How Many Shockwave Therapy Sessions Do I Need?
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How Many Shockwave Therapy Sessions Do I Need? A Physical Therapist Answers
By Nova Physical Therapy | North Hollywood, CA
Patient Question
"How many shockwave therapy sessions will I need, and how long does it take to know if it's working?"
The Short Answer
There is no single number of shockwave therapy sessions that is appropriate for every patient.
Extracorporeal Shockwave Therapy (ESWT) protocols vary depending on the condition being treated, the type of shockwave technology used, symptom duration, treatment parameters, functional limitations, response to treatment, and the overall rehabilitation plan.
Some research protocols use a relatively short series of treatments, but the appropriate frequency and number of sessions should be individualized rather than automatically applying the same protocol to every patient.
At Nova Physical Therapy, shockwave therapy should be considered as one potential component of a comprehensive rehabilitation plan following an appropriate physical therapy evaluation.
What Is Shockwave Therapy?
Shockwave therapy, also known as Extracorporeal Shockwave Therapy or ESWT, uses acoustic energy applied externally to a targeted area.
It is non-invasive and has been studied for several musculoskeletal conditions, particularly certain persistent tendon-related disorders.
Research has investigated ESWT for conditions such as:
- Plantar heel pain
- Achilles tendinopathy
- Patellar tendinopathy
- Lateral elbow tendinopathy
- Calcific rotator cuff tendinopathy
- Other selected tendon-related conditions
However, evidence is not equally strong for every condition, and shockwave therapy is not appropriate for every patient.
Why Isn't There One Standard Number of Treatments?
Shockwave therapy protocols used in research vary considerably.
Treatment decisions may depend on factors such as:
- The area being treated
- Duration of symptoms
- Severity of functional limitations
- Previous treatments
- Patient tolerance
- Treatment response
- Type of shockwave device
- Energy and treatment parameters
- Overall rehabilitation program
For this reason, seeing an advertisement promising that a specific number of shockwave treatments will "fix" every condition should be approached cautiously.
Healthcare treatment should be individualized.
How Quickly Does Shockwave Therapy Work?
Response to treatment varies.
Some patients may notice changes during the treatment period, while others may experience more gradual changes over the following weeks.
Shockwave therapy should not necessarily be viewed as an immediate pain-relief treatment.
Researchers continue to investigate how ESWT may influence biological and pain-related processes within treated tissues.
More importantly, progress should not be measured by pain alone.
Your physical therapist may also monitor changes in:
- Walking tolerance
- Strength
- Mobility
- Exercise tolerance
- Ability to climb stairs
- Ability to work
- Ability to participate in sports
- Ability to perform daily activities
Functional improvement is an important part of determining whether rehabilitation is progressing.
Does More Shockwave Therapy Mean Better Results?
Not necessarily.
More treatment is not automatically better treatment.
Shockwave therapy involves multiple treatment variables, including:
- Number of impulses
- Energy level
- Treatment frequency
- Treatment location
- Device characteristics
Increasing treatment exposure without clinical justification does not guarantee improved outcomes.
Treatment should be based on current evidence, examination findings, clinical judgment, patient response, and functional goals.
Should Shockwave Therapy Be Combined With Exercise?
For many tendon-related conditions, rehabilitation should not rely solely on a passive treatment.
Depending on examination findings, a comprehensive physical therapy program may also include:
- Progressive strengthening
- Tendon-loading exercises
- Mobility exercises
- Functional movement training
- Balance training
- Activity modification
- Patient education
- Home exercise programs
- Gradual return to work
- Gradual return to sports
Shockwave therapy may therefore be used as an adjunct to an active rehabilitation program when clinically appropriate.
What Conditions Have Been Studied?
Research has examined shockwave therapy across several tendon-related conditions.
A 2024 systematic review and meta-analysis evaluating multiple tendinopathies reported improvements in pain across several conditions, although results varied and substantial differences existed between studies.
Other research has found more uncertain results for particular conditions, including Achilles tendinopathy.
This is important because it demonstrates why shockwave therapy should not be marketed as a universal treatment for every type of pain.
The evidence must be considered separately for each condition and each patient.
What Happens Before Starting Shockwave Therapy?
At Nova Physical Therapy, an appropriate physical therapy evaluation may include:
- Medical history review
- Symptom history
- Functional movement assessment
- Strength testing
- Mobility assessment
- Flexibility assessment
- Activity tolerance assessment
- Review of previous treatment
- Review of occupational or sports demands
- Goal setting
The physical therapist also determines whether findings require referral to another healthcare provider.
Following the evaluation, an individualized plan of care can be developed based on your examination findings and functional goals.
How Do We Know Whether Treatment Is Helping?
Rather than focusing exclusively on pain scores, progress may be evaluated through meaningful functional changes.
For example:
Plantar Heel Pain
Can you walk farther or tolerate standing better?
Achilles Tendon Symptoms
Can you tolerate walking, stairs, or progressive strengthening more comfortably?
Tennis Elbow
Can you grip, lift, work, or participate in recreational activities more effectively?
Shoulder Tendon Symptoms
Can you reach, lift, dress, sleep, or perform overhead activities with improved function?
These functional changes help guide rehabilitation decisions.
Is Shockwave Therapy Appropriate for Everyone?
No.
Shockwave therapy may not be appropriate depending on the treatment location, medical history, medications, underlying health conditions, and other clinical factors.
Before treatment, your physical therapist should review relevant medical information and determine whether shockwave therapy is appropriate.
When findings are outside the physical therapist's scope or require additional medical evaluation, referral to an appropriate healthcare provider should occur.
What Does Research Say?
Recent systematic reviews suggest that extracorporeal shockwave therapy may improve pain and function in certain tendinopathies.
However, results vary substantially between conditions and studies.
For example, evidence has been reported for plantar heel pain, lateral elbow tendinopathy, and some shoulder tendon conditions, while evidence for other conditions remains less certain.
These differences reinforce an important principle:
Shockwave therapy should be selected based on the condition, examination findings, current evidence, and individual patient—not simply because someone has pain.
Why Patients Choose Nova Physical Therapy
At Nova Physical Therapy, our mission is simple:
We Care.
Technology can be valuable, but technology should never replace a comprehensive evaluation and individualized rehabilitation program.
Our treatment philosophy emphasizes:
- Evidence-based care
- Individualized treatment plans
- Patient education
- Functional outcomes
- Progressive exercise
- Movement optimization
- Appropriate use of rehabilitation technology
- Long-term health and wellness
When shockwave therapy is appropriate, our goal is to integrate it into a rehabilitation program designed around your specific functional needs.
Frequently Asked Questions
How many shockwave therapy sessions will I need?
There is no universal number. Treatment protocols vary depending on the condition, technology, clinical findings, and individual response.
How often is shockwave therapy performed?
Treatment frequency varies among protocols and conditions. Your treatment schedule should be determined based on the specific clinical situation and treatment parameters.
Does one shockwave session work?
Individual responses vary, and a single treatment should not be assumed to produce a specific outcome.
Does shockwave therapy permanently fix tendon pain?
No treatment can guarantee permanent resolution of symptoms. Long-term management may also require addressing strength, activity tolerance, loading demands, mobility, and other relevant factors.
Do I still need exercises if I'm receiving shockwave therapy?
Often, yes. For many tendon-related conditions, progressive exercise and rehabilitation remain important components of care.
How do I know if I'm a candidate for shockwave therapy?
An appropriate clinical evaluation is the best way to determine whether shockwave therapy may be suitable for your presentation.
Schedule an Evaluation
If persistent heel, Achilles, elbow, knee, or shoulder tendon symptoms are limiting your ability to walk, work, exercise, or participate in activities you enjoy, Nova Physical Therapy can help determine whether physical therapy and shockwave therapy may be appropriate.
Our licensed physical therapists provide comprehensive evaluations and individualized rehabilitation programs focused on improving movement and function.
Contact Nova Physical Therapy today to schedule your comprehensive physical therapy evaluation and learn whether shockwave therapy may be appropriate for you.
Disclaimer
The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, or treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.
Extracorporeal Shockwave Therapy (ESWT) is not appropriate for every patient or every musculoskeletal condition. The number, frequency, intensity, and other treatment parameters should be determined individually based on clinical evaluation, current evidence, medical history, patient presentation, and professional judgment.
Physical therapists practice within applicable California laws and regulations and refer patients to other healthcare professionals when additional medical evaluation is indicated.
Individual results may vary. Nova Physical Therapy does not guarantee specific outcomes from shockwave therapy, physical therapy, exercise, or any healthcare intervention discussed in this article.
References
- Elgendy MH, et al. Effectiveness of Extracorporeal Shockwave Therapy in Treatment of Upper and Lower Limb Tendinopathies: A Systematic Review and Meta-Analysis. Physiotherapy Research International. 2024.
- 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.
- Xue X, et al. Effect of Extracorporeal Shockwave Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis. BMC Musculoskeletal Disorders. 2024.
- Physical Therapy Board of California (PTBC). Physical Therapy Practice Act.
- Physical Therapy Board of California (PTBC). Consumer Information: Physical Therapy Evaluation and Treatment.
- American Physical Therapy Association (APTA). Guide to Physical Therapist Practice.
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