Clinical process
How shockwave therapy works
Quick answer
Shockwave therapy works through a five-step clinical process: assessment, identification of the target tissue, selection of appropriate treatment settings, application of acoustic or pressure waves through the skin with coupling gel, and progressive rehabilitation that builds the capacity needed for lasting recovery.
- 01
Step 1 — Clinical assessment
A physiotherapist evaluates the problem before any treatment decision is made.
- Pain location and symptom history
- Activity limitations and aggravating movements
- Tendon or soft-tissue loading tolerance
- Strength and mobility testing
- Previous treatment and its effect
- Relevant imaging, when available
- Medical history and screening for contraindications
- 02
Step 2 — Target identification
The clinician identifies the tissue or region requiring treatment through examination and, where appropriate, medical reports or imaging. The device does not independently diagnose your condition.
- 03
Step 3 — Treatment settings
Clinically appropriate parameters are selected. We do not publish universal energy levels, frequencies, pressures or impulse counts as instructions for patients.
- Treatment type and device
- Target tissue and depth considerations
- Condition and chronicity
- Patient comfort and feedback
- Response to previous sessions
- The clinic's clinical protocol
- 04
Step 4 — Acoustic or pressure-wave application
Coupling gel is applied and the applicator is moved over the target area. During treatment you may experience:
- Repetitive tapping or pulsing
- Pressure over the treated area
- Temporary sensitivity
- Mild discomfort over the affected area
- 05
Step 5 — Rehabilitation and progression
After treatment, your plan may include:
- Load-management guidance
- Mobility exercises
- Strengthening and tendon-loading work
- Balance or control training
- Running or sport-specific progression
- Workplace and ergonomic advice
- Home exercise instructions
Shockwave may create a useful treatment stimulus, but long-term recovery usually depends on correcting the movement, strength, loading or training factors contributing to the problem.
What the treatment does in the tissue
A simplified sequence of what happens when the applicator is placed over a symptomatic area. Nothing here describes tissue being broken, shattered or destroyed.
- Stage 1
Applicator positioned
The head is placed over the symptomatic area with coupling gel.
- Stage 2
Waves enter the tissue
Acoustic or pressure waves travel from the applicator into the target region.
- Stage 3
Mechanical stimulation
The target tissue receives a repeated mechanical stimulus (mechanotransduction).
- Stage 4
Local biological signalling
Cellular signalling and local circulation may be influenced by that stimulus.
- Stage 5
Pain modulation
Some patients report reduced sensitivity, which can improve rehabilitation tolerance.
- Stage 6
Rehabilitation progression
Better tolerance allows progressive loading, which is what builds capacity over time.
This illustration is simplified for patient education. Biological responses vary, and the treatment must be selected and administered by a trained clinician.
Potential effects are described carefully
Mechanical stimulation · mechanotransduction · pain modulation · local biological signalling · potential support for tissue remodelling · potential support for local circulation · rehabilitation progression. These are possible mechanisms discussed in the literature, not guaranteed outcomes.
Medical disclaimer. Information on this website is provided for general education and does not replace an individual clinical diagnosis or medical advice. Shockwave therapy is not suitable for every person or every condition. A qualified clinician must assess suitability.
Written by the Back2Health physiotherapy and rehabilitation team · Clinically reviewed by the Back2Health clinical team · Last reviewed 3 August 2026
Find out whether shockwave is right for your condition
Start with a clinical assessment. The Back2Health team will evaluate the source of your symptoms, explain whether shockwave is appropriate and build a rehabilitation plan around your goals.