Does Shockwave Therapy Hurt, and What Should I Expect After Treatment?

Does Shockwave Therapy Hurt, and What Should I Expect After Treatment? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

You've been dealing with persistent heel pain, Achilles tendon discomfort, or another musculoskeletal problem.

You've tried modifying your activities, resting, stretching, or exercising, but your symptoms continue to interfere with daily life.

Then you hear about shockwave therapy.

It sounds promising, but the name raises a few questions.

“Does shockwave therapy actually hurt?”

“Will I be sore afterward?”

“Can I walk or exercise after treatment?”

“What happens during the first session?”

“How do I know if the treatment is working?”

These are reasonable questions to ask before considering a new treatment.

Shockwave therapy, also called extracorporeal shockwave therapy (ESWT), is a noninvasive intervention that delivers acoustic energy to a targeted treatment area.

It has been studied for several musculoskeletal conditions, particularly certain persistent tendon-related disorders and plantar heel pain.

However, the experience and potential benefits vary depending on the condition, the type of device, treatment settings, individual sensitivity, and the overall rehabilitation program.

Understanding what happens before, during, and after treatment can help you make a more informed decision.

Patient Question

“I'm considering shockwave therapy for my persistent pain, but I'm concerned about how much it will hurt. What should I expect during the session, will I feel sore afterward, and can I return to my normal activities?”

The Short Answer

Shockwave therapy can cause discomfort during treatment, particularly when the applicator is placed over a sensitive area.

Some patients describe the sensation as repeated tapping or pressure. Others experience more noticeable discomfort.

The intensity depends on the treatment area, device, settings, and individual response.

After treatment, some patients experience temporary soreness, redness, or mild swelling. Bruising can also occur.

These effects are generally short-lived, although complications are possible and should not be dismissed.

Most importantly, shockwave therapy should not be excessively painful, and more pain does not mean better results.

Treatment should be individualized, with the clinician monitoring your response and adjusting the procedure when appropriate.

Shockwave therapy is not a universal treatment for musculoskeletal pain. It may be considered for selected conditions after an appropriate evaluation and review of the available evidence.

What Exactly Is Shockwave Therapy?

Shockwave therapy is a noninvasive intervention that uses acoustic energy delivered through a treatment device.

There are two broad categories commonly discussed in musculoskeletal care.

1. Focused shockwave therapy

Focused shockwave devices concentrate acoustic energy within a targeted region.

The treatment depth and energy settings depend on the device and clinical application.

2. Radial pressure wave therapy

Radial devices produce pressure waves that spread outward from the applicator.

The physical characteristics and energy distribution differ from focused shockwave therapy.

Although both are commonly discussed under the term shockwave therapy, they are not technically identical.

Research involving one type of device should not automatically be applied to another.

A clinician should consider the available evidence for the specific condition, device, and treatment protocol.

Does Shockwave Therapy Hurt During Treatment?

It can.

The treatment may produce a repetitive tapping or pressure sensation.

When the applicator passes over an already sensitive region, discomfort may increase.

For example, a patient receiving treatment near the plantar fascia may notice greater sensitivity over certain areas of the heel.

Another patient receiving treatment for a tendon-related condition may experience discomfort near the affected tendon.

However, the experience varies.

Some patients tolerate treatment comfortably, while others require adjustments.

Does more pain mean the treatment is working?

No.

There is no established rule that greater treatment pain produces better outcomes.

A 2025 international expert consensus published in the British Journal of Sports Medicine recommended beginning shockwave treatment at a tolerable energy level and adjusting treatment according to the patient's response.

The expert recommendations also emphasized combining shockwave therapy with appropriate physical therapy exercises for relevant tendon and joint conditions.

Treatment should not become an exercise in tolerating unnecessary pain.

What Happens During a Shockwave Therapy Session?

The exact procedure depends on the condition, device, treatment protocol, and clinician.

A typical appointment may involve the following steps.

Step 1: Clinical evaluation

Before considering shockwave therapy, the clinician should review your symptoms, relevant medical history, functional limitations, previous treatment, and examination findings.

This helps determine whether the presentation is appropriate for physical therapy and whether shockwave therapy is a reasonable treatment option.

Step 2: Safety screening

The clinician should review potential contraindications and precautions.

Certain medical conditions, implanted devices, anatomical regions, and treatment settings may make shockwave therapy inappropriate.

Step 3: Identifying the treatment area

The clinician identifies the appropriate treatment region using the clinical findings and the requirements of the specific treatment protocol.

Some indications or devices may require imaging guidance or additional medical involvement.

Step 4: Applying the treatment

A coupling gel may be applied to the skin.

The clinician positions the applicator and delivers the prescribed treatment according to the device and protocol.

Step 5: Monitoring your response

Your comfort and symptom response should be monitored throughout the procedure.

Settings or treatment may be adjusted when clinically appropriate.

Step 6: Post-treatment instructions

After treatment, the clinician should explain any relevant activity modifications, expected short-term responses, warning signs, and rehabilitation exercises.

Shockwave therapy should fit into an individualized treatment plan rather than being treated as an isolated procedure.

Why Might My Pain Increase After Shockwave Therapy?

Some patients experience temporary soreness or increased sensitivity after treatment.

The treated region may feel more sensitive during walking, gripping, lifting, or other activities that load the area.

This does not automatically indicate that the treatment was harmful.

However, it also does not prove that healing has occurred.

A 2024 systematic review of shockwave therapy for upper-limb tendon disorders reported temporary increases in pain and local reactions, including redness, swelling, small bruises, and minor bleeding beneath the skin.

These reactions were generally temporary in the included studies.

Patients should contact their treating clinician if symptoms are unusually severe, persist, or progressively worsen.

Is It Normal to Have Bruising After Shockwave Therapy?

Bruising is a recognized potential adverse effect.

Other possible local reactions include:

• Skin redness
• Tenderness
• Temporary swelling
• Small areas of bleeding beneath the skin
• Increased discomfort around the treatment area

These reactions do not occur in every patient.

The likelihood may depend on the device, treatment settings, anatomical region, medications, and individual medical history.

Significant bruising, unusual swelling, or worsening pain should be reported to the treating clinician.

Patients with bleeding disorders or who take anticoagulant medications should disclose that information before treatment.

Can Shockwave Therapy Damage a Tendon?

Shockwave therapy is generally considered a noninvasive intervention, but noninvasive does not mean risk-free.

The International Society for Medical Shockwave Treatment identifies contraindications and precautions that depend on the treatment technique and energy level.

Reported or potential complications include hematoma, nerve irritation, and tendon injury, although serious complications are uncommon in many clinical studies.

A 2025 Mayo Clinic clinical overview also identified a theoretical risk of tendon rupture and emphasized the importance of appropriate patient selection and treatment administration.

This is why shockwave therapy should not be applied indiscriminately to every painful tendon.

The clinician must consider the clinical presentation, relevant medical history, treatment area, and device-specific requirements.

Can I Walk After Shockwave Therapy?

That depends on the condition being treated and your symptoms.

For some patients, ordinary walking may remain appropriate.

For others, particularly when treating a painful weight-bearing region, temporary adjustments may be recommended.

For example, a patient receiving treatment for plantar heel pain may need to modify prolonged walking or high-impact activities based on the treatment protocol and symptom response.

The goal is not necessarily complete rest.

It is to manage loading appropriately while supporting the overall rehabilitation plan.

Follow the instructions provided by your treating clinician.

Can I Exercise After Shockwave Therapy?

Exercise recommendations should be individualized.

A patient receiving treatment for Achilles tendon symptoms may require different activity guidance from someone receiving treatment for a shoulder condition.

Depending on the presentation, the clinician may recommend temporarily modifying:

• Exercise intensity
• Resistance
• Running or jumping
• Sports participation
• Prolonged walking
• Repetitive loading
• Other activities that significantly aggravate symptoms

However, prolonged inactivity is not automatically necessary.

Appropriate progressive exercise may remain an important part of rehabilitation.

The specific timing and dosage should follow the clinician's instructions and the applicable treatment protocol.

Should I Use Ice After Shockwave Therapy?

There is no universal post-treatment rule that applies to every device, condition, and protocol.

Some shockwave protocols discourage certain pain-relieving interventions immediately after treatment, while others use different recommendations.

The clinical importance of these restrictions is not equally established across all indications.

Patients should follow their treating clinician's specific instructions rather than assuming that every online aftercare recommendation applies to them.

Should I Take Ibuprofen After Treatment?

Do not independently stop or change prescribed medications because of shockwave therapy.

Some shockwave protocols recommend avoiding nonsteroidal anti-inflammatory drugs around treatment, but recommendations vary, and the clinical evidence for specific medication restrictions is not uniform across conditions.

If you take ibuprofen, naproxen, aspirin, anticoagulants, or other medications, discuss them with your treating clinician and prescribing medical professional.

Medication decisions should be individualized.

How Long Does Soreness Last After Shockwave Therapy?

Temporary soreness may resolve relatively quickly, but there is no guaranteed recovery timeline.

Your response can depend on:

• The condition being treated
• The anatomical region
• Treatment settings
• Device type
• Baseline symptom severity
• Activity level
• Individual sensitivity
• Other medical considerations

The important distinction is between an expected temporary response and symptoms that are unusually severe or progressively worsening.

If your symptoms are significantly worse, interfere substantially with normal function, or do not improve as expected, contact your treating clinician.

Will I Feel Better Immediately After the First Session?

Not necessarily.

Some patients report early symptom changes.

Others notice little immediate difference.

Some experience temporary soreness before their symptoms return to baseline.

Shockwave therapy research commonly evaluates outcomes over multiple weeks or months rather than relying only on immediate post-treatment changes.

An immediate reduction in pain is not a reliable guarantee of long-term success.

Similarly, the absence of immediate improvement does not automatically establish that the treatment has failed.

The response should be assessed alongside functional progress and the broader rehabilitation plan.

How Many Shockwave Therapy Sessions Will I Need?

There is no universal number of sessions appropriate for every condition.

Treatment protocols vary according to:

• The specific musculoskeletal presentation
• The type of shockwave device
• Treatment energy
• Treatment frequency
• Patient response
• Clinical goals
• Available evidence

A 2025 international expert consensus described commonly recommended protocols involving three to five sessions at intervals of one to two weeks for selected tendon and bone indications.

However, that is not a universal prescription.

The number of sessions should be determined by the applicable evidence, device protocol, clinician's assessment, and patient response.

More sessions do not automatically produce better outcomes.

What Conditions Might Benefit From Shockwave Therapy?

Shockwave therapy has been studied for several musculoskeletal conditions, including:

Plantar heel pain

Certain Achilles tendon disorders

Some other persistent tendon-related conditions

Calcific rotator cuff tendinopathy

The strength of the evidence varies considerably.

For example, the 2025 rotator cuff tendinopathy clinical practice guideline distinguishes between calcific and noncalcific presentations.

It states that clinicians may use or recommend shockwave therapy for adults with calcific rotator cuff tendinopathy to reduce pain and disability.

However, it recommends against using shockwave therapy for pain and disability in adults with noncalcific rotator cuff tendinopathy.

This distinction matters.

A treatment that may be appropriate for one shoulder condition may not be appropriate for another.

Likewise, evidence from plantar heel pain cannot automatically be generalized to every tendon or joint condition.

Is Shockwave Therapy Better Than Physical Therapy Exercises?

Not universally.

Shockwave therapy and exercise are not necessarily competing treatments.

For selected musculoskeletal presentations, shockwave therapy may be considered as an adjunct to a comprehensive rehabilitation program.

However, the benefits of adding shockwave therapy are not consistent across all conditions or studies.

Exercise may address impairments that shockwave therapy alone cannot adequately address, such as:

Muscle performance

Strength

Movement tolerance

Functional loading

Balance

Activity tolerance

Return to work

Return to exercise and sport

For someone with persistent tendon-related symptoms, reducing discomfort is only one potential goal.

Restoring the capacity to tolerate meaningful activities is equally important.

Can Physical Therapy Help?

Physical therapy can play an important role in evaluating and managing appropriate musculoskeletal conditions for which shockwave therapy is being considered.

A physical therapist may assess:

• Pain and symptom behavior
• Joint mobility
• Muscle performance
• Strength
• Movement patterns
• Functional limitations
• Activity tolerance
• Work-related demands
• Sports participation
• Current exercise capacity
• Response to previous treatment

Based on the examination, rehabilitation may include individualized therapeutic exercise, activity modification, progressive strengthening, functional training, patient education, and other appropriate interventions.

Shockwave therapy may be considered when the clinical presentation, evidence, device requirements, and applicable professional scope support its use.

It should not replace the physical therapy evaluation or be presented as a guaranteed solution.

What Does Research Say?

1. 2025 International Expert Consensus

An international modified Delphi study published in the British Journal of Sports Medicine developed recommendations for shockwave therapy in sports medicine.

The expert panel recommended starting treatment at a tolerable energy level and adjusting treatment based on the patient's response.

For relevant tendon and joint conditions, the panel also supported combining shockwave therapy with physical therapy exercises.

These recommendations represent expert consensus and should not be interpreted as proof that every protocol or indication is equally effective.

2. 2024 Systematic Review of Tendinopathies

A systematic review and meta-analysis published in BMC Sports Science, Medicine and Rehabilitation included 45 clinical studies examining shockwave therapy for various tendinopathies.

The researchers reported pain improvements across several conditions.

However, differences in treatment protocols, patient populations, anatomical regions, and study methods limit how confidently the findings can be generalized to an individual patient.

3. 2024 Review of Upper-Limb Tendon Disorders

A systematic review published in Frontiers in Medicine evaluated the effectiveness and safety of shockwave therapy for upper-limb tendon disorders.

No serious long-term adverse effects were reported in the included studies.

Temporary pain increases, redness, swelling, minor bruising, and small hematomas were among the reported reactions.

The absence of serious complications in those studies does not mean that complications are impossible.

4. 2025 Rotator Cuff Clinical Practice Guideline

The 2025 rotator cuff tendinopathy guideline provides condition-specific recommendations.

It supports considering shockwave therapy for calcific rotator cuff tendinopathy but recommends against its use for noncalcific rotator cuff tendinopathy to reduce pain and disability.

This demonstrates why the underlying clinical presentation matters more than simply having shoulder pain.

5. 2025 Review of Hip and Pelvic Tendinopathies

A 2025 systematic review examined 18 studies involving shockwave therapy for tendinopathies around the hip and pelvis.

Six studies reported adverse events, including increased pain and skin irritation, with an overall reported rate of approximately 12% among the 557 participants in those studies.

The authors reported encouraging findings for some conditions but emphasized the need for better research and more standardized treatment protocols.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for persistent musculoskeletal symptoms may include, when appropriate:

• A detailed history of your symptoms
• Review of previous treatment
• Review of relevant medical history
• Assessment of pain and symptom behavior
• Range-of-motion testing
• Muscle-performance testing
• Functional movement assessment
• Evaluation of activity tolerance
• Review of work or sports demands
• Screening for findings requiring medical referral
• Discussion of your rehabilitation goals

If shockwave therapy is being considered, the evaluation should also address whether the specific condition is supported by evidence and whether any contraindications or precautions are present.

The treatment plan should be individualized rather than based on the assumption that every persistent pain condition requires shockwave therapy.

When Should You Seek Medical Attention?

Shockwave therapy is not appropriate for every patient or every condition.

Before treatment, inform your clinician about relevant medical history, including bleeding disorders, anticoagulant use, pregnancy, implanted electronic devices, cancer involving the proposed treatment region, and other significant medical conditions.

The importance of individual contraindications depends on the device, energy level, and treatment location.

Seek prompt medical evaluation if you experience:

• Severe or rapidly worsening pain
• Significant or expanding swelling
• Extensive or worsening bruising
• New or progressive numbness
• Significant weakness or loss of function
• Signs of infection
• A sudden popping sensation followed by major functional loss
• Other unusual or concerning symptoms

New chest pain, shortness of breath, or other potentially life-threatening symptoms require emergency evaluation.

Why Patients Choose Nova Physical Therapy

We Care.

At Nova Physical Therapy, we believe treatment should begin with understanding the patient—not simply selecting a machine or modality.

Two patients may both report persistent heel pain, yet have different examination findings, activity limitations, medical histories, and rehabilitation needs.

One patient may benefit from a progressive exercise program.

Another may require additional medical evaluation.

For an appropriately selected patient, shockwave therapy may be considered as one component of a comprehensive rehabilitation approach.

Our focus is on:

Individualized physical therapy evaluations

Evidence-informed clinical decision-making

Progressive strengthening

Movement and functional rehabilitation

Patient education

Appropriate treatment selection

Return to meaningful daily activities

The goal is not simply to complete a series of treatments.

The goal is to help patients improve their functional capacity and work toward the activities that matter to them.

That's what We Care means to us.

Frequently Asked Questions

Does shockwave therapy hurt?

It can cause discomfort, especially over sensitive areas. The sensation varies according to the device, treatment settings, anatomical region, and individual response.

Is shockwave therapy supposed to be very painful?

No. More pain does not establish that the treatment is more effective. Treatment intensity should be adjusted appropriately.

Is it normal to feel sore afterward?

Temporary soreness can occur. Severe, persistent, or worsening symptoms should be discussed with the treating clinician.

Can shockwave therapy cause bruising?

Yes. Redness, tenderness, swelling, and bruising are recognized potential adverse effects.

Can I walk after shockwave therapy?

Walking recommendations depend on the condition being treated, the treatment protocol, and your symptoms.

Can I work out after treatment?

Exercise may need to be modified temporarily. Follow your clinician's individualized instructions.

Can I return to work the same day?

Some patients may be able to resume their usual work, while others may need temporary modifications, particularly when their work places substantial demand on the treated area.

Will I feel better after one session?

Not necessarily. Responses vary, and improvement should be assessed over time.

How many shockwave therapy sessions do I need?

The number of sessions depends on the condition, device, treatment protocol, and clinical response. There is no universal treatment schedule.

Is shockwave therapy safe?

Shockwave therapy is generally well tolerated in appropriately selected patients, but adverse effects and contraindications exist.

Can shockwave therapy replace exercise?

Not necessarily. Progressive exercise and functional rehabilitation may remain essential components of treatment.

Is shockwave therapy appropriate for every tendon problem?

No. The evidence varies by condition. Some clinical guidelines support its use for selected presentations while recommending against it for others.

Schedule an Evaluation

If persistent musculoskeletal pain is affecting your ability to walk, exercise, work, or participate in everyday activities, an individualized physical therapy evaluation can help identify relevant functional limitations and appropriate rehabilitation options.

Shockwave therapy may be considered for selected patients when supported by the clinical findings, available evidence, device requirements, and applicable scope of practice.

Explore Nova Physical Therapy's services and learn more about physical therapy care in North Hollywood, CA.

Disclaimer

This article is intended for general educational purposes only and does not constitute medical advice, medical diagnosis, individualized treatment recommendations, or clearance for shockwave therapy.

The information does not establish that shockwave therapy is appropriate for any particular condition or patient.

Treatment selection requires consideration of the clinical presentation, medical history, contraindications, precautions, device-specific requirements, current evidence, and applicable professional scope of practice.

Physical therapists in California provide evaluation, rehabilitation, treatment planning, instruction, and other authorized interventions under the California Physical Therapy Practice Act. A physical therapy license does not authorize the diagnosis of disease.

The use of a particular shockwave device or procedure must be independently assessed for compliance with applicable laws, professional requirements, training, and device labeling.

Shockwave therapy does not guarantee pain relief, tissue healing, functional improvement, or prevention of recurrence.

Individual results vary. Consult an appropriately qualified healthcare professional for personalized guidance.

References

1. International Society for Medical Shockwave Treatment. ISMST Guidelines for Extracorporeal Shock Wave Therapy. 2024. Clinical guidelines and contraindications.
2. Recommendations for Use of Extracorporeal Shockwave Therapy in Sports Medicine: An International Modified Delphi Study. British Journal of Sports Medicine. 2025. https://doi.org/10.1136/bjsports-2024-109082
3. Majidi L, et al. The Effect of Extracorporeal Shock-Wave Therapy on Pain in Patients With Various Tendinopathies: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BMC Sports Science, Medicine and Rehabilitation. 2024;16:93. https://doi.org/10.1186/s13102-024-00884-8
4. Efficacy and Safety of Extracorporeal Shock Wave Therapy for Upper Limb Tendonitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Medicine. 2024. https://doi.org/10.3389/fmed.2024.1394268
5. Desmeules F, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2025. https://doi.org/10.2519/jospt.2025.13182
6. Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12018363/
7. Mayo Clinic. Shockwave Treatment: A New Wave for Musculoskeletal Care. 2025. https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/shockwave-treatment-a-new-wave-for-musculoskeletal-care/mac-20590258
8. Physical Therapy Board of California. Physical Therapy Practice Act.https://www.ptbc.ca.gov/laws/pt_practice_act.shtml