More shockwave doubts

• May 12, 2025 • by Paul Ingraham
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A weekly nugget or two of pain science news and ideas for patients and pros, usually 400–1000 words. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Scott Gavura, a long-time runner and the resident skeptical pharmacist at ScienceBasedMedicine.org:

“Given I’m currently limping and cursing my Achilles, I felt it was a good time to review the evidence and controversy associated with extracorporeal shock wave therapy (ESWT), so I’ll be better prepared when it’s offered to me at my next physiotherapy appointment.”

Anatomical diagram of the Achilles tendon, highlighting the full tendon on one leg (from the back of the heel up to the mid-calf), and where it usually hurts on the other leg: roughly the lower third of the tendon, extending into the heel.

Blue outlines the whole Achilles tendon, and red the typical location of Achilles tendinitis pain … and probably the single most common target for shockwave therapy.

He came to the inevitably underwhelming conclusion:

“Given ESWT is so widely available from health care professionals, it would be reasonable to assume that there is a good evidence base for the therapy — but that is not the case.”

Someday I might disagree with Scott about something, but it hasn’t happened yet. As he often does, he referenced my work on this topic:

“[Ingraham] noted “bizarre lack of quality research”, which does not substantiate the hype about this therapy. Moreover, the mechanisms of action remain poorly understood, and there’s ongoing debate over whether the observed benefits are due to the shockwaves themselves or placebo and contextual effects.”