Does shockwave therapy actually work?

Short answer

The effect was small. Pain drops after shockwave therapy, but it also dropped with a fake treatment, and the extra drop was only 0.78 points out of 10 in the shoulder. The elbow, Achilles tendon and heel showed no meaningful difference.

Does shockwave therapy actually work?
'Shockwaves → stimulate the tendon → less pain' — does this formula hold?
Shockwave therapy is widely used for elbow, shoulder, Achilles tendon and heel pain. The real question is not whether people feel better afterward, but whether they feel better than with a fake treatment where the machine makes noise but delivers almost no shockwave. We checked by body part.
Pain did drop after treatment
But it also dropped with a fake treatment
In a trial of 88 people with heel pain, 37% in the shockwave group and 24% in the fake-treatment group had their pain cut by half or more after 3 months. Both groups got better over time, and statistically there was no difference between them.
Shoulder: 0.78 points more relief out of 10
Half of the 1.5 points you would actually notice
An analysis that pooled 32 trials (2,281 people) with shoulder tendon pain found that in the 9 trials (608 people) comparing against a fake treatment, pain fell 0.78 points more on a 10-point scale. That is about half of the 1.5 points considered a noticeable difference. Having calcium deposits in the tendon or not made no difference.
Same story for the elbow and Achilles tendon
Not meaningfully better than a fake treatment
An analysis that pooled 27 trials (1,871 people) with outer elbow pain found shockwaves were not meaningfully better than a fake treatment or a steroid injection. A 2026 analysis of 9 trials (557 people) with Achilles tendon pain also found no meaningful benefit for pain or function.
Heel: only a small 45-person trial showed a difference
In a 200-person trial the gap was 0.02 points
In a 45-person trial (2003), morning pain fell 2.6 points more out of 10 with shockwaves than with a fake treatment. Trials of 88 people and 200 people (2024) found no difference. In the 200-person trial, adding shockwaves differed by just 0.02 points in pain at 6 months from custom insoles and advice alone.
Unpleasant reactions were more common
26 vs 7 per 100 people
In 5 shoulder trials (295 people), side effects occurred in 41 of 156 people with shockwaves and 10 of 139 with a fake treatment. That is 26 vs 7 per 100 people. In the Achilles trials, 2 tendon ruptures were reported after focused shockwave therapy.
Bottom line: shockwaves are only slightly better than a fake treatment
The formula weakens at the 'shockwaves → less pain' link
Pain drops after shockwave therapy, but it also dropped with a fake treatment. The extra drop was 0.78 points out of 10 in the shoulder, and the elbow, Achilles tendon and heel showed no meaningful difference. Most of the improvement happened without the shockwaves.