Shockwave Therapy

Shockwave Therapy?

Shockwave therapy (also called extracorporeal shockwave therapy, or ESWT) uses focused acoustic pressure waves delivered through the skin to stimulate healing in stubborn, chronic tendon and soft tissue injuries — the kind that haven’t responded to rest, stretching, or standard rehab alone.

The waves increase blood flow to the area, stimulate the body’s natural repair process, and help break the cycle of chronic, poorly-healing tissue. It’s a well-researched, evidence-backed treatment for a specific category of injuries: tendinopathies that have become stubborn or chronic.

At Back Nine, shockwave is used as one tool within a broader treatment plan — not a standalone fix. It’s most effective when paired with the loading and strengthening work that actually rebuilds tendon capacity long-term.

What Shockwave Can Help With

The strongest evidence for shockwave therapy is in chronic tendinopathies — cases where pain has been present for weeks to months and hasn’t responded to a reasonable trial of rest, stretching, or basic rehab. Conditions we commonly treat with shockwave include:

  • Plantar fasciitis (chronic heel pain)

  • Achilles tendinopathy

  • Patellar tendinopathy (“jumper’s knee”)

  • Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow)

  • Rotator cuff tendinopathy, including calcific tendinitis

  • Hip and greater trochanteric pain (case-by-case, depending on body type and tissue depth)

What to expect:

  • Sessions typically run 5–10 minutes for the treatment area itself, as part of a regular visit.

  • You’ll feel a rhythmic tapping or pulsing sensation, and some tenderness over the area being treated — most people describe it as uncomfortable but tolerable, not sharp or unbearable.

  • No numbing or anesthesia is needed.

  • Most protocols involve a series of sessions (commonly once a week for 3–6 weeks), not a single treatment.

  • Mild soreness for a day or two afterward is normal, similar to a deep tissue massage.

Why it’s paired with exercise, not used alone:

Shockwave changes the biology of the tissue — it doesn’t rebuild strength or capacity on its own. The research supporting shockwave is strongest when it’s combined with a loading and strengthening program, which is why every shockwave patient at Back Nine leaves with exercise alongside treatment, not instead of it.

Frequently Asked Questions

  • It’s uncomfortable more than painful — most people describe a deep, rhythmic tapping sensation and some tenderness, especially in the first session or two as the treated area is often already sensitive. Discomfort typically decreases across sessions as the tissue responds. We adjust intensity based on what you can tolerate.

  • Most conditions respond to a series of 3–6 sessions, spaced about a week apart. Some people notice improvement within the first couple of sessions; for others, meaningful change takes the full series. We’ll reassess along the way and adjust the plan if it’s not tracking the way we’d expect.

  • This varies by condition and how long you’ve had it. Chronic tendon issues that have been present for months typically take several weeks of treatment before you notice a real shift — shockwave is stimulating a biological repair process, not providing instant relief. We’ll set expectations specific to your case at your evaluation.

  • Back Nine is a cash-based practice, so we don’t bill insurance directly for any service, including shockwave.

  • Shockwave isn’t appropriate for acute injuries (recent fractures, active infections, or fresh tears), for anyone who is pregnant, or for use directly over certain implants or growth plates in younger athletes. It also isn’t the right tool for every type of pain — during your evaluation, we’ll confirm whether your specific issue is a good match before recommending it.

  • Dry needling targets muscle tightness and trigger points using a thin needle to release tension and restore movement. Shockwave targets tendon tissue itself, using acoustic waves to stimulate healing in chronic, poorly-responding tendon injuries. They address different tissues and different problems — some patients benefit from one, some from both as part of a broader plan.

  • No referral is needed — Maine allows direct access to physical therapy. At your evaluation, we’ll assess whether shockwave is appropriate for what you’re dealing with, or whether a different approach makes more sense.

Find Out If Shockwave Is Right for You?

If you’ve been dealing with stubborn heel, elbow, knee, or shoulder pain that hasn’t budged with rest or basic stretching, it may be time for a different approach. Schedule an evaluation and we’ll figure out the right plan together — shockwave included, if it’s the right fit.

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