is shockwave therapy painful? all you should know

If you've been told that shockwave therapy — formally known as Extracorporeal Shockwave Therapy, or ESWT — might help your injury, the first question you probably have is: "Will it hurt?" It's entirely reasonable to want an honest answer before you book, so this guide explains exactly what to expect at each stage of treatment, what the latest clinical research says about comfort and safety, and how our team at CK Physio approaches every session. 

Shockwave Therapy: What to Expect Before, During and After Treatment

Shockwave therapy is not painful for most people — though you should expect to feel something. During a session at CK Physio, patients typically describe a firm tapping or pulsating sensation, sometimes accompanied by a brief, dull ache in the treated area. Our Chartered Physiotherapists can adjust the intensity at any point to keep you comfortable throughout your treatment.

What Is Shockwave Therapy? A Plain-English Explanation

Extracorporeal Shockwave Therapy uses a hand-held device to deliver low-energy acoustic pressure waves — not electrical shocks — directly through the skin to an injured or painful area of the body. The word "extracorporeal" simply means the treatment is delivered from outside the body, with no injections, incisions, or anaesthetic required.

The technique was first used in the 1980s in urology to break up kidney stones, and its application in musculoskeletal physiotherapy has grown significantly since the early 1990s. Today, a growing body of peer-reviewed research describes ESWT as a non-invasive, well-tolerated treatment option that can support tissue healing, reduce chronic pain, and improve function in a range of musculoskeletal conditions.

There are two main types used in physiotherapy practice: focused shockwave therapy (fESWT) and radial shockwave therapy (rESWT). While both work on the same underlying principle — stimulating the body's natural repair mechanisms through mechanical energy — they differ in how they deliver that energy, and each has specific applications.

Does Shockwave Therapy Hurt? The Honest Answer

This is the question patients ask most often, and the honest answer is: it depends on the individual, the body area being treated, and the intensity setting used. The majority of patients describe the sensation as a firm, rapid tapping — not pain in the conventional sense.

According to patient information published by the St George's University Hospitals NHS Foundation Trust, patients may feel a tapping or pulsating sensation during treatment, with the intensity adjusted throughout to ensure comfort while still achieving therapeutic benefits. Some patients experience mild soreness in the treated area immediately afterwards, but this typically resolves within a few hours to a couple of days.

Clinically, what is happening is worth understanding. The acoustic waves stimulate nociceptors — the nerve receptors responsible for detecting pain — in the injured tissue. This response is actually part of how the treatment works: the stimulation triggers a pro-inflammatory healing response, increases blood flow, and encourages tissue regeneration through a process called mechanotransduction. So while some degree of sensation is normal, and even therapeutic, our physiotherapists at CK Physio will always work within your personal comfort threshold.

Before your session begins, you will be asked about your pain levels and any areas of concern. The device intensity starts low and is gradually increased only to the point that is therapeutically effective for you. You can signal to your physiotherapist at any time and the settings will be reduced immediately.

What the Research Says About Shockwave Therapy Comfort and Safety

Sources: PMC / Frontiers in Medicine — Recent Advances in Shockwave Therapy 2025, Royal National Orthopaedic Hospital ESWT Patient Guide 2026

The safety profile of shockwave therapy is well-established. A 2025 narrative review published in the journal Healthcare — examining evidence from PubMed, Cochrane, EMBASE, and PEDro databases — concluded that "ESWT is a safe treatment, with hardly any adverse effects reported" across conditions including tendinopathies, plantar fasciitis, myofascial pain, and osteoarthritis. The same review identified solid evidence (Level 1) for its use in managing pain from a range of musculoskeletal conditions, including Achilles tendinopathy, calcific shoulder tendinitis, lateral epicondylitis, and plantar fasciitis.

A 2024 meta-analysis of 18 randomised controlled trials in Frontiers in Medicine — covering rotator cuff tendinitis, lateral epicondylitis, and other upper limb tendinopathies — found that ESWT was significantly more effective than placebo in relieving pain at both three- and six-month follow-up periods, with radial ESWT producing particularly strong results.

From a patient comfort perspective, current clinical guidance from NHS physiotherapy departments notes that sensations during shockwave therapy range from mild tapping to short-lived discomfort in the treated zone — and that this is normal and expected. The Royal National Orthopaedic Hospital, one of the UK's leading specialist orthopaedic centres, describes ESWT as non-invasive, performed on an outpatient basis with minimal reported side effects.

At CK Physio in Hanwell, West London, our Chartered Physiotherapists follow evidence-based protocols and continuously monitor your comfort throughout every session. Because each patient's pain tolerance and tissue sensitivity differ, intensity is always personalised — never set at a fixed level and forgotten.

Conditions Commonly Managed with Shockwave Therapy

Shockwave therapy is one of the more versatile tools available to a Chartered Physiotherapist. It is typically recommended for persistent musculoskeletal conditions where standard treatments alone haven't produced sufficient improvement — usually after a period of around three to six months. The following table summarises the conditions where clinical evidence is strongest.

Source: Extracorporeal Shock Wave Therapy for Musculoskeletal Pain: A Narrative Review, Healthcare 2023 (updated literature search August 2025)

Not sure whether shockwave therapy is appropriate for your condition? The right starting point is always an assessment with a Chartered Physiotherapist, who will review your history, examine the affected area, and recommend the most suitable treatment pathway — which may include shockwave therapy alongside exercise rehabilitation and manual therapy.

What Happens During a Shockwave Therapy Session at CK Physio

Understanding the process in detail can help reduce any pre-treatment anxiety. Here is a step-by-step overview of what your shockwave therapy appointment at CK Physio typically involves.

Side Effects and Risks: What Is Normal After Shockwave Therapy?

Shockwave therapy has an excellent safety record when delivered by a qualified physiotherapist. That said, like any therapeutic procedure, it is not entirely free of side effects — and knowing what is normal helps you stay calm and prepared.

Common, temporary side effects that may appear within the first 24–72 hours include mild tenderness or aching at the treatment site, slight redness or warmth of the skin, and occasional bruising. These reactions are a natural part of the induced healing response and generally resolve within a few days. The Bradford Hospitals NHS Trust advises that any of these symptoms normally settle themselves within a week.

Rare complications — including persistent post-treatment pain, significant  swelling, altered skin sensation, or numbness — can occur in a small number of cases. These should be reported to your physiotherapist if they persist beyond one week.

One important point: the NHS advises against taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen in the days surrounding shockwave therapy sessions. This is because the treatment works partly by triggering a controlled pro-inflammatory healing response, and anti-inflammatories may interfere with this mechanism. Paracetamol is a suitable alternative for post-session discomfort if needed.

How Many Shockwave Therapy Sessions Will I Need?

The standard course of shockwave therapy for most musculoskeletal conditions consists of three sessions, typically spaced one to two weeks apart. This spacing is important: it allows the initial healing response triggered by each session to progress before the next stimulus is applied.

Some patients notice an improvement in symptoms after their first session. Others find the treated area feels temporarily more sensitive for a day or two before improvement begins — this is a normal part of the body's response to the treatment and should not be taken as a sign that the therapy is not working. Your physiotherapist will monitor your progress across the course and may recommend additional sessions if needed or adjust your exercise rehabilitation programme accordingly.

Shockwave therapy at CK Physio is never delivered in isolation. It works best as part of a broader treatment plan that may include manual therapy, targeted exercise prescription, and lifestyle advice — all designed to address the root cause of your condition and support long-term recovery.

Shockwave Therapy vs. Other Treatment Options

One of the reasons patients are often referred for shockwave therapy is that it offers a non-surgical alternative for conditions that have not responded to conventional physiotherapy alone. This is worth putting in context alongside other options.

This table is for general reference only. Treatment decisions should always be made in consultation with a Chartered Physiotherapist or your GP, based on your individual diagnosis and history.

Frequently Asked Questions About Shockwave Therapy Pain and Safety

Is shockwave therapy painful?

For most patients, shockwave therapy is not painful — though it does produce a noticeable sensation. You will typically feel a rapid tapping or pulsating during the treatment, which may be accompanied by mild discomfort in the treated area. Your physiotherapist can reduce the intensity at any point. Any post-treatment soreness usually fades within 24–72 hours.

What does shockwave therapy feel like?

Most patients describe shockwave therapy as feeling like a firm, repetitive tapping or vibration against the skin. The sensation varies depending on the area being treated and the type of shockwave used. Radial shockwave tends to feel broader and more diffuse; focused shockwave produces a more targeted, deeper sensation. Neither type should feel severe or unmanageable.

Can I go back to normal activities after shockwave therapy?

Yes. Shockwave therapy is an outpatient procedure with no recovery period. You can return to normal daily activities on the same day. High-impact activities or sport may need to be moderated for 24–48 hours after a session — your physiotherapist at CK Physio will advise you based on your specific condition and how you respond to treatment.

How many shockwave therapy sessions will I need?

A typical course of shockwave therapy consists of three sessions, spaced one to two weeks apart. Some patients respond after fewer sessions; others require additional treatment depending on the severity and chronicity of their condition. Your Chartered Physiotherapist will monitor your progress and adapt the plan accordingly.

Can I take painkillers before or after shockwave therapy?

Paracetamol is generally considered safe to take for comfort before or after a session. However, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen should be avoided for approximately two weeks surrounding your treatment course. NSAIDs can interfere with the pro-inflammatory healing response that shockwave therapy is designed to stimulate, potentially reducing its effectiveness.

Is shockwave therapy available on the NHS?

Shockwave therapy is available on NHS referral for certain conditions — usually where symptoms have persisted for three to six months or more and have not responded adequately to other treatments. If you do not meet NHS referral criteria, or prefer not to wait, shockwave therapy is also available privately at CK Physio. Contact our clinic for current pricing or visit our bookings page for details.

Are there any long-term risks of shockwave therapy?

The long-term safety record of ESWT is well-established in the clinical literature. Serious complications are rare when the procedure is performed by a qualified physiotherapist. The most significant rare risk — tendon rupture — is most commonly associated with very recent corticosteroid injections to the same area, which is why this is a contraindication. Your physiotherapist will screen for all relevant risk factors before proceeding.

Sources and further reading: St George's University Hospitals NHS Foundation Trust — Shockwave Therapy · Royal National Orthopaedic Hospital — ESWT Patient Guide · Bradford Hospitals NHS Trust — Radial Shockwave Therapy · Extracorporeal Shock Wave Therapy for MSK Pain — Healthcare (MDPI) 2023 · Recent Advances in Shockwave Therapy for MSK Disorders — PMC/Frontiers 2025 · ESWT Efficacy for Upper Limb Tendonitis Meta-Analysis — Frontiers in Medicine 2024