Shockwave therapy for knee osteoarthritis has a larger research base than most people expect. Several systematic reviews of randomized trials report less pain and better function than sham treatment. The same research also sets clear limits. The benefit is smaller when shockwave is added to active rehabilitation, it appears weaker in severe osteoarthritis, and the human trials in these reviews do not show that shockwave regrows cartilage. This article summarizes what the reviews found and where the evidence stops.
What shockwave therapy is
Extracorporeal shockwave therapy (ESWT) sends short, high-pressure acoustic pulses into tissue from a handpiece on the skin. Focused shockwave concentrates energy at a set depth. Radial shockwave is strongest at the skin and spreads as it travels. The trials below used both types and many different settings, which is one reason the results vary. For a broader introduction, see our shockwave therapy overview.
What the systematic reviews found
A 2019 meta-analysis of 50 trials. Liao and colleagues, writing in Clinical Rehabilitation, pooled 50 randomized controlled trials with 4,844 patients. Shockwave was associated with higher treatment success than control treatments, along with less pain and better function on the WOMAC osteoarthritis index. Two factors predicted the size of the effect: the energy level used and the length of follow-up.
A 2023 review with GRADE recommendations. Silva and colleagues, also in Clinical Rehabilitation, included 12 randomized trials. Against sham, shockwave improved short-term function and reduced pain at short, medium, and long-term follow-up. When shockwave was added to exercise therapy, it still helped, but the authors noted those gains may not be clinically meaningful. The effects were clearer against placebo than against active rehabilitation.
A 2024 umbrella review. Tang and colleagues, in the International Journal of Surgery, combined eight earlier meta-analyses. Compared with sham, shockwave improved WOMAC scores, range of motion, and the Lequesne index. Pain on a 0–10 visual analog scale was about 2 points lower on average (mean difference −2.0).
A 2024 review of 24 studies. Liao and colleagues, in the Journal of Orthopaedics, reviewed 24 studies with 888 patients. Shockwave was effective compared with sham, and adding it to muscle-strengthening exercise worked better than exercise alone. It was not effective for severe knee osteoarthritis.
How to read these numbers
A few points help put the results in context. First, most of these figures are averages across many trials and patients. An average pain reduction of about 2 points on a 0–10 scale means some people improved a lot, some a little, and some not at all. It does not predict any one person's result.
Second, what shockwave is compared with changes the answer. Against a sham device, it looks clearly helpful. Against, or on top of, a good exercise program, the extra benefit shrinks. That is a reason to use shockwave alongside rehabilitation, not instead of it.
Third, pain and function scores describe how people feel and move. They are the outcomes that matter most to patients, but they are not measures of joint structure. A better WOMAC score does not mean the joint itself has changed.
Does the dose matter?
The research suggests it does. A 2024 dose-response meta-analysis by Chen and colleagues in the Journal of Orthopaedics analyzed seven randomized trials with 450 participants. Higher shockwave energy was linked to better WOMAC scores at 1 and 4 weeks and lower pain scores at 4 and 12 weeks. The link for WOMAC was not significant at 12 weeks. The 2019 meta-analysis also found energy level was a significant predictor, and the 2024 review of 24 studies reported better results with higher energy or more pulses.
None of these papers settles the best protocol. The 2024 review states that the optimal dose and pulse count are still unclear. In practice, the dose is set to the tissue, the patient's tolerance, and the response from one visit to the next.
Where the evidence is thinner
The reviews above are encouraging, but they have limits:
- Comparison matters. Effects are largest against sham. Against or on top of active rehabilitation, the extra benefit is smaller.
- Severity matters. One 2024 review found no benefit in severe osteoarthritis.
- Protocols vary. Trials differ in device type, energy, number of pulses, number of sessions, and where the pulses were aimed. Pooling them gives an average effect, not a recipe.
- Follow-up is short. Most trials report outcomes over weeks to a few months, not years.
- Pain outcomes include placebo response. Every trial of a pain treatment includes some. Sham-controlled trials help separate it, but they do not remove it.
What about cartilage?
This is where claims about shockwave most often go beyond the evidence. The human trials above measure pain, function, and range of motion. They do not show that shockwave regrows cartilage, reverses osteoarthritis, or changes the long-term course of the disease.
Most findings about cartilage and the bone beneath it come from animal and cell studies. A 2025 study in The American Journal of Sports Medicine, for example, found that radial shockwave reduced markers of cellular aging in the bone beneath the cartilage in arthritic rats and in cultured bone cells. We cover that study in cellular senescence, adhesion, and shockwave. Work like this helps explain how shockwave might act on joint tissue. It is not evidence that the same thing happens in a human knee, and we do not present it that way.
Focused or radial?
Both have been studied in knee osteoarthritis, and both appear in the reviews above. Head-to-head comparisons are few and small, and the trials use different settings, so we do not treat either type as categorically better for the knee. The choice depends on the target. Focused shockwave suits a specific, deeper spot, such as a tendon attachment or a localized painful area near the joint. Radial shockwave spreads across more superficial muscle and tendon. Our radial vs. focused shockwave article explains the physics.
Where EMTT fits
EMTT (extracorporeal magnetotransduction therapy) is not shockwave. It uses a pulsed magnetic field rather than a pressure wave. Its evidence base is much smaller. The best trial so far is a 2026 double-blind, sham-controlled study by Hollander and colleagues in the Journal of Back and Musculoskeletal Rehabilitation.
That trial enrolled 126 patients with three diagnoses: knee osteoarthritis (31), rotator cuff enthesopathy (43), and lumbar spondyloarthrosis (52). After eight weekly sessions, pain at 12 weeks for the whole cohort was 2.2 with EMTT versus 4.2 with sham on a 0–10 scale. Those are combined results across all three diagnoses. We do not quote a knee-only result from this trial. Follow-up ended at 12 weeks, and the trial measured symptoms, not cartilage. More on the therapy is on our EMTT page. When we pair it with shockwave, the reasoning is in EMTT alone or with shockwave.
How we use this in practice
The research supports shockwave as one option for reducing knee osteoarthritis pain and improving function in some people. It does not support it as a cure or as a replacement for the rest of knee care. Exercise-based rehabilitation remains a core part of osteoarthritis care, and injections and joint replacement help many people.
We start with an exam of the knee, the tissue around it, and the hip and foot that load it. If shockwave or EMTT fits the findings, we explain why and what results are realistic. If it does not, we say so. See how we approach knee osteoarthritis treatment, or book a new patient exam.
Sources
- Liao CD, Tsauo JY, Liou TH, Chen HC, Huang SW. Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials. Clinical Rehabilitation. 2019;33(9):1419-1430. PMID 31066293. (link)
- Silva AC, Almeida VS, Veras PM, et al. Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and GRADE recommendations. Clinical Rehabilitation. 2023;37(6):760-773. PMID 36524275. (link)
- Tang P, Wen T, Lu W, et al. The efficacy of extracorporeal shock wave therapy for knee osteoarthritis: an umbrella review. International Journal of Surgery. 2024;110(4):2389-2395. PMID 38668665. (link)
- Liao PC, Chou SH, Shih CL. A systematic review of the use of shockwave therapy for knee osteoarthritis. Journal of Orthopaedics. 2024;56:18-25. PMID 38765896. (link)
- Chen TY, Chou SH, Shih CL. Extracorporeal shockwave therapy in the management of knee osteoarthritis: a systematic review of dose-response meta-analysis. Journal of Orthopaedics. 2024;52:67-73. PMID 38435314. (link)
- 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. Journal of Back and Musculoskeletal Rehabilitation. 2026;39(3):885-895. PMID 41313312. (link)
