Shockwave therapy has been tested in many placebo-controlled trials, and the results do not point in one direction. Some well-run trials found a clear benefit, others found none, and the answer depends on the condition, the type of device and what the treatment was compared with. This article summarizes key trials for heel pain, tennis elbow, Achilles pain and the shoulder, along with what they do and do not show.
Key points
- "Shockwave therapy" covers radial and focused devices. EMTT is a different treatment that uses a magnetic field, not a pressure wave.
- For chronic plantar fasciitis, two large sham-controlled trials found more improvement than placebo. An earlier trial of similar size found no difference.
- For tennis elbow, sham-controlled trials disagree, and a 2005 Cochrane review found little or no benefit.
- For Achilles tendinopathy, the trials cited here compared shockwave with exercise or waiting, not with a sham treatment.
- For calcific shoulder tendinitis, one double-blind trial found a clear benefit. A 2020 Cochrane review across shoulder conditions found mostly small differences from placebo.
- People in the placebo groups also improved, often substantially. Side effects were usually temporary pain, redness or swelling.
Three treatments under one name
Radial shockwave sends a pressure wave that spreads out from the applicator and is strongest at the skin surface. Focused shockwave concentrates the energy in a smaller zone at a chosen depth. Trials of one type do not automatically apply to the other, so the device used is noted for each trial below. Some trial reports do not say which type was used.
EMTT (extracorporeal magnetotransduction therapy) is not a shockwave treatment. It applies a pulsed electromagnetic field. It is covered separately below.
Heel pain (plantar fasciitis)
The heel pain trials show why a single study rarely settles the question.
- No difference from placebo. In a 2002 Australian trial in JAMA, 166 adults with heel pain received three weekly sessions of ultrasound-guided shockwave or a placebo version. Improvement in pain at 6 and 12 weeks was almost identical in the two groups (Buchbinder 2002).
- A small focused trial. In 40 patients, three weekly sessions of focused shockwave reduced heel pain more than placebo, but the difference was not statistically significant (Gollwitzer 2007).
- A larger radial trial. In 245 patients, three sessions of radial shockwave were followed by treatment success in 61.0% of the shockwave group and 42.2% of the placebo group (Gerdesmeyer 2008).
- A larger focused trial. In 250 patients with heel pain for at least six months, three weekly sessions of focused shockwave reduced a composite heel-pain score by 69.2%, compared with 34.5% for placebo, at 12 weeks. The trial was industry-funded (Gollwitzer 2015).
Taken together, the two largest sham-controlled trials favored shockwave, while an earlier trial of similar size did not. More detail is in our plantar fasciitis evidence review.
Tennis elbow (lateral epicondylitis)
- No difference from placebo. In a multicenter trial of 272 patients, three sessions of 2,000 pulses given with local anesthetic produced success rates of 25.8% with shockwave and 25.4% with placebo (Haake 2002).
- A positive trial. In 114 patients, three weekly low-dose sessions without anesthetic were followed by at least a 50% reduction in pain in 61% of the shockwave group and 29% of the placebo group at 12 weeks (Pettrone 2005).
- The 2005 Cochrane review pooled nine placebo-controlled trials with 1,006 participants and concluded that shockwave provided little or no benefit for pain and function in tennis elbow (Buchbinder 2005).
Research since then has not settled the question. Our tennis elbow evidence review covers more recent analyses.
Achilles tendinopathy
Achilles pain at the heel bone (insertional) and Achilles pain a few centimeters above the heel (midportion) behave differently and are studied separately. Neither trial below used a sham treatment, so they compare shockwave with other care rather than with placebo.
- Insertional. In 50 patients, low-energy shockwave was compared with an eccentric loading exercise program. At four months, 64% of the shockwave group and 28% of the exercise group reported being completely recovered or much improved (Rompe 2008).
- Midportion. In 75 patients, success rates were 60% with eccentric loading, 52% with shockwave and 24% with a wait-and-see approach. Exercise and shockwave did not differ significantly from each other (Rompe 2007).
See also insertional vs. midportion Achilles tendinopathy.
Shoulder: calcific and non-calcific rotator cuff problems
Calcific tendinitis. In a double-blind trial of 144 patients with chronic calcifying tendinitis of the rotator cuff, two sessions about two weeks apart were compared with sham treatment. At six months, the Constant shoulder score improved by 31.0 points with high-energy shockwave, 15.0 points with low-energy shockwave and 6.6 points with sham. Both active groups did significantly better than sham (Gerdesmeyer 2003).
Across rotator cuff conditions. A 2020 Cochrane review included 32 trials with 2,281 participants, 25 of them in calcific disease. Compared with placebo at about three months, shockwave reduced pain by 0.78 points on a 10-point scale and improved function by 7.9 points on a 100-point scale. Both differences were below the amounts the authors considered clinically important (1.5 and 10 points). Subgroup analyses did not show a difference between people with and without calcium deposits. The authors found "very few clinically important benefits" and uncertainty about safety (Surace 2020).
Guidance. In 2022, the UK's National Institute for Health and Care Excellence (NICE) advised that shockwave for calcific tendinopathy of the shoulder should be used only in research, citing no major safety concerns but insufficient evidence of efficacy (NICE IPG742).
Individual trials and reviews therefore point in different directions for the shoulder. Our rotator cuff evidence review covers more studies.
The evidence at a glance
| Condition | Compared with | What the cited studies found | Main limits |
|---|---|---|---|
| Plantar fasciitis | Sham | Two large trials (radial and focused) favored shockwave; one earlier trial found no difference | Conflicting trials; the largest focused trial was industry-funded |
| Tennis elbow | Sham | One large trial found no difference, one trial found benefit; the 2005 Cochrane review found little or no benefit | Protocols differed, including use of local anesthetic |
| Insertional Achilles | Exercise | More patients improved with shockwave at four months | One trial of 50 patients; no sham group |
| Midportion Achilles | Exercise or waiting | Shockwave and exercise both better than waiting, similar to each other | No sham group |
| Calcific shoulder tendinitis | Sham | One double-blind trial found clear benefit | Cochrane review found small average effects; NICE recommends use only in research |
| Knee osteoarthritis | Sham | An umbrella review of eight meta-analyses found better pain and function scores with shockwave | Small trials, overlap between reviews and inconsistent results |
| Trapezius myofascial pain | Sham or ultrasound; usual treatments | Less pain than sham or ultrasound; not better than dry needling, trigger point injection or laser | 10 trials, 480 participants |
Knee osteoarthritis is summarized from Tang 2024 and trapezius myofascial pain from Zhang 2020. More detail is in our knee osteoarthritis evidence review.
What about EMTT?
Two controlled trials are most often cited for EMTT.
- EMTT added to shockwave (2018). In 86 patients with rotator cuff tendinopathy, everyone received three shockwave sessions plus eight sessions of either active or sham EMTT. Both groups improved. The active EMTT group had greater pain reduction at 24 weeks. This trial tests EMTT as an add-on, not on its own (Klüter 2018).
- EMTT on its own (published online November 2025, in the May 2026 issue). In a single-center, double-blind trial, 126 adults with knee osteoarthritis, rotator cuff enthesopathy or lumbar spondyloarthrosis received eight weekly sessions of active or sham EMTT. At 12 weeks, average pain was 2.2 out of 10 with EMTT and 4.2 with sham, and physical health scores (SF-12) were also higher with EMTT. The trial was run in 2016 and 2017, was not prospectively registered, followed patients for only 12 weeks and used devices supplied by the manufacturer (Hollander 2026).
More detail is in our article on the EMTT placebo-controlled trial.
Sessions, energy and follow-up in these trials
- Sessions. Most shockwave trials above used three sessions about a week apart. The calcific shoulder trial used two sessions about two weeks apart. The EMTT trial used eight weekly sessions.
- Pulses. Where reported, the shockwave trials used about 2,000 pulses per session. The EMTT trial used 10,000 pulses per session.
- Follow-up. Main results were usually measured at 12 weeks to six months. Few trials followed patients for longer.
These protocols describe what was tested in the trials. They are not a standard course, and the Cochrane shoulder review noted that the varied protocols may have included doses too low to work.
Side effects
Reported side effects were mostly short-lived. In the 250-patient focused heel trial, the only device-related side effects were temporary pain and swelling. In the Cochrane shoulder review, side effects were reported in 41 of 156 people after shockwave and 10 of 139 after placebo, with low certainty about the estimate. In the EMTT trial, there were no serious side effects; skin redness (49.2% vs 9.5%) and pain during treatment (42.9% vs 17.5%) were more common with active treatment.
What the trials measured, and what they did not
The trials measured pain and function scores. They did not show how the treatment works inside tissue. Explanations of how shockwave or EMTT works come mainly from laboratory and animal studies, and the EMTT trial included no imaging or biomarker measures.
The placebo groups matter as much as the treatment groups. In the large heel trials, 42.2% of the placebo group met the success criteria in one trial, and placebo reduced heel pain by 34.5% in the other. Some of the improvement after any treatment reflects time, natural recovery and placebo effects.
Where the evidence stops
- The trials enrolled people with specific diagnoses, usually with symptoms lasting months. The results do not automatically apply to other conditions or to pain that has not been diagnosed.
- Protocols, devices and outcome measures vary from trial to trial, which makes results hard to combine.
- Several of the trials were funded by, or linked to, device manufacturers.
- Most trials followed patients for six months or less.
- Results are averages. Some people in each trial improved a great deal and others did not.
Whether shockwave or EMTT is reasonable for a particular problem is a question for a clinician who has examined you.
References
- Buchbinder R, et al. JAMA. 2002;288(11):1364-1372. PMID 12234230. (link)
- Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. J Foot Ankle Surg. 2007;46(5):348-357. PMID 17761319. (link)
- Gerdesmeyer L, et al. Am J Sports Med. 2008;36(11):2100-2109. (link)
- Gollwitzer H, Saxena A, DiDomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015;97(9):701-708. PMID 25948515.
- Haake M, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am. 2002;84(11):1982-1991. PMID 12429759.
- Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am. 2005;87(6):1297-1304. PMID 15930540. (link)
- Buchbinder R, et al. Cochrane Database Syst Rev. 2005;(4):CD003524. (link)
- Rompe JD, et al. J Bone Joint Surg Am. 2008;90(1):52-61. PMID 18171957. (link)
- Rompe JD, Nafe B, Furia JP, Maffulli N. Am J Sports Med. 2007;35(3):374-383. PMID 17244902.
- Gerdesmeyer L, Wagenpfeil S, Haake M, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573-2580. PMID 14625334. (link)
- Surace SJ, Deitch J, Johnston RV, Buchbinder R. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database Syst Rev. 2020;3:CD008962. PMID 32128761. (link)
- National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. Interventional procedures guidance IPG742. 2022. (link)
- Tang P, Wen T, Lu W, et al. The efficacy of extracorporeal shock wave therapy for knee osteoarthritis: an umbrella review. Int J Surg. 2024;110(4):2389-2395. PMID 38668665. (link)
- Zhang Q, Fu C, Huang L, et al. Arch Phys Med Rehabil. 2020;101(8):1437-1446. PMID 32234411. (link)
- Klüter T, Krath A, Stukenberg M, et al. Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: a prospective randomized controlled trial. Electromagn Biol Med. 2018;37(4):175-183. PMID 30183430.
- Hollander K, Burgkart R, von Eisenhart-Rothe R, Vester J, Gerdesmeyer L. Extracorporeal magnetotransduction therapy (EMTT) for management of musculoskeletal disorders: a double-blind, placebo-controlled, randomised trial. J Back Musculoskelet Rehabil. 2026;39(3):885-895. PMID 41313312. (link)
