Shockwave therapy has a meaningful clinical evidence base for greater trochanteric pain syndrome (GTPS) and gluteal tendinopathy. Randomized trials have reported improvements in pain and function with both focused and radial ESWT, and several studies show better longer-term outcomes than corticosteroid injection. The evidence is not uniformly positive, though. Systematic reviews differ in their conclusions, protocols vary, and many trials have a high risk of bias. Exercise and load management remain core treatments. Shockwave is best viewed as an adjunct or selected intervention, not a substitute for diagnosis or rehabilitation.
What has shockwave been studied for in the hip?
The trials enrolled people with chronic GTPS: pain and tenderness over the greater trochanter on the outside of the hip, usually lasting months. Gluteus medius and minimus tendinopathy is regarded as a major local contributor, but GTPS is a regional syndrome, and many trials defined it clinically rather than by imaging.
That matters for how the evidence applies. These results do not automatically transfer to lateral hip pain from hip osteoarthritis, a significant tendon tear, or pain referred from the lower back or a nerve root. How those are told apart is covered in GTPS vs. hip bursitis.
The key studies at a glance
| Study | Design | Comparison | Main finding | Key limitation |
|---|---|---|---|---|
| Ramon 2020 | RCT, 103 patients | Focused ESWT + exercise vs. sham + same exercise | Pain 6.3 to 2.0 vs. 4.7 at 2 months | Short protocol; one device type |
| Carlisi 2019 | RCT, 50 patients | Focused ESWT vs. therapeutic ultrasound | Less pain at 2 and 6 months | Function not clearly better |
| Heaver 2023 | RCT, 104 patients | Focused ESWT vs. guided steroid injection | Similar at 3 months; ESWT better at 12 months | 11 lost to follow-up |
| Rompe 2009 | Randomized controlled clinical trial; sequential assignment, 229 patients | Radial ESWT vs. home training vs. steroid injection | Injection best at 1 month; radial best at 4 months | Sequential, not concealed, allocation |
| Rhim 2024 | Meta-analysis, 8 RCTs, 754 patients | ESWT vs. other treatments | Modest short-term pain benefit | 7 of 8 trials high risk of bias |
| Harding 2024 | Review, 12 studies, 1,121 participants | ESWT vs. control | No statistically significant pooled advantage | Marked heterogeneity; mixed designs |
Focused shockwave trials
Focused ESWT plus exercise vs. sham plus exercise. Ramon and colleagues ran a multicenter randomized trial in 103 patients with chronic GTPS, published in the Journal of Bone and Joint Surgery in 2020. Both groups did the same specific exercise program and had three weekly sessions. One group received focused ESWT at 0.20 mJ/mm², the other a sham dose of 0.01 mJ/mm². In a 103-patient multicenter randomized trial, pain fell from 6.3 to 2.0 after focused ESWT plus exercise, compared with 4.7 after sham treatment plus the same exercise program at two months. Secondary outcomes were also better in the ESWT group at almost every follow-up, and no complications were reported. The authors reported that 86.8% met the study's success criterion at two months, maintained through six months.
Because both groups exercised, this design isolates the added effect of shockwave more cleanly than trials comparing shockwave with no treatment.
Focused ESWT vs. therapeutic ultrasound. Carlisi and colleagues randomized 50 patients with GTPS and gluteal tendinopathy (mean age 61, 86% women), reported in Clinical Rehabilitation in 2019. Focused ESWT produced greater pain reduction than therapeutic ultrasound at two months (2.08 vs. 3.36) and six months (0.79 vs. 2.03). Functional scores improved in both groups without a clear between-group advantage.
Focused ESWT vs. corticosteroid injection. Heaver and colleagues randomized 104 patients (94 women, mean age 61.5) to focused ESWT or an ultrasound-guided corticosteroid injection, published in Hip International in 2023. At three months both groups had improved, without clear differences in pain, function or quality of life. At 12 months the focused ESWT group had better pain (37.1 vs. 55.0), Harris Hip Score (69.7 vs. 57.5) and SF-36 scores (52.4 vs. 47.7). A positive Trendelenburg test, a sign of abductor dysfunction, improved in the ESWT group and stayed improved, while the injection group returned to baseline. Short-term differences were limited, but by a year the focused ESWT group was doing better.
Radial shockwave trials
Radial ESWT vs. home training vs. steroid injection. Rompe and colleagues studied 229 patients with refractory GTPS in the American Journal of Sports Medicine in 2009. Patients received a home training program, a single corticosteroid injection, or repetitive low-energy radial shockwave. Treatment success was defined as "completely recovered" or "much improved."
| Follow-up | Steroid injection | Home training | Radial ESWT |
|---|---|---|---|
| 1 month | 75% | 7% | 13% |
| 4 months | 51% | 41% | 68% |
| 15 months | 48% | 80% | 74% |
Steroid injection worked fastest at one month. By four months radial ESWT had the highest success rate, while at 15 months radial ESWT and home training both outperformed injection. Home training was numerically highest at 15 months, so this trial does not show shockwave beating exercise long term. Patients were assigned sequentially rather than by concealed randomization, which weakens the comparison.
A separate, smaller 2009 study. In the same journal and year, Furia, Rompe and Maffulli reported a case-control study of 66 patients: 33 received low-energy shockwave and 33 had other nonoperative care without shockwave. At 12 months pain scores were 2.7 vs. 6.3. That study was not randomized and should not be confused with the 229-patient trial above.
Is more energy better? Wheeler and colleagues randomized 120 patients with long-standing GTPS (mean symptom duration 45 months) to three sessions of radial ESWT at the recommended or maximally tolerated dose, or at a minimal dose. Everyone did a structured home exercise program. Both groups improved, with no measurable additional benefit from the higher dose. The authors could not say whether radial ESWT was ineffective in this group or whether the minimal dose was itself enough. The practical point is narrower: more shockwave energy is not automatically better.
Shockwave vs. exercise
Notarnicola and colleagues compared therapeutic exercise with ESWT in a randomized trial with crossover for non-responders, published in the Journal of Personalized Medicine in 2023. Pain and function improved across the study over six months, with no significant differences between the exercise, ESWT and combined sequences. Another randomized study found both therapeutic exercise and ESWT effective without a clear overall winner.
Exercise has strong evidence of its own. In the 204-patient LEAP trial in the BMJ, education about tendon loading plus exercise achieved global success in 51 of 66 participants at eight weeks, compared with 38 of 65 after corticosteroid injection and 20 of 68 with wait and see. It remained ahead of injection for global improvement at 52 weeks, although pain no longer differed between those two groups by then. Shockwave is not a replacement for that kind of program.
What do the systematic reviews show?
The JBJS Reviews meta-analysis. Rhim and colleagues pooled 8 randomized trials with 754 patients in 2024: five on focused ESWT and three on radial. ESWT gave lower pain scores than other treatments at two to four months (standardized mean difference −0.43), with substantial heterogeneity (I² 83%). Function on the Lower Extremity Functional Scale was better at six months, but the difference did not reach the minimal clinically important difference. Focused ESWT showed greater pain reduction than radial in the pooled analysis. Seven of the eight trials were rated high risk of bias, and the authors urged caution.
A review that did not find a clear advantage. Not every synthesis reaches the same conclusion. A separate 2024 review of 1,121 participants did not find a statistically significant overall advantage over control for pain or function, despite effect estimates generally favoring shockwave. Harding and colleagues, in Musculoskeletal Care, included 5 randomized and 7 non-randomized studies. They still considered shockwave a viable option but highlighted heterogeneity and the need for more robust trials.
The 2025 treatment review. Bremer and colleagues, in Clinical Rehabilitation, restricted their analysis to medium- or high-quality randomized trials with low risk of bias. They concluded that education and exercise can be cautiously recommended as the core approach, potentially supplemented by corticosteroid injection or focused ESWT, and that definitive trials are still needed.
Is focused or radial shockwave better for gluteal tendinopathy?
Both radial and focused ESWT have evidence in GTPS. A 2024 pooled analysis favored focused ESWT for pain, but the underlying trials were heterogeneous and largely high risk of bias. Device selection should therefore be based on the target, depth, examination and clinical context rather than a claim that one modality is universally superior.
Several of the stronger individual trials used focused ESWT, which concentrates energy at a selectable depth over the tendon insertion. The largest early trial used radial ESWT, which spreads energy across a broader, more superficial field. For the wider comparison, see radial vs. focused shockwave.
Shockwave vs. corticosteroid injection
The pattern across trials is about timing. A steroid injection tends to work fastest. In the Rompe trial it was clearly best at one month, and the LEAP trial found it better than wait and see at eight weeks. Shockwave trials show their advantage later: at four and 15 months in Rompe, and at 12 months in Heaver. That is a difference in time course, not evidence that injection does not work.
What shockwave does not do
The trials measure pain, function and quality of life. They do not show that shockwave regenerates the gluteal tendon or repairs a tendon tear, and a significant tear may need a different pathway. Shockwave also does not release the IT band. Claims about tissue repair go beyond what the human evidence in GTPS shows.
Who may be a candidate?
Shockwave is most often considered when lateral hip pain has persisted despite appropriate loading and activity changes, and the examination points to the gluteal tendons. Situations that need a different first step include:
- A fall, inability to bear weight or suspected fracture
- Marked abductor weakness suggesting a significant tear
- Groin-dominant pain, locking or catching suggesting the hip joint
- Back pain with numbness, tingling or weakness
- Fever, unexplained weight loss or a history of cancer
How Novo approaches lateral hip pain
We examine first. Focused shockwave and radial shockwave are options chosen by what the exam shows, alongside load management and progressive exercise rather than in place of them. See how we approach lateral hip pain and gluteal tendinopathy, tendon problems elsewhere on chronic tendinopathy, or shockwave therapy in Denver and the four tools we use.
References
- Ramon S, Russo S, Santoboni F, et al. Focused shockwave treatment for greater trochanteric pain syndrome: a multicenter, randomized, controlled clinical trial. Journal of Bone and Joint Surgery (American). 2020;102(15):1305-1311. PMID 32769596. (link)
- Carlisi E, Cecini M, Di Natali G, et al. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clinical Rehabilitation. 2019;33(4):670-680. PMID 30585498. (link)
- Heaver C, Pinches M, Kuiper JH, et al. Greater trochanteric pain syndrome: focused shockwave therapy versus an ultrasound guided injection: a randomised control trial. Hip International. 2023;33(3):490-499. PMID 34784804. (link)
- Rompe JD, Segal NA, Cacchio A, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine. 2009;37(10):1981-1990. PMID 19439758. (link)
- Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. American Journal of Sports Medicine. 2009;37(9):1806-1813. PMID 19439756. (link)
- Wheeler PC, Dudson C, Calver R, et al. Three sessions of radial extracorporeal shockwave therapy gives no additional benefit over "minimal-dose" radial extracorporeal shockwave therapy for patients with chronic greater trochanteric pain syndrome: a double-blinded, randomized, controlled trial. Clinical Journal of Sport Medicine. 2022;32(1):e7-e18. PMID 33512943. (link)
- Notarnicola A, Ladisa I, Lanzilotta P, et al. Shock waves and therapeutic exercise in greater trochanteric pain syndrome: a prospective randomized clinical trial with cross-over. Journal of Personalized Medicine. 2023;13(6):976. PMID 37373965. (link)
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. PMID 29720374. (link)
- Rhim HC, Shin J, Beling A, et al. Extracorporeal shockwave therapy for greater trochanteric pain syndrome: a systematic review with meta-analysis of randomized clinical trials. JBJS Reviews. 2024;12(8). PMID 39297780. (link)
- Harding D, Cameron L, Monga A, Winter S. Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis. Musculoskeletal Care. 2024;22(2):e1892. PMID 38777616. (link)
- Bremer T, Nicklen P, Fearon A, Morrissey D. The efficacy of gluteal tendinopathy treatments: a systematic review. Clinical Rehabilitation. 2025;39(5):600-617. PMID 40223303. (link)
