Shockwave therapy is a treatment in which high-energy acoustic pulses act mechanically on overloaded tendons, tendon attachments and fascia. It is best documented for chronic heel pain and calcifications in the shoulder tendons, while for other complaints research results are mixed. The treatment can be unpleasant, but the intensity is adjusted to what you can tolerate. In Rydułtowy it costs PLN 100.
Below we explain how shockwave therapy works, which complaints it is used for, what it feels like, who cannot have the treatment and how to prepare for it.
In brief
- Shockwave therapy is recommended, among others, in guidelines on chronic heel pain (JOSPT, 2023).
- The treatment costs PLN 100, or PLN 200 combined with manual therapy.
- The most important contraindications include pregnancy, blood clotting disorders and cancer in the treatment area.
- The physiotherapist decides the number of sessions after a consultation (PLN 180).
- The clinic in Rydułtowy is open Mon–Fri 7:00–20:00, private visits only (not covered by NFZ, the Polish public health fund).
Contents
What does shockwave therapy involve?
The physiotherapist places the device’s applicator on the skin over the painful spot, on a gel that helps conduction. The device produces a series of short acoustic pulses that spread through the tissues. They are thought to stimulate repair processes, improve blood supply and reduce sensitivity to pain. In physiotherapy, radial shockwaves are most often used; they act more superficially than focused shockwaves.
Shockwave therapy does not “smash” tissues or a bony spur – its effect is biological, not mechanically destructive. The physiotherapist adjusts the number of pulses, frequency and pressure to the complaint and the patient’s response.
What does shockwave therapy help with?
Shockwave therapy has the best-documented effect for chronic heel pain related to the plantar fascia and for calcific tendinopathy of the shoulder. It is also used for tennis elbow, chronic Achilles tendon pain, jumper’s knee and pain on the outer side of the hip, although here the research results are less clear-cut. It is usually considered when exercise alone is not enough.
A review of studies from the PEDro database (Schmitz et al., 2015) rated shockwave therapy as effective and safe for some indications, but not all of them. That is why we treat it as a complement to an exercise programme, not as a stand-alone treatment. We describe examples in our posts on heel spurs and jumper’s knee.
Does shockwave therapy hurt?
During the treatment you feel a rhythmic tapping and, at the painful spot, local tenderness, which is sometimes clearly unpleasant. The physiotherapist sets the intensity so that it is bearable and adjusts it during the session. After the treatment the area may be red and more sensitive; less often a small bruise appears. You can usually go straight back to your everyday activities.
A temporary increase in pain after the treatment can be normal, but if it lasts noticeably longer or swelling appears, tell the physiotherapist before the next session. The physiotherapist decides the duration and settings of the treatment individually.
Who cannot have shockwave therapy?
Shockwave therapy is not used in pregnancy, with blood clotting disorders or anticoagulant treatment, with cancer in the treatment area, skin infection or inflammation, over growth plates in children, or over the lungs, large blood vessels and nerves. Caution is needed with, among others, a pacemaker, thrombosis, a recent injury and a recent steroid injection. The physiotherapist makes the decision after a medical interview.
Full list of contraindications:
- pregnancy;
- blood clotting disorders, anticoagulant medicines;
- cancer in the treatment area;
- infection, wound or skin inflammation at the treatment site;
- growth plates in children and teenagers within the treatment area;
- the area of the lungs, large blood vessels, nerves, head and spine;
- pacemaker and other implanted devices – no treatment near them, decision after consultation;
- venous thrombosis in the treatment area;
- recent injury, acute inflammation, a recent steroid injection at that site;
- sensory disturbances and neuropathy in the treatment area;
- metal implants within the treatment area.
How should you prepare, and can it be combined with manual therapy?
Before the treatment, tell the physiotherapist about your medicines, especially anticoagulants, any implants, pregnancy and previous injections. Bring ultrasound or X-ray results if you have had them, and do not apply ointment to the treatment area. Shockwave therapy is often combined with manual therapy and exercise. At the “W zdrowym ciele” clinic, manual therapy combined with shockwave therapy costs PLN 200.
| Parameter | Shockwave therapy |
|---|---|
| Indications | chronic heel pain, calcific tendinopathy of the shoulder, chronic overload of tendon attachments |
| Contraindications | including pregnancy, blood clotting disorders, cancer in the area, skin infection (full list above) |
| What it feels like | rhythmic tapping, local tenderness, sometimes unpleasant |
| Combining | manual therapy, exercise |
| Price | PLN 100; with manual therapy PLN 200; packages: 5 visits PLN 450 (valid 1 month), 10 visits PLN 800 (2 months), 15 visits PLN 1100 (3 months); a package covers shockwave therapy only, and unused visits expire after the validity period |
| Home visit |
Prices valid from 08.2026. A package is a way of paying for a series of treatments, not a recommendation of how many you need: the physiotherapist decides the number of sessions after the consultation, and you can also pay for each session separately.
Good to know: we explain how shockwave therapy differs from a treatment that warms the tissues in the post TECAR or shockwave therapy – which to choose.
Summary
Shockwave therapy acts mechanically on overloaded tendons and their attachments, and is best documented for chronic heel pain and calcifications in the shoulder. The treatment costs PLN 100 (PLN 200 with manual therapy), can be unpleasant and requires contraindications to be ruled out, including pregnancy and blood clotting disorders.
Frequently asked questions
How many shockwave therapy sessions are needed?
The physiotherapist decides the number of sessions individually after the consultation. It depends on the type of complaint, how long it has lasted and how you respond to the first sessions. Before each further session, pain and function are assessed. If there is no improvement, the treatment plan is changed rather than continuing the same treatment indefinitely.
Can I exercise after shockwave therapy?
Usually yes, although straight after the session it is best to avoid putting very heavy load on the treated area, e.g. a long run or jumping. The exercises recommended by the physiotherapist are usually continued, as they are the basis of treating overload injuries. The details depend on the complaint, so it is worth agreeing them during the visit.
Does shockwave therapy break up calcifications?
In calcific tendinopathy of the shoulder, after shockwave therapy the calcifications shrink or disappear in some people, as confirmed by imaging. However, the mechanism is more complex than simply “breaking up” the deposit. With a heel spur, shockwave therapy does not remove the bony growth, but acts on the overloaded plantar fascia.
Can shockwave therapy cause harm?
When contraindications have been ruled out, side effects are usually mild and temporary: redness, tenderness, a small bruise or a short-lived increase in pain. The risk rises when the treatment is applied over the wrong structures or in people with blood clotting disorders. That is why the physiotherapist always takes a medical interview and examines you before the treatment.
Can I have shockwave therapy after a steroid injection?
After a steroid injection near a tendon, a gap is usually kept before shockwave therapy, as the tissue may be weakened. The length of this gap is decided individually with the doctor and physiotherapist. That is why before the first session you need to give the dates and sites of any previous injections.
Do I need a referral for shockwave therapy?
A referral is usually not required for a private treatment at the “W zdrowym ciele” clinic, but before the first session the physiotherapist takes a medical interview and carries out an examination. The clinic has no contract with the NFZ (the Polish public health fund). The treatment costs PLN 100, or PLN 200 combined with manual therapy. A physiotherapy consultation costs PLN 180.
Sources
- Schmitz C. et al., Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database, British Medical Bulletin, 2015.
- Koc T.A. et al., Heel Pain – Plantar Fasciitis: Revision 2023. Clinical Practice Guidelines, Journal of Orthopaedic & Sports Physical Therapy, 2023.
- ISMST (International Society for Medical Shockwave Treatment), Consensus statement on ESWT indications and contraindications.
About the author: Tatiana Grabowska, MSc – master’s degree in physiotherapy, licence to practise number PWZFz 11646 (Polish licence to practise as a physiotherapist). Since 2013 she has run the “W zdrowym ciele” physiotherapy and rehabilitation clinic in Rydułtowy; she has about 12 years of professional experience. Physiotherapist’s profile
- Consultation180 PLN
- Referralnot needed
- ReceptionMon–Fri: 7.00–20.00
