If you have been told you have tendonitis and it has not settled in the timeframe you expected, the first useful thing to know is that the label is probably wrong, and that changes what actually helps. Shockwave therapy has a role in persistent tendon pain, but only a particular one.
Tendonitis implies inflammation. For most persistent tendon pain, that is not what is going on. Once symptoms have been present for more than a few weeks, what is typically found is a degenerative change in the tendon structure rather than an active inflammatory process. The more accurate term is tendinopathy.
This is not a semantic point. If you treat a degenerative tendon as though it is inflamed, you rest it, ice it and take anti-inflammatories, and you get short-term relief followed by the same problem when you return to activity, now with a weaker tendon than you started with.
Tendon adapts to load. Progressive, appropriately dosed loading is the treatment with the most consistent support across every tendon site, and it is the part of the plan that produces lasting change. It is also slow: meaningful tendon adaptation takes months, not weeks, which is the part people find hardest to accept.
There is no passive treatment, ours included, that substitutes for this.
The evidence for shockwave in tendinopathy varies considerably by which tendon is involved, and any clinic quoting you a single success rate across all tendon problems is oversimplifying.
For calcific tendinopathy of the shoulder, it is among the best-evaluated treatments available. For Achilles tendinopathy, reviews of mid-portion cases found moderate-quality evidence of benefit when shockwave was added to standard care, while a review examining it as a standalone treatment found very low quality evidence and no advantage over other conservative options. Patellar and gluteal tendinopathy have reasonable but smaller supporting evidence.
For tennis elbow, the placebo-controlled evidence is not supportive, and we do not recommend it as a primary treatment there.
The consistent thread is that shockwave performs as an adjunct to loading and not as a replacement for it. That is how we use it.
The practical problem with tendon rehabilitation is not usually that people disagree with the plan. It is that the tendon is too painful to load at a level that produces adaptation, or that repeated flare-ups keep interrupting progress and people give up before the months required have passed.
Reducing pain enough to load properly and stay consistent is therefore a real contribution to the outcome, even though the loading is what does the structural work.
A typical course is three to five sessions a week apart. It is uncomfortable during application for most people but brief, and there is no downtime. We expect you to continue your loading program throughout, and we adjust that program as your tolerance improves.
We set markers at the outset, usually pain during a specific loaded movement plus a function measure, and review against them. If pain has improved but you are not loading more, the treatment has not bought anything worth paying for.
Shockwave is not suitable for every presentation. Acute tendon injuries, suspected tears, and pain that has not been properly diagnosed all need assessment first. There are also medical circumstances where it is not appropriate, which we screen for.
If a tendon problem has been dragging on, the questions worth answering are which tendon, what stage, and what load it currently tolerates. Book an assessment at our Merrylands clinic and we will build the loading plan first, then tell you whether shockwave is worth adding.
Unified Chiro treats back pain, neck pain, sciatica and sports injuries from two clinics in Western Sydney — Merrylands and Lansvale.
Chiropractic care · Chiropractic adjustments · Dry needling & cupping · Remedial massage · Shockwave therapy · Cold laser therapy