update. EFORT Open Rev. 2020 Oct 26;5(10):584-592.
  9. ↑ 9.0 9.1 9.2 9.3 Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma. 2020 May;11(Suppl 3):S309-18.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Smallcomb M, Khandare S, Vidt ME, Simon JC. Therapeutic Ultrasound and Shockwave Therapy for Tendinopathy: A Narrative Review. Am J Phys Med Rehabil. 2022 Aug 1;101(8):801-807.
  11. ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 ISMST – International Society for Medical Shockwave Treatment. ESWT Guidelines. 3rd edition [Updated July 2023]. Available from: https://shockwavetherapy.org/wp-content/uploads/2024/01/ISMST-Guidelines-for-ESWT-_-engl-20240103.pdf [accessed 19 April 2026]
  12. ↑ 12.0 12.1 12.2 Crevenna R, Mickel M, Schuhfried O, Gesslbauer C, Zdravkovic A, Keilani M. Focused Extracorporeal Shockwave Therapy in Physical Medicine and Rehabilitation. Curr Phys Med Rehabil Rep. 2021; 9:1–10.
  13. ↑ 13.0 13.1 13.2 Rola P, Włodarczak A, Barycki M, Doroszko A. Use of the Shock Wave Therapy in Basic Research and Clinical Applications-From Bench to Bedsite. Biomedicines. 2022 Feb 28;10(3):568.
  14. ↑ The International Society for Medical Shockwave Treatment (ISMST). Physical principles of ESWT. Available from: https://shockwavetherapy.org/physical-principles-of-eswt/ [accessed 13 April 2026]
  15. ↑ Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res. 2001 Jun;(387):8-17.
  16. ↑ Cheing G, Chang H. Extracorporeal Shock Wave Therapy. JOSPT. 2003;33(6):303-62.
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 De la Corte-Rodríguez H, Román-Belmonte JM, Rodríguez-Damiani BA, Vázquez-Sasot A, Rodríguez-Merchán EC. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthcare (Basel). 2023 Oct 26;11(21):2830.
  18. ↑ 18.0 18.1 Reilly JM, Bluman E, Tenforde AS. Narrative Review on the Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions PM R. 2018 Dec;10(12):1385-403.
  19. ↑ Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012 Jun 17;2(1):33-7.
  20. ↑ 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: 854-61.
  21. ↑ Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM. Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta. J Bone Joint Surg Br. 2002 Apr;84(3):457-61.
  22. ↑ Davis TA, Stojadinovic A, Anam K, Amare M, Naik S, Peoples GE, Tadaki D, Elster EA. Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury. Int Wound J. 2009 Feb;6(1):11-21.
  23. ↑ Waugh CM, Morrissey D, Jones E, Riley GP, Langberg H, Screen HR. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy. Eur Cell Mater. 2015 May 15;29:268-80.
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 24.6 24.7 Tenforde AS, Borgstrom HE, DeLuca S, McCormack M, Singh M, Hoo JS, Yun PH. Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM R. 2022 May;14(5):611-19.
  25. ↑ 25.0 25.1 Dudoń A, Stania M. Shockwave or Ultrasound Therapy for Tendinopathy? A Systematic Review and Meta-Analysis. J Clin Med. 2026 Mar 5;15(5):2007.
  26. ↑ Ranjithkumar N, Paul J, Alagesan J, Viswanathan R. Comparative Effectiveness of Extracorporeal Shock Wave Therapy, Low-level Laser Therapy, and Ultrasound in the Treatment of Rotator Cuff Tendinopathy. Biomed Pharmacol J 2025;18(1).
  27. ↑ Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012; 7:11.
  28. ↑ 28.0 28.1 28.2 Al-Siyabi Z, Karam M, Al-Hajri E, Alsaif A, Alazemi M, Aldubaikhi AA. Extracorporeal Shockwave Therapy Versus Ultrasound Therapy for Plantar Fasciitis: A Systematic Review and Meta-Analysis. Cureus. 2022 Jan 2;14(1):e20871.
  29. ↑ 29.0 29.1 Testa G, Vescio A, Perez S, Consoli A, Costarella L, Sessa G, Pavone V. Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review. J Clin Med. 2020 Feb 6;9(2):453.
  30. ↑ Burton I. Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review. Sports Med Health Sci. 2021 Nov 11;4(1):8-17.
  31. ↑ Nartea R, Ghiorghiu I, Alexe MD, Gheorghievici GL, Mitoiu BI. Current Concepts in Pathogenesis and Conservative Management of Supraspinous Tendinopathies Using Shockwave Therapy-A Narrative Review of the Literature. Biomedicines. 2025 Sep 12;13(9):2253.
  32. ↑ 32.0 32.1 32.2 Rau OR, Cheng J, Jivanelli B, Tenforde AS, Wyss JF. Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review. HSS J. 2025 Apr 23:15563316251332189.
  33. ↑ Stania M, Pawłowski M, Benduch M, Dudon A, Hirjaková Z, Bzdúšková D, Kimijanová J. Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis. Sci Rep. 2026 Feb 6;16(1):7632.
  34. ↑ 34.0 34.1 34.2 Zhang R, Wang Z, Liu R, Zhang N, Guo J, Huang Y. Extracorporeal Shockwave Therapy as an Adjunctive Therapy for Frozen Shoulder: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2022 Feb 4;10(2):23259671211062222.
  35. ↑ Moen MH, Rayer S, Schipper M, Schmikli S, Weir A, Tol JL, Backx FJ. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study. Br J Sports Med. 2012 Mar;46(4):253-7.
  36. ↑ Gomez Garcia S, Ramon Rona S, Gomez Tinoco MC, Benet Rodriguez M, Chaustre Ruiz DM, Cardenas Letrado FP, et al. Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial. Int J Surgery, 2017;46:102-9.
  37. ↑ Orscelik A, Büyüklüoğlu G, Kocahan T, Akınoğlu B, Günaydın H, Karaaslan B. Efficacy of extracorporeal shock wave therapy and electrotherapy in medial tibial stress syndrome: a randomised study. Turk J Sports Med. 2025; 60(1):19-24.
  38. ↑ 38.0 38.1 38.2 Lou J, Wang S, Liu S, Xing G. Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Aug;96(8):529-534.
  39. ↑ Pabón-Carrasco M, Coheña-Jiménez M, Pérez-Belloso AJ, Algaba-Del-Castillo J, Cáceres-Matos R, Castro-Méndez A. Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. Healthcare (Basel). 2024 Jun 19;12(12):1223.
  40. ↑ Mittermayr R, Haffner N, Feichtinger X, Schaden W. The role of shockwaves in the enhancement of bone repair - from basic principles to clinical application. Injury. 2021 Jun;52(Suppl2):S84-90.
  41. ↑ Starosta M, Marek K, Redlicka J, Miller E. Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb-A Narrative Review. J Clin Med. 2024 Mar 30;13(7):2017.
  42. ↑ Su Y, Fu X, Huang Y. Consensus statement on the clinical application of extracorporeal shock wave therapy for diabetic foot ulcers (2025 Edition). Int J Surg. 2026 Jan 1;112(1):71-83.
  43. ↑ 43.0 43.1 Rhim HC, Singh M, Maffulli N, Saxena A, Leal C, Gerdesmeyer L, et al. Recommendations for use of extracorporeal shockwave therapy in sports medicine: an international modified Delphi study. Br J Sports Med. 2025 Sep 2;59(18):1287-301.
  44. ↑ Ren P, Wang Z, Liang Z, Xia S, Yuan X, Zhou F, Liu X. Radial extracorporeal shock wave therapy for pain and function in adults with knee osteoarthritis: protocol for a placebo-controlled, randomized clinical trial. Trials. 2025 Apr 25;26(1):139.
  45. ↑ Labek G, Auersperg V, Ziernhöld M, Poulios N, Bohler N. Einfluss von Lokalanästhesie und Energieflussdichte bei niederenergetischer Extrakorporaler Stoßwellentherapie der chronischen Plantaren Fasziitis. Z Orthop Ihre Grenzgeb 2005; 143(2): 240-46.[in German]
  46. ↑ Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L. Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res. 2005 Jul;23(4):931-41.
  47. ↑ Korakakis V, Kotsifaki R, Sotiralis Y. Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis. JOSPT. 2026 March 27;0:1-49.
  48. ↑ Langmore Podiatry. Shockwave Therapy Demonstration. Available from: https://www.youtube.com/watch?v=P5dibaAu7pQ [accessed 23 April 2026]
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Extracorporeal_Shockwave_Therapy&oldid=381737"