Can Shockwave Therapy Cause Damage? Safety, Side Effects and What Actually Happens

By Clinton Grobbelaar, Physiotherapist. Published 16 September 2026.

Can shockwave therapy cause damage? On the published evidence, serious harm is rare. NICE has reviewed extracorporeal shockwave therapy for several tendon problems and concluded the evidence raises no major safety concerns. Common side effects are temporary: soreness, skin reddening, swelling, bruising and occasionally numbness. Tendon rupture is listed as a rare or theoretical risk.

The honest complication is not safety. It is effectiveness, which varies a great deal depending on which tendon is treated. This article covers both, because the two get tangled together and a clinic that answers only the first is not telling you much.

What is shockwave therapy and what does it do?

Extracorporeal shockwave therapy, usually shortened to ESWT, delivers high-energy acoustic pulses through the skin into a tendon using a handheld probe. NICE describes it as high-energy sound waves directed through the skin to the affected area, sometimes guided by ultrasound. NICE is careful about the mechanism, stating that it is not known exactly how it works, but that it is thought it might stimulate healing of the tendons.

It is used for chronic, stubborn tendon problems rather than fresh injuries. The NHS leaflet from Wrightington, Wigan and Leigh Teaching Hospitals lists plantar fasciitis, patellar tendinitis, Achilles tendinopathy, greater trochanteric pain syndrome and proximal hamstring tendinitis. Brookwood Physio uses shockwave therapy for chronic tendinosis and tendon calcification.

Can shockwave therapy cause damage to a tendon?

This is the fear that stops most people booking, so here it is plainly. Tendon or ligament rupture appears on the risk list, but it is described as rare. The NHS shockwave leaflet lists it among potential adverse effects, and NICE lists tendon rupture as a theoretical risk in its patient information on shockwave therapy for tennis elbow.

Set against that, NICE's position is consistent across separate pieces of guidance. For Achilles tendinopathy, NICE states that the evidence raises no major safety concerns. For refractory plantar fasciitis, NICE states the same. What genuinely reduces the risk is who holds the probe and whether you were screened properly beforehand. The contraindication list below is not a formality.

Does shockwave therapy hurt?

Yes, to a degree, and clinics that claim otherwise are overselling it.

The same NHS shockwave leaflet states that most patients do experience some pain or discomfort during the procedure. NICE notes that treatment may be carried out under local anaesthesia if high-energy shockwaves are used, because it can be painful.

The treatment itself is short: the same NHS leaflet puts a session at approximately five minutes of actual shockwave delivery. Intensity can usually be adjusted, so it is worth speaking up rather than enduring it silently. Some soreness afterwards is expected and is not a sign something went wrong.

What are the side effects of shockwave therapy?

That NHS shockwave leaflet lists bruising, pain, swelling, skin reddening, numbness, skin breakdown and, in rare cases, tendon or ligament rupture. It adds that these side effects should resolve within a week, before the next treatment session.

NICE's patient information on shockwave therapy for tennis elbow lists pain at the treatment site, temporary skin reddening, temporary swelling, nausea, bruising and skin damage. It gives one figure worth knowing: in one study, 42 of 134 patients experienced temporary reddening of the skin.

The Cochrane review of shock wave therapy for lateral elbow pain reported adverse effects that were minimal and temporary, naming transient pain, reddening of the skin and nausea. Across all three sources the pattern is the same: side effects are common, mild and short-lived.

Who should not have shockwave therapy?

The NHS shockwave leaflet sets out clear exclusions. Absolute contraindications include pregnancy, being under 18, a recent steroid injection at the site, clotting disorders, implanted cardiac devices, cancer, infection at the treatment site and epilepsy.

Relative contraindications, meaning it may still be possible but needs discussion, include anticoagulant medication, a fracture near the treatment site, and inflammatory conditions during a flare-up.

If any of these apply, say so before booking rather than at the start of the session. Several rule shockwave out entirely, and there is usually a sensible alternative.

What does a course of shockwave therapy involve?

The NHS shockwave leaflet describes a course as one treatment session a week for three consecutive weeks, with sessions no more than two weeks apart, and a follow-up assessment 4 to 6 weeks after the final session. NICE notes more loosely that shockwave therapy can be given in one or more sessions.

That follow-up gap matters. Shockwave is not judged on how you feel walking out of the room. On cost, private clinics price it either per session or as a course, and the figure varies between providers. Ask for the total cost of the full course up front, since a single session is rarely the plan.

What should you do after a session?

The NHS shockwave leaflet gives two pieces of aftercare advice that surprise people.

• Avoid strenuous, pain-provoking activities that stress the treated area for 48 hours.
• Do not use ice on the treated area or take non-steroidal anti-inflammatory medicines, because these may reduce the healing effect. This is the opposite of standard injury advice, and it catches people out. If you normally reach for ibuprofen after a sore session, check with your clinician first.

Does shockwave therapy actually work?

This is where the honest answer gets more complicated than the safety answer, and where it depends entirely on which tendon.

NICE's position on Achilles tendinopathy is that current evidence on efficacy of the procedure is inconsistent and limited in quality and quantity, and that it should only be used with special arrangements for clinical governance, consent and audit or research. NICE reached the same conclusion for refractory plantar fasciitis, describing the efficacy evidence as inconsistent.

For tennis elbow the evidence is less encouraging still. A Cochrane review of nine trials involving over 1,000 participants concluded that shock wave therapy provides little or no benefit in terms of pain and function, with 11 of 13 pooled analyses showing no significant advantage over placebo. NICE's own patient information for tennis elbow cites a trial in which 32 of 124 patients improved with shockwave compared with 31 of 122 given a placebo.

So shockwave therapy is a reasonable option for certain chronic, treatment-resistant tendon problems after loading exercise has been given a fair run. It is not a first-line treatment, and for lateral elbow pain the evidence does not support it. Clinton has spent over 30 years in private practice, and shockwave is used at Brookwood Physio as one tool within a hands-on programme rather than as a standalone fix.

When to get assessed first

Shockwave treats a diagnosis, so the diagnosis has to be right. Speak to a physiotherapist or GP before booking any shockwave course if:

1. The pain came on suddenly with a snap, pop or tearing sensation rather than building over months.
2. You have numbness, pins and needles or weakness, which points to a nerve rather than a tendon.
3. There is swelling, redness, heat or fever, which needs infection excluded.
4. The pain is present at complete rest or wakes you at night.
5. You have had a steroid injection at the site recently, are pregnant, take anticoagulants or have any condition on the contraindication list above.
6. You have not yet tried a structured loading programme, since that is first-line treatment for most tendinopathy and shockwave is generally considered only for cases that have not responded to it.

Frequently asked questions