Shockwave Therapy: How Acoustic Waves Break the Cycle of Chronic Pain

If you have been living with chronic tendon pain — the heel that stabs with every morning step, the elbow that aches with every handshake, the shoulder that wakes you at night — and traditional treatments have not worked, there is a technology that may change everything. Radial Pressure Wave (Shockwave) therapy at DakshinRehab in Moosapet, Hyderabad uses FDA-cleared acoustic waves to restart the healing process in damaged tendons that have stopped responding to rest, medication, and conventional physiotherapy.

What Is Shockwave Therapy and How Does It Work? Shockwave therapy — more precisely called Radial Pressure Wave (RPW) therapy — delivers high-energy acoustic waves into damaged tissue through a handheld applicator pressed against the skin. These pressure waves propagate into the tendon or muscle at the speed of sound, creating a controlled micro-trauma at the cellular level. This may seem counterintuitive — why would you create more trauma in already damaged tissue? The answer lies in a process called mechanotransduction: the conversion of mechanical stimulus into biological healing responses. Chronic tendon conditions like tendinopathy occur when a tendon enters a failed healing cycle — the initial injury triggers inflammation, but instead of progressing through the normal repair phases, the tissue gets stuck in a degenerative state with disorganised collagen, poor blood supply, and chronic pain. Shockwave therapy breaks this cycle by triggering three key biological responses.

The Three Healing Mechanisms: First, neovascularisation — the shockwaves stimulate the formation of new blood vessels in the damaged tendon. Chronic tendon conditions are characterised by poor blood supply, which prevents the delivery of oxygen and growth factors needed for repair. By stimulating new capillary growth, shockwave therapy restores the blood supply that natural healing requires. Second, breakdown of calcifications and scar tissue — acoustic waves physically fragment calcific deposits (common in calcific tendonitis of the shoulder) and disorganised scar tissue that has replaced healthy tendon fibres. This allows the body to reabsorb the debris and lay down properly organised collagen. Third, pain modulation — the high-energy waves overstimulate pain nerve endings, leading to a reduction in substance P (a pain neurotransmitter) and an increase in pain threshold. Many patients experience immediate pain reduction after the first session.

Conditions We Treat with Shockwave at DakshinRehab: Plantar fasciitis is one of the most responsive conditions — that stabbing heel pain with your first steps in the morning. Research shows that shockwave therapy produces significant improvement in 75–80 % of plantar fasciitis patients who have not responded to other treatments. Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are chronic tendon conditions at the elbow that respond exceptionally well, particularly when they have persisted beyond 3 months despite rest and bracing. Calcific tendonitis of the shoulder, where calcium deposits form within the rotator cuff tendons, is a primary indication — shockwaves break down the calcification while stimulating the body's reabsorption mechanisms. Patellar tendinopathy (jumper's knee), Achilles tendinopathy, IT band syndrome, and greater trochanteric pain syndrome (hip bursitis) all respond to targeted shockwave protocols.

What a Shockwave Session Feels Like: Each session at DakshinRehab takes approximately 10–15 minutes per treatment area. Our physiotherapist applies a coupling gel to the skin and positions the Chattanooga RPW2 handpiece over the target area, identified through clinical assessment and palpation. The device delivers 2,000–3,000 impulses per session at a pressure calibrated to the specific condition and tissue depth. You will feel a rapid tapping sensation — the intensity is gradually increased based on your tolerance. It is not pain-free, but it is well within manageable limits. Most patients describe it as a deep, rhythmic pressure. Some conditions (particularly calcific tendonitis) may produce temporary discomfort during treatment that subsides within hours. A typical treatment course involves 3–6 sessions spaced 5–7 days apart, allowing the biological healing response to develop between sessions.

Shockwave Combined with Our Comprehensive Approach: At DakshinRehab, shockwave therapy is integrated into a complete treatment program, not used in isolation. For shoulder pain, shockwave for calcific deposits is combined with TECAR therapy for capsular mobility and Redcord Neurac for scapular stability retraining. For knee conditions, shockwave for patellar tendinopathy is paired with hip strengthening and gait correction using 3D analysis. For plantar fasciitis, shockwave addresses the tissue pathology while foot biomechanics assessment, orthotic prescription, and calf flexibility work address the mechanical causes. This multi-modal approach ensures that shockwave restarts the healing process and our rehabilitation prevents the condition from recurring.

Evidence and Expected Outcomes: Published research consistently supports shockwave therapy for chronic tendon conditions. Meta-analyses report success rates of 75–90 % for plantar fasciitis, 65–80 % for tennis elbow, and 70–85 % for calcific tendonitis. At DakshinRehab, most patients notice improvement within 2–3 sessions, with maximum benefit typically reached 4–6 weeks after completing the treatment course (as the biological healing response continues after the final session). Important expectations: shockwave works best for chronic conditions (lasting 3+ months) that have not responded to conventional treatment. Acute injuries, recent fractures, and areas near growth plates are contraindications. We assess every patient's suitability before beginning treatment.