Living with chronic pain can be frustrating, especially when it keeps you from the activities you love, whether that’s climbing at Stone Gardens or running the trails at Discovery Park. If you’ve tried traditional treatments for persistent tendon, muscle, or joint pain without success, it can feel like you’re out of options. At Union Physical Therapy, we offer an advanced, non-invasive solution: Extracorporeal Shockwave Therapy (ESWT), a powerful technology designed to stimulate your body’s natural healing processes and resolve chronic pain at its source.
Our Seattle physical therapists use this evidence-based treatment to help outdoor athletes and active individuals overcome stubborn injuries and get back to their lives, stronger and without limitations.
Understanding Your Chronic Pain
Chronic musculoskeletal conditions, such as tendinopathies and plantar fasciitis, are often characterized by a stalled or failed healing response. Months of pain are typically not due to active inflammation, but rather to degenerative changes, reduced blood flow, and a buildup of scar tissue that prevent the tissue from fully repairing itself. This is why passive treatments often provide only temporary relief—they don’t address the underlying biological roadblocks. ESWT is designed to break this cycle by restarting and amplifying the body’s own regenerative capabilities.
How Shockwave Therapy Works: A Modern Approach to Healing
ESWT is a non-invasive procedure where a specialized device delivers focused acoustic waves through the skin to a precise target area. This is not an electrical shock, but rather a series of powerful mechanical pulses. The fundamental principle behind its effectiveness is mechanotransduction—the conversion of these physical sound waves into a cascade of biochemical signals within your cells.
This targeted energy triggers several key physiological effects to promote healing:
Stimulates New Blood Vessel Growth (Neovascularization):
ESWT significantly increases blood flow by stimulating the formation of new micro-vessels. This enhanced circulation delivers the vital oxygen and nutrients needed to repair damaged tissue, especially in tendons which naturally have a poor blood supply.
ESWT significantly increases blood flow by stimulating the formation of new micro-vessels. This enhanced circulation delivers the vital oxygen and nutrients needed to repair damaged tissue, especially in tendons which naturally have a poor blood supply.
Modulates Inflammation:
The therapy can help shift the cellular environment from a chronic, pro-inflammatory state to an anti-inflammatory, pro-regenerative state, allowing for productive healing.
The therapy can help shift the cellular environment from a chronic, pro-inflammatory state to an anti-inflammatory, pro-regenerative state, allowing for productive healing.
Stimulates Collagen and Growth Factors:
Shockwaves trigger the release of growth factors and stimulate the cells responsible for creating collagen, the primary building block of tendons and ligaments, restoring tissue strength and integrity.
Shockwaves trigger the release of growth factors and stimulate the cells responsible for creating collagen, the primary building block of tendons and ligaments, restoring tissue strength and integrity.
Provides Lasting Pain Relief:
ESWT helps reduce pain by desensitizing nerve endings and potentially interrupting pain signals transmitted by chronically irritated nerve fibers. By healing the underlying tissue, it addresses the source of the pain for long-term relief.
ESWT helps reduce pain by desensitizing nerve endings and potentially interrupting pain signals transmitted by chronically irritated nerve fibers. By healing the underlying tissue, it addresses the source of the pain for long-term relief.
Conditions We Effectively Treat with Shockwave Therapy
The clinical evidence for ESWT is strong and growing. We utilize this therapy as part of a comprehensive treatment plan for a variety of stubborn musculoskeletal conditions, particularly when other conservative treatments have failed.
Chronic Plantar Fasciopathy (Heel Pain)
Plantar fasciopathy is one of the most well-studied and FDA-approved indications for ESWT. Level 1 evidence from multiple systematic reviews and meta-analyses consistently shows that ESWT is effective in significantly reducing pain and improving function for patients with chronic heel pain. For cases involving heel spurs, fESWT has also been shown to reduce the size of calcifications.
Greater Trochanteric Pain Syndrome (Lateral Hip Pain)
Commonly known as hip bursitis or gluteal tendinopathy, this condition responds exceptionally well to focused ESWT. A Level 1 multicenter randomized controlled trial found that fESWT combined with an exercise protocol was significantly more effective than exercise alone in reducing pain and improving function. A systematic review also reported superior outcomes for ESWT compared to conservative treatments or corticosteroid injections.
Rotator Cuff Tendinopathy (Shoulder Pain)
For chronic shoulder pain, especially cases involving calcific deposits, ESWT is a powerful intervention. Level 1a evidence shows that ESWT provides significantly better pain relief and functional recovery compared to control groups. The mechanical energy helps break down calcium deposits, facilitating their resorption by the body and relieving pressure and pain.
Lateral Epicondylitis (Tennis Elbow)
As an FDA-approved treatment for chronic tennis elbow, ESWT has been shown in Level 1a meta-analyses to provide statistically significant improvements in pain reduction and grip strength compared to other methods.
Other Conditions
Emerging and strong evidence also supports the use of ESWT for other conditions such as
Achilles Tendinopathy and Patellar Tendinopathy (Jumper’s Knee), particularly when integrated with a comprehensive eccentric exercise program.
Your Path to Recovery with Shockwave Therapy
At Union Physical Therapy, ESWT is never a standalone treatment. It is a powerful tool integrated into a comprehensive rehabilitation plan designed to produce lasting results.
- Comprehensive Evaluation: Your journey begins with a thorough assessment by a Doctor of Physical Therapy to confirm your diagnosis and determine if ESWT is the right choice for you. We may use diagnostic ultrasound to visualize the tissue and precisely target the treatment.
- ESWT Sessions: A typical course of treatment involves 3-5 weekly sessions. 24 During the procedure, we will apply a gel to your skin and use a handheld applicator to deliver the acoustic waves. You may feel some discomfort during the treatment, which we use as feedback to ensure we are targeting the correct area.
- Integrated Rehabilitation: In conjunction with your ESWT sessions, you will engage in a tailored physical therapy program. This includes specific exercises to strengthen the supporting muscles, improve flexibility, and correct any underlying biomechanical issues that contributed to your injury in the first place.
- Return to Activity: Our ultimate goal is to get you back to the activities you love without pain. We will guide you through a gradual and safe return to your sport or hobbies, ensuring the treated tissue is strong and resilient.
Begin Your Recovery in Seattle Today
Find relief from chronic tendon pain with advanced Shockwave Therapy in Seattle. Our expert physical therapists target the root cause of your pain.
Frequently Asked Questions about ESWT in Seattle
Why should I have ESWT done by a physical therapist?
Physical therapists are experts in movement and musculoskeletal health. By integrating ESWT into a complete rehabilitation program, we don’t just treat the painful tissue—we address the root cause of the problem, including movement patterns, strength deficits, and biomechanics, to ensure a more comprehensive and lasting recovery.
Will my insurance cover ESWT?
Coverage for ESWT varies significantly between insurance plans. While some plans cover it for specific FDA-approved conditions like plantar fasciitis, many still consider it investigational for other uses. Our administrative team will help you understand your benefits. Union Physical Therapy also offers self-pay options for this service.
Are there side effects?
Side effects are generally minor and temporary. They can include localized redness, mild swelling, or bruising at the treatment site, which usually resolves within a few days. Serious complications are very rare when performed by a qualified professional.
How long does a session take and how many will I need?
A single ESWT session is quick, usually taking 5-10 minutes. Most conditions respond well to a series of 3 to 5 sessions, typically scheduled one week apart.
Is shockwave therapy painful?
You may experience some discomfort during the treatment, which typically lasts only a few minutes. Most patients describe it as a tapping or pulsing sensation that is tolerable. We adjust the intensity to your comfort level while ensuring the treatment is effective.
References
Andres, B. M., & Murrell, G. A. (2008). Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clinical Orthopaedics and Related Research, 466(7), 1539–1554. https://doi.org/10.1007/s11999-008-0260-1
Aqil, A., Siddiqui, M. R., Solan, M., Redfern, D. J., Gulati, V., & Cobb, J. P. (2013). Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clinical Orthopaedics and Related Research, 471(11), 3645–3652. https://doi.org/10.1007/s11999-013-3132-2
Bannuru, R. R., Flavin, N. E., Vaysbrot, E., Harvey, W., & McAlindon, T. (2014). High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Annals of Internal Medicine, 160(8), 542–549. https://doi.org/10.7326/M13-1982
Chen, Y. J., Wang, C. J., Yang, K. D., Kuo, Y. R., Huang, H. C., & Wang, F. S. (2004). Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. Journal of Orthopaedic Research, 22(4), 854–861. https://doi.org/10.1016/j.orthres.2003.11.011
d’Agostino, M. C., Craig, K., Tibalt, E., & Respizzi, S. (2015). Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. International Journal of Surgery, 24(Pt B), 147–153. https://doi.org/10.1016/j.ijsu.2015.11.030
Korakakis, V., Whiteley, R., Tzavara, A., & Malliaropoulos, N. (2018). The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. British Journal of Sports Medicine, 52(6), 387–407. https://doi.org/10.1136/bjsports-2016-097347
Liao, C. D., Xie, G. M., Tsauo, J. Y., Chen, H. C., & Liou, T. H. (2018). Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders, 19(1), 278. https://doi.org/10.1186/s12891-018-2204-6
Yao, G., Chen, J., Duan, Y., & Chen, X. (2020). Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. BioMed Research International, 2020, 2064781. https://doi.org/10.1155/2020/2064781
Author & Medical Review
Authored by: Mitch Owens, PT, COMT
Mitch is a co-founder of Union Physical Therapy who specializes in treating athletes and individuals with complex musculoskeletal conditions using advanced, evidence-based modalities.
Medically Reviewed by: Elisa Owens, DPT on September 4, 2025.
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If you are struggling with chronic heel pain that makes your first steps in the morning extremely painful, focused extracorporeal shockwave therapy (fESWT) is the non-invasive treatment you need. Unlike traditional methods, fESWT acts as a “biological reset button” to restart the healing process at a cellular level. At Union Physical Therapy in Wallingford, we […]