01
Duration
Pain has lasted more than 3 to 6 months
Shockwave is for chronic problems, not recent injuries.
Radial shockwave therapy · Tseri, Nicosia
Shockwave therapy: when it helps and when it doesn’t
Our guide to radial shockwave therapy: what it does, which chronic tendon problems it has evidence for, what a session is like, and why we don’t recommend it to everyone.
- GESY-registered clinic
- Storz Medical device (Switzerland)
- Team of 8 physiotherapists
- Strovolou 51, Tseri
01 · The technology
What radial shockwave therapy is
Radial shockwave therapy (rESWT) uses high-energy acoustic waves. A handpiece delivers them through the skin to the painful spot. The energy spreads over a depth of a few centimetres, so it suits tendons and fascia close to the surface.
Exactly how it works is not fully known. Studies in cells and animals show that the mechanical stimulus triggers healing processes: more blood flow, new blood vessels and activation of tendon cells. In people, we measure the result that matters to you: less pain and better function in specific chronic conditions.
Radial or focused?
There are two types: radial and focused shockwave therapy. At AlexPhysio we use radial shockwave, with a device by Storz Medical (Switzerland). Focused shockwave reaches deeper and has the most evidence for calcifications. Radial shockwave also has positive controlled studies in calcific tendinopathy of the shoulder. When focused shockwave is the better option for you, we tell you.
02 · When it fits
Second line, not first line
Shockwave is rarely the first treatment. For most tendon problems, the foundation is progressive loading: exercises that gradually increase the load the tendon can handle. We recommend shockwave when you have done 3 to 6 months of such a programme properly and progress has stalled.
02
Exercise
You have followed a proper exercise programme
Progressive tendon loading, with guidance, for several weeks.
03
Progress
Improvement has stalled
This is where shockwave acts as an accelerator: it helps the exercise programme get moving again.
04
Diagnosis
The diagnosis is clear
And it matches an evidence-based indication. If it isn’t clear, we find the cause first.
The most important thing to know
Shockwave does not replace exercise. In a study on the Achilles tendon, at 4 months 82% of people who did exercise plus shockwave were much better, compared with 56% with exercise alone. At 1 year the difference had disappeared, partly because many in the exercise group eventually had shockwave as well. Put simply: shockwave speeds up recovery, exercise completes it.
03 · Indications
Which problems it has evidence for
Not all indications have the same level of evidence. We tell you openly where it is strong, moderate or weak. In all of them, shockwave is combined with an exercise programme.
Chronic plantar fasciitis
Heel pain, with or without a heel spur. This is the most studied indication, with several controlled studies against sham treatment.
Strongest evidenceAchilles tendinopathy
In the middle of the tendon or where it attaches to the heel.
Moderate evidencePain on the outside of the hip
Greater trochanteric pain syndrome, gluteal tendinopathy.
Moderate evidenceTennis elbow
Studies don’t all agree, so we use it selectively.
Moderate evidenceCalcific tendinopathy of the shoulder
In the supraspinatus. Controlled studies with radial shockwave showed less pain and resorption of the calcification, although most research is on focused shockwave.
Moderate evidencePatellar tendinopathy
Jumper’s knee. Studies show a small or uncertain benefit. We only consider it after a proper loading programme has been exhausted, and we tell you so clearly.
Weak evidenceCalcific tendinopathy: our protocol
- 4 sessions, one a week. A fifth only if there is partial improvement.
- Reassessment of pain and function 4 weeks after the last session.
- If you have not improved, we take an X-ray then and decide on referral for focused shockwave or ultrasound-guided needling (barbotage).
- If you have improved, the X-ray is taken at 12 weeks, because resorption of the calcification continues for months.
✗ When radial shockwave is not the right tool
- Rotator cuff tendinopathy without calcification. Studies show no clear benefit over sham treatment.
- Acute injury or a recent tendon tear.
- Pain without a clear diagnosis. We find the cause first.
04 · The procedure
What a session is really like
Treatment is uncomfortable and often painful for a few minutes. We do not use local anaesthetic, because studies suggest it may reduce effectiveness.
01
First visit
Assessment first
We confirm the diagnosis and check that the indication fits. We record pain and function, so we have a baseline to compare against.
02
Every session
Locating the spot
We find the most tender point by touch and apply gel to the skin.
03
A few minutes
Treatment
About 2,000 pulses per session, at the painful spot.
04
You stay in control
Intensity
We gradually raise the energy to the highest level you can tolerate. You can ask us to lower it or stop at any time.
Schedule
Usually 3 sessions, one a week. Up to 5, only if there is measurable but incomplete improvement. Reassessment 4 and 12 weeks after the last session.
After the session
Redness, mild swelling or small bruises are common and settle within 1 to 2 days. Pain may increase for 24 to 48 hours.
The first 48 hours
Avoid heavy loading of the area, such as running and jumping. After that, continue your exercise programme as we have given it to you. If you need a painkiller, prefer paracetamol to anti-inflammatories for the first few days, unless your doctor has told you otherwise. This is a precaution, not a proven rule.
05 · Expectations
What to realistically expect
The result is not immediate. Improvement builds gradually, which is why studies measure it 12 weeks after the last session.
Shockwave genuinely helps, but not everyone. That is why we measure your progress and don’t continue if there is no result.
For the other indications there are fewer studies and the results are more variable.
06 · Safety
When we don’t use it
Serious complications are rare. At your first assessment we ask about your medical history and medication.
Contraindications (ISMST)
The International Society for Medical Shockwave Treatment rules out treatment when there is a malignant tumour, a fetus, or a pacemaker or defibrillator in the treatment area.
Blood thinners or a clotting disorder
We assess you first and, if needed, ask your doctor’s opinion.
Infection or an open wound
We do not treat an area with an infection or an open wound.
Children and teenagers
We do not treat near open growth plates.
Recent cortisone injection
After a recent cortisone injection in the same spot, we wait before starting.
07 · Our promise
The AlexPhysio commitment
We don’t recommend shockwave because we own the device. We recommend it only when it suits your condition.
Honesty from the start
If it isn’t the right tool for you, we tell you at the first assessment.
No sessions “just in case”
We start with 3 and decide together, based on measurements rather than impressions.
We measure the result
We record pain and function before we start, and again 4 and 12 weeks after the last session. At 4 weeks we decide whether anything more is needed; at 12 weeks we judge the final result.
We stop when it isn’t working
If there is no meaningful improvement, we re-examine the diagnosis and, if needed, refer you to an orthopaedic specialist.
Always with exercise
Shockwave is never given as a stand-alone “fix”.
08 · FAQ
What our patients ask
Is shockwave therapy painful?
Yes, it is uncomfortable and often painful for a few minutes. We set the intensity to the highest level you can tolerate and stop whenever you ask. We do not use local anaesthetic, because it may reduce the effect.
How many sessions will I need?
Usually 3, one a week. We add up to 2 more only if there is measurable but incomplete improvement.
When will I see results?
Some people feel a difference within the first few weeks. Usually, though, improvement builds gradually, which is why we assess it 4 and 12 weeks after the last session.
Can I have shockwave only, without exercises?
We don’t recommend it. Shockwave speeds up recovery, but it does not replace progressive loading of the tendon.
Does it help with a heel spur?
Heel pain usually comes from the plantar fascia, not from the spur itself. Chronic plantar fasciitis, with or without a spur, is the best-evidenced indication for shockwave.
Does it help with calcific tendinopathy of the shoulder?
In many cases, yes. In controlled studies, radial shockwave reduced pain and helped resorb the calcification, with wide variation in results. Most research is on focused shockwave, so we check with an X-ray: 4 weeks after treatment if you have not improved, 12 weeks if you have. If the calcification is not resolving, we refer you.
Are there side effects?
Usually redness, mild swelling, small bruises or increased pain for 1 to 2 days. Serious complications are rare.
Is it covered by GESY? How much does it cost?
Yes. With a GESY referral from your doctor, shockwave is given within the physiotherapy session, with the €10 co-payment per visit. Without GESY, each shockwave session costs €35. See how physiotherapy with GESY works.
Sources
Scientific evidence
The main studies and guidelines this page is based on.
Gerdesmeyer L, et al. Radial shockwave versus sham in chronic plantar fasciitis (245 patients). Am J Sports Med, 2008. DOI
Rompe JD, et al. Eccentric loading with or without shockwave for Achilles tendinopathy. Am J Sports Med, 2009. DOI
Rompe JD, et al. Home training, corticosteroid injection or radial shockwave for lateral hip pain. Am J Sports Med, 2009. DOI
Cacchio A, et al. Radial shockwave for calcific tendinopathy of the shoulder (90 patients). Phys Ther, 2006. PubMed
Kvalvaag E, et al. Radial shockwave with exercise for shoulder pain, with or without calcification. Am J Sports Med, 2017. DOI
Lippi L, et al. Meta-analysis of shockwave therapy for plantar fasciitis. Eur J Phys Rehabil Med, 2024. DOI
Stania M, et al. Radial versus focused shockwave for tendinopathies, a meta-analysis. Sci Rep, 2026. DOI
Surace SJ, et al. Shockwave therapy for rotator cuff disease, Cochrane review, 2020. DOI
ISMST. Indications and contraindications for shockwave therapy. shockwavetherapy.org
Book an appointment
We start with the right diagnosis
Call us for an assessment. If shockwave isn’t the right tool for you, we will tell you at the first appointment.
GESY-registered clinic
With a GESY referral, a €10 co-payment per visit. Without GESY, €35 per shockwave session.
Always with an exercise programme
Shockwave speeds up recovery, exercise completes it.
Measurable progress
We measure pain and function before and after. If it isn’t working, we stop.
Team of 8 physiotherapists in Tseri
Strovolou 51, close to Lakatamia, Strovolos, Dali and Latsia.
AlexPhysio
Phone96 666 081
WhatsAppSend a message
ParkingGround floor, street-level entrance. Parking around the clinic, underground or at ParkinTown (give reception your registration number).
HoursMon, Thu: 09:15–19:15
Tue: 09:15–18:30
Wed: 09:00–18:30
Fri: 09:15–17:00
Tue: 09:15–18:30
Wed: 09:00–18:30
Fri: 09:15–17:00
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Bring to your first appointment
- Ultrasound scans, MRI or X-rays, if you have them
- Which treatments and exercises you have already tried, and for how long
- A list of your medication, especially if you take blood thinners
- Comfortable clothes and the shoes you usually wear