SPECIALTY TOPICS · GUIDE

Shockwave Therapy

Extracorporeal shockwave therapy for heel, shoulder, tendon, knee and erectile problems: what the FDA approved, what Cochrane and other reviews show by condition, and the risks.

Content last updated October 22, 2026. This page has not been medically reviewed.

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What this page covers

Extracorporeal shockwave therapy (ESWT) is a procedure in which a clinician uses a device to direct pulses of acoustic energy through the skin to a painful area. The key question is not "does shockwave work?" but "for which condition, compared with what, and by how much?" We give no device settings or treatment schedules; those belong to the treating clinician.

Evidence labels used: approved medicine (here, an approved device for a named use), promising but limited, mixed, no good evidence of benefit. See How We Label Evidence.

Evidence by condition

Condition	What we read	Label
Plantar fasciitis (heel pain)	A 2026 network meta-analysis of 63 trials (4,170 people) comparing injection and shockwave treatments found ESWT showed broad efficacy across domains and timepoints. [5][6] A separate 2026 meta-analysis of 14 trials (797 people) found radial ESWT not superior to other electrical or physical modalities, with high risk of bias in most studies. [7][8]	Promising but limited
Rotator cuff (shoulder) tendon problems	A Cochrane review of 32 trials (2,281 people) found very few clinically important benefits and uncertainty about safety. [9][10] Versus placebo, mean pain was 0.78 points better on a 0-10 scale, below the 1.5 points the authors called clinically important. [11] A 2024 meta-analysis of 16 trials (1,093 people) reported better pain relief and function, calling the evidence limited. [12][13]	Mixed
Achilles tendinopathy	A 2026 meta-analysis found no clinically meaningful benefit for pain and disability; two Achilles tendon ruptures followed focused shockwave. [14][15]	No good evidence of benefit
Knee osteoarthritis	An umbrella review pooled eight meta-analyses. [16] It summarizes earlier reviews rather than testing anything new, and we did not read the underlying trials.	Promising but limited
Erectile dysfunction	An abridged Cochrane review found low-intensity shockwave may slightly improve short-term erectile function, with low certainty and uncertain clinical importance. [17][18] We did not verify regulatory status for this use: proper evidence not found on a US approval.	Promising but limited

Not the same as other devices

Handheld percussive massagers are a different technology: Massage Guns and Percussive Devices. For other physical modalities see Other Physical Modalities. To evaluate a specific device, use How to Evaluate a Health Device.

Frequently asked questions

Is shockwave therapy FDA approved?

The FDA database lists approvals of two devices for chronic proximal plantar fasciitis. [2][4] We did not verify approvals for other conditions.

Does shockwave therapy work for plantar fasciitis?

A 2026 network meta-analysis found broad efficacy, while another 2026 meta-analysis found radial shockwave not superior to other modalities; risk of bias was high. [6][8]

Does it work for Achilles tendon pain?

A 2026 meta-analysis found no clinically meaningful benefit. [14]

Is it safe?

Safety data are limited, and tendon ruptures were reported after focused shockwave in Achilles trials. [10][15]

More details: evidence, limits and cautions

The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.

What the US FDA approved

The FDA lists two shock-wave pain-relief generators approved through the premarket approval pathway for heel pain. The EMS Swiss DolorClast (decision 8 May 2007) [1] is indicated for chronic proximal plantar fasciitis in patients 18 or older with symptoms for 6 months or more and a history of unsuccessful conservative therapy. [2] The HealthTronics OssaTron (decision 12 October 2000) [3] was approved for chronic proximal plantar fasciitis that had failed to respond to conservative treatment; its withdrawal date is listed as 8 February 2021. [4] Read 2026-10-22 from the FDA database.

An approval names a device and an indication. We did not find, in what we read, an approval for the other conditions below, so use for them is outside the approved labeling and its evidence has to be judged on its own. A clinic offering a treatment does not prove it is approved; see Claim Check: "FDA Registered" vs Product Approval.

Why the results disagree

Trials use different devices, doses and comparison groups, and the Cochrane review notes that some may have tested sub-therapeutic doses, possibly hiding real benefits. [10] Placebo (sham) comparisons matter because pain changes with time and expectation. Reading a single "positive" meta-analysis without these limits can mislead; see Reading Early-Stage Research.

Safety and who should check first

Safety data are limited: the Cochrane shoulder review described uncertainty about safety, [10] and tendon ruptures were reported after focused shockwave in Achilles trials. [15] Both FDA-approved heel-pain indications above are for people whose conservative treatment had not worked. [2][4] People with new, severe or unexplained pain, swelling, numbness or weakness need an assessment first; see Talking With a Health Professional.

References

Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.