What happens after a shockwave session

The treated area is usually sore for 24 to 48 hours. That soreness feels like a deep bruise, sits directly over the spot that was treated, and fades without anything being done about it. Most people go back to work the same afternoon and sleep normally that night. Nothing is injected and nothing is cut, so there is no wound, no dressing and no stitches to come out.

That is the whole of it for the majority of people. The rest of this guide covers the less common reactions, the ones that are worth a phone call, and the situations where the treatment should not be given at all.

What it feels like during the session

A session delivers roughly five minutes of actual treatment. The handpiece is pressed firmly onto the skin over the painful area with gel in between, and energy arrives as rapid pulses rather than as one hit.

Most people describe the sensation as strongly uncomfortable rather than sharp. It is usually worst directly over the sorest part of the tendon, which is inconveniently also the part that needs treating. Say something at the time if it crosses from uncomfortable into unbearable. Energy level, pulse rate and handpiece angle are all adjustable mid-session, and there is nothing to be gained by enduring a setting that is too high.

Because a course typically runs to three to five sessions about a week apart, the clinician can also change the settings next time based on how you reacted to this one. The practical detail of the appointment is covered in what a shockwave session involves.

The common side effects

These are the reactions people report most often. Every one of them is local, meaning it sits where the handpiece sat.

  • Soreness or aching over the treated area, typically for 24 to 48 hours.
  • Redness of the skin, which usually fades within a few hours of the appointment.
  • Local swelling around the treated tendon or its attachment.
  • Small bruises, which turn up more readily over bony areas such as the heel or the outside of the elbow.
  • Numbness or tingling in the skin over the treatment site, which normally passes within a day.

None of these needs treating in itself. They are the tissue reacting to a firm mechanical stimulus, and they behave the way a deep bruise behaves.

The flare that catches people out

Some people find their original pain gets briefly worse before it settles. This is common enough that UK guidance names it.

For the hip, in NICE interventional procedures guidance IPG376, now HealthTech guidance HTG248, on shockwave for refractory greater trochanteric pain syndrome, recommendation 1.2 states that patients should be informed about the possibility of pain during and after treatment, and the risk that symptoms may worsen. That is a consent requirement placed on the clinician, and it exists because the possibility is real.

A flare in the first few days is not automatically a sign that something has gone wrong. It is still worth reporting, because the clinician may want to drop the energy level at the next session or space the sessions out.

Who should not have shockwave therapy

Assessment before a course exists partly to catch these. The contraindications generally observed are:

  • Pregnancy, where the area being treated is near the trunk.
  • Active infection in or around the tissue being treated.
  • A tumour in the treatment field.
  • An open growth plate in the treatment field, which matters for younger teenagers whose skeletons are still maturing.
  • Anticoagulant medication, which calls for careful assessment rather than an automatic refusal.

Tell the clinician about every medication you take and about a pregnancy that is early or unconfirmed. None of these questions is a formality.

When to contact the clinician

Ordinary post-session soreness improves day by day. Get in touch if it does not.

  • Pain that climbs steadily instead of settling, so that day three is worse than day one.
  • Swelling that keeps growing rather than peaking and fading.
  • Numbness or tingling that is still there after a couple of days.
  • Being unable to put weight through the leg when you could before the session.
  • Any sign of infection in the skin over the treated area, such as spreading heat or redness with fever.

A clinician would far rather hear about a symptom that turns out to be nothing than find out about it at the next appointment a week later.

The 48 hours after treatment

Keep moving normally. Walking, stairs and ordinary daily loading are fine unless you have been told otherwise. Sitting still for two days is not what recovery from a shockwave session looks like.

Hold off the hard session. Heavy loading of the treated tendon in the first day or two tends to make the soreness worse and tells you nothing useful.

Ask what to take. Advice on painkillers around a course of shockwave varies between clinicians, so ask what applies to you rather than reaching for whatever is in the cupboard.

Keep going with the loading programme. A course of shockwave runs alongside a progressive loading rehabilitation programme rather than replacing it, and the exercises are usually the part that carries the longer-term change.

How to judge whether the course helped

Soreness in the first 48 hours tells you nothing about whether the treatment is going to help. Tendon problems move slowly, and the honest point to review a course is six to twelve weeks after the final session, with a comparison against how the problem behaved before it started.

If you are weighing up whether a course is worth having in the first place, the evidence is set out in full in does shockwave therapy work, and the treatment itself is described on the shockwave therapy service page. For the commonest reason people ask about it, see plantar fasciitis.

Frequently asked questions

What are the side effects of shockwave therapy?

The common side effects are local and short lived. Expect soreness over the treated area for 24 to 48 hours, along with skin redness, mild swelling, small bruises, and sometimes numbness or tingling that passes. A brief flare of the original pain in the days after a session is also recognised.

Is shockwave therapy painful?

Most people find it strongly uncomfortable rather than sharp, and each session delivers only around five minutes of actual treatment. The energy level, the pulse rate and the angle of the handpiece can all be changed during the session, so say something at the time if it becomes too much.

How long does it take to recover from shockwave therapy?

There is no formal recovery period and nothing is injected or cut. The treated area is commonly sore for 24 to 48 hours, and most people carry on with ordinary daily activity immediately. Heavy loading of the treated tendon is usually held back for a day or two.

Who should not have shockwave therapy?

Treatment is generally avoided in pregnancy where the area being treated is near the trunk, and where there is active infection or a tumour in the treatment field, or an open growth plate. Anyone taking an anticoagulant needs careful assessment first rather than an automatic refusal.

Can shockwave therapy make the pain worse?

A temporary flare of the original pain is recognised. NICE guidance on shockwave for greater trochanteric pain syndrome requires that patients are told about pain during and after treatment, and about the risk that symptoms may worsen. Pain that climbs rather than settles should be reported.