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What is shock wave therapy
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive method in which acoustic waves of defined energy are transmitted through the skin into damaged tissue. The waves are generated outside the body and focused at a depth of 0.5–7 cm.
Mechanism: the mechanical energy of the wave causes micro-traumatization of tissue, triggering a local healing response — increased blood flow, recruitment of progenitor cells, breakdown of calcium deposits (in calcific tendinopathies). The method has been used in orthopedics for over 25 years.
Indications and evidence
Heel spur and plantar fasciitis
The most studied indication. Meta-analyses show significant pain reduction 12 weeks after ESWT compared to placebo.
Calcific tendinitis of the shoulder
ESWT breaks down calcium deposits in the supraspinatus tendon. Efficacy confirmed in RCTs for calcifications over 5 mm.
Tendinopathies (tennis elbow, Achilles)
Chronic degenerative tendon changes. ESWT stimulates angiogenesis and tissue remodeling. Moderate efficacy, comparable to other conservative methods.
ESWT and regenerative methods
ESWT and regenerative injections solve different tasks and often complement each other:
ESWT before injections
Shock waves “loosen” chronically altered tissue and improve its blood supply — this may increase the availability of target cells for growth factors from PRP or CGF.
Different zones
ESWT is effective for tendons, fascia, and entheses. Regenerative injections — for joints and intra-tissue structures under ultrasound guidance.
Limitations
ESWT is not used for malignancies in the treatment zone, pregnancy, acute infections, coagulation disorders. The full list of contraindications is determined by the physician.
Free clinic and treatment plan selection
Describe your case and attach the physician’s report. We will find clinics that use both ESWT and regenerative methods — and build a sequential plan.
Submit request +49 160 5736643Recovery and timelines
After an outpatient injection procedure, most patients return to normal activity within 1–3 days. Sport and heavy loads are resumed according to the physician’s plan, usually after 2–6 weeks, alongside therapeutic exercise. The effect is assessed after 6–12 weeks. After surgery, rehabilitation takes longer and depends on the operation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Lou J et al. 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.
- Rompe JD et al. Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am, 2008.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
FAQ: shock wave therapy
During the impulses you feel discomfort or moderate pain; the intensity is adjusted to the patient’s sensations and increased gradually. The treated area may be sore for 1–2 days afterwards. Painkillers and cooling during this time are best agreed with the physician.
A usual course is 3–5 sessions about a week apart, each lasting 10–20 minutes. The effect develops gradually, so the result is assessed 8–12 weeks after the course. Continuing exercises and adjusting load at the same time is important.
Radial shockwaves spread energy near the skin surface and act to a depth of 3–5 cm — used for superficial tendinopathies and fasciitis. Focused shockwaves concentrate energy at a point up to 12 cm deep — for deep structures and bone. The physician chooses the type according to where the problem is.
They are different methods. Shockwave therapy is a mechanical stimulus and is best studied in chronic tendinopathies and plantar fasciitis. PRP is injected into the tissue. In tendinopathies the methods are sometimes combined; in joint osteoarthritis shockwave therapy is usually not used.
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.