Shockwave Therapy

The Science Behind Shockwave

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses to a targeted tissue zone. Unlike ultrasound, which transmits continuous sound waves, shockwave energy is delivered in discrete, high-pressure pulses that produce measurable mechanical effects at the cellular level.

The biological response is well-characterized: shockwave energy disrupts the abnormal, disorganized collagen networks that form in chronically injured tendons, stimulates angiogenesis (new blood vessel formation), promotes tenocyte activity for collagen regeneration, and — in calcific cases — breaks down hydroxyapatite deposits that conventional therapy cannot reach. The result is a tissue environment primed for healing.

Conditions We Treat with Shockwave

Shockwave therapy is most effective for chronic tendinopathies and calcific conditions where the tissue has failed to heal through the normal inflammatory process:

• Plantar fasciitis — heel pain with first-step morning pain, resistant to stretching and orthotics
• Achilles tendinopathy — insertional or mid-portion, often seen in runners and active adults
• Calcific shoulder tendinitis — calcium deposits within the rotator cuff causing severe acute or chronic pain
• Rotator cuff tendinopathy — chronic shoulder pain with overhead activity
• Patellar tendinopathy (jumper's knee) — anterior knee pain with jumping or stair use
• Lateral epicondylitis (tennis elbow) — outer elbow pain with gripping or extension
• Greater trochanteric pain syndrome — lateral hip pain, often misdiagnosed as bursitis
• Trigger points — myofascial knots in the trapezius, gluteus, and other large muscle groups

Our Shockwave Protocol

Targeted Diagnostic Assessment

Before treatment, Dr. DeFabio performs musculoskeletal ultrasound or reviews existing imaging to confirm the diagnosis and precisely localize the pathological tissue. Accurate targeting is the difference between effective treatment and missed pathology.

Treatment Parameters

Sessions last 10 to 20 minutes depending on the area being treated. Pressure, frequency, and pulse count are selected based on tissue type, condition chronicity, and your tolerance. Most patients complete 3 to 5 sessions spaced one week apart.

Integration with Rehabilitation

Shockwave is most effective when paired with a structured loading program — eccentric exercises and progressive tendon loading immediately following the treatment course. Dr. DeFabio prescribes a targeted rehabilitation protocol to reinforce the biological changes driven by the shockwave sessions.

What to Expect

The handpiece is applied directly to the skin over the treatment area with ultrasound gel. Pulses are delivered in rapid succession. Most patients describe the sensation as a focused, tolerable pressure — intensity is adjusted to your comfort. Post-treatment soreness lasting 24 to 48 hours is normal and signals active tissue remodeling.

Improvement often begins after the second or third session. Maximum benefit typically becomes apparent 6 to 8 weeks after completing the treatment series as collagen remodeling concludes.