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Shockwave therapy is one of the most effective conservative treatments in modern orthopaedics. At our practice in Palma de Mallorca, we have been using extracorporeal shockwave therapy (ESWT) successfully for years to treat a wide range of conditions. In this article, I share my experience as a specialist in orthopaedics and trauma surgery and explain what patients can expect from this therapy.
What Is Shockwave Therapy?
Extracorporeal shockwave therapy (ESWT) uses high-energy sound waves directed from outside the body onto the affected tissue. These shockwaves create controlled mechanical impulses that stimulate healing processes in the tissue.
There are two main forms:
- Focused shockwaves: High-energy, concentrated waves that penetrate deep into tissue and work with pinpoint accuracy
- Radial shockwaves: Waves that spread from the skin surface and treat larger areas
At our practice, we use both forms depending on the indication to achieve optimal results.
How Does Shockwave Therapy Work?
The shockwaves trigger several biological processes in the tissue:
Neovascularisation
The mechanical impulses stimulate the formation of new blood vessels in the treated area. More blood vessels mean better oxygen and nutrient supply to the damaged tissue.
Stimulation of Growth Factors
Shockwaves activate the release of growth factors such as VEGF (Vascular Endothelial Growth Factor) and eNOS. These factors accelerate tissue repair at the cellular level.
Dissolution of Calcifications
In calcification conditions (e.g. calcific shoulder), focused shockwaves can fragment calcium deposits and initiate their resorption by the body.
Pain Modulation
Shockwaves influence pain transmission by reducing the release of Substance P and activating the gate-control mechanisms of the nervous system.
Indications: When Does Shockwave Therapy Help?
Based on our clinical experience, the most common and successful indications are:
Calcific Shoulder (Tendinosis Calcarea)
Calcific shoulder is a well-documented indication for shockwave therapy in published studies. The focused shockwaves can fragment the calcium deposits in the rotator cuff and support their natural resorption — indication and outcome are assessed individually.
Heel Spur and Plantar Fasciitis
Chronic heel pain often responds well to shockwave therapy. Combined with insoles and stretching exercises, it is described in published studies as an established conservative option for patients with foot problems.
Tennis Elbow and Golfer’s Elbow
Epicondylitis of the elbow — whether lateral (tennis) or medial (golf) — is a classic indication. Particularly in chronic cases that do not respond to conventional therapy, shockwave therapy delivers convincing results.
Achilles Tendon Problems
Insertional tendinopathy and achillodynia in runners and athletes respond well to a combination of shockwaves and eccentric training.
Patellar Tendinopathy (Jumper’s Knee)
Particularly in athletes with chronic patellar tendon problems, shockwave therapy is an evidence-based treatment option.
The Procedure: What to Expect
Many patients are unsure about what to expect during shockwave therapy. Here is a step-by-step description of the typical procedure:
Before Treatment
- Diagnosis: Thorough clinical examination and imaging if needed (ultrasound, X-ray)
- Informed consent: Discussion of the indication, expected outcomes and possible side effects
- Planning: Determination of the treatment area and energy level
During Treatment
- The patient sits or lies comfortably, depending on the treatment area
- Contact gel is applied to the skin
- The shockwave handpiece is positioned on the pain point
- 1,500-3,000 impulses per session, lasting approximately 10-15 minutes
- The intensity is gradually increased and adjusted to pain tolerance
Pain During Treatment
To be honest: the treatment is not pain-free. Most patients describe an intense tapping or pressure sensation that can be uncomfortable depending on the area and energy level. However, the discomfort is tolerable and is actually a sign that the correct spot is being treated. After the session, any discomfort subsides quickly.
After Treatment
- Mild redness or swelling in the treatment area is normal
- No painkillers (especially no anti-inflammatories like ibuprofen) for the first 48 hours — they would diminish the desired healing stimulus
- Sports break: 2-3 days of rest for the treated area
- Initial effect: Often noticeable after the first session, main effect after 2-3 sessions
Expected Course and Published Response Rates
Published studies and clinical guidelines (see editorial policy, e.g. Cochrane and AWMF sources) describe good response rates for shockwave therapy in the following main indications:
| Indication | Sessions |
|---|---|
| Calcific shoulder (tendinosis calcarea) | 3-5 |
| Heel spur / plantar fasciitis | 3-5 |
| Tennis / golfer's elbow | 3-5 |
| Achilles tendinopathy | 3-5 |
| Patellar tendinopathy | 3-5 |
Indication and individual treatment success are assessed during the initial examination. For many patients, the full effect appears 4-12 weeks after the final session, as the biological healing processes need time.
Combination with Other Treatments
At our practice, we achieve the best results by combining shockwave therapy with other treatments:
- Cryotherapy at -110°C: Reduces inflammation and accelerates recovery between shockwave sessions
- PRP therapy (platelet-rich plasma): Platelet-rich plasma enhances the regenerative effects of shockwaves
- Physiotherapy: Targeted exercise stabilises results long-term
- Orthopaedic insoles: Essential for lasting relief in foot problems
As a qualified sports scientist (Diplom-Sportlehrer) and active athlete, I understand the importance of a holistic treatment approach. We combine conventional and complementary methods to achieve the best possible outcome — always with the goal of avoiding surgery.
Possible Side Effects
Shockwave therapy is a very safe procedure. Possible temporary side effects:
- Redness and mild swelling in the treatment area (1-2 days)
- Temporary increase in pain (normal and part of the healing process)
- Small bruises (rare)
Serious complications are extremely rare.
Contraindications
- Active infection in the treatment area
- Blood clotting disorders or anticoagulant medication
- Pregnancy
- Tumours in the treatment area
- Children and adolescents (open growth plates)
Frequently Asked Questions
How many sessions do I need?
Typically 3-5 sessions at 1-2 week intervals are sufficient. The exact number depends on the diagnosis and individual response. After 2-3 sessions, most patients report significant improvement.
Does insurance cover shockwave therapy?
Private health insurance typically covers shockwave therapy. For patients with national health insurance visiting or living in Mallorca, we can discuss coverage on an individual basis.
Is shockwave therapy an alternative to surgery?
Yes, in many cases. For calcific shoulder, heel spurs and chronic tendon problems, shockwave therapy can replace surgery. Studies show comparable long-term results with significantly lower risk. Our principle: conservative before surgical.
Can I exercise immediately after treatment?
We recommend 2-3 days of rest for the treated area after each session. Light activities (swimming, walking) are generally possible immediately. Intense loading of the treated structure should be avoided for 48-72 hours.
Would you like to know whether shockwave therapy can help with your condition? Book an appointment on +34 971 68 43 45 at our practice in Palma de Mallorca, Avinguda Mexico, 15. Consultations in English, Spanish and German.
