Does shockwave therapy work for tendon pain?

In a 2026 meta-analysis of eight randomised trials (458 participants), extracorporeal shockwave therapy did not differ significantly from sham shockwave on pain or function scores in chronic Achilles tendinopathy across follow-ups. A second 2026 meta-analysis, of nine trials (530 patients), asked a different question: whether radial or focused shockwave is better. It found no clear superiority of either for pain or function.

Does shockwave therapy beat sham for Achilles tendinopathy?

Ni et al., PeerJ 2026 pooled randomised trials comparing extracorporeal shockwave therapy (ESWT) with sham ESWT in chronic Achilles tendinopathy. Pain was measured as change on a visual analogue scale (VAS), and function as change on the VISA-A and AOFAS scores.

The authors set minimal clinically important differences (the smallest change that matters to patients) at 1.1 on the 10-point VAS, 8 on the 100-point VISA-A and 12 on the 100-point AOFAS. No significant differences between ESWT and sham were observed on these outcomes across follow-ups (all P above 0.05). Adverse events occurred in 4.5% with ESWT versus 1.2% with sham, a difference that was not significant (P = 0.12).

The authors also ran subgroup analyses, which they describe as hypothesis-generating. In people whose symptoms had lasted under 12 months, VAS scores fell more with ESWT than with sham at 1 month (weighted mean difference -0.76, P = 0.03) and at 3 months (-1.23, P = 0.001).

Is radial or focused shockwave better for tendinopathy?

Stania et al., Scientific Reports 2026 compared radial shockwave (RSWT) with focused shockwave (FSWT) in nine randomised trials and 530 patients with upper or lower limb tendinopathy. This is a head-to-head comparison of two forms of the treatment, so it does not show whether either beats sham.

The authors observed no clear superiority of either type for pain or function, because certainty of evidence was low or very low. Moderate-quality evidence indicated that radial shockwave improved wrist extensor strength in tennis elbow more than focused shockwave (mean difference 1.81, 95% CI 0.97 to 2.64), while grip strength did not differ significantly (0.57, 95% CI -1.68 to 2.82).

Both treatments were similarly safe, but the authors note that their conclusions are limited by low-quality evidence. Recovery methods for another group are compared in our post on recovery techniques for distance runners.

The bottom line

• In 8 sham-controlled trials (458 participants), shockwave did not differ significantly from sham on Achilles tendinopathy pain or function across follow-ups.
• A possible short-term pain benefit in symptoms under 12 months is a hypothesis-generating subgroup signal.
• Radial and focused shockwave showed no clear superiority over each other for pain or function in 9 trials (530 patients), with low or very low certainty.