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Written by Felicia Cher, Senior Musculoskeletal Physiotherapist at Physio & Sole Clinic
If you’ve been dealing with persistent tendon or muscle pain, chances are you’ve heard about shockwave treatment.
Some patients tell me it was a game-changer.
“Others say it helped… briefly.”
And a few wonder why it didn’t seem to work at all.
As a physiotherapist, this question comes up often: “Why does shockwave therapy work for some people, but not others?”
The short answer is this: Shockwave therapy isn’t the treatment itself, it’s the trigger.
What happens around it determines whether it truly helps.
Let me explain.
The Problem: Persistent Pain That Just Won’t Go Away
Many active adults, runners, gym-goers, and office workers in Singapore come to us with conditions like:
- Plantar fasciitis
- Achilles tendinopathy
- Tennis or golfer’s elbow
- Chronic shoulder or hip tendon pain
They’ve often tried:
- Resting
- Stretching
- Massage
- Painkillers
And when symptoms linger for months, shockwave treatment starts to sound like the next logical step.
The Frustration: “It Helped… Then the Pain Came Back”
Here’s the part that frustrates patients most:
“The pain improved after shockwave, but a few weeks later, it returned.”
This doesn’t mean shockwave therapy failed. It usually means the expectations around it were incomplete. Shockwave is frequently misunderstood as a fix. In reality, it’s better understood as a biological signal.
What Does Shockwave Therapy Actually Do?
Shockwave treatment uses controlled acoustic waves applied to injured tissue. Clinically, it can:
- Increase local blood flow
- Stimulate cellular activity in chronically irritated tissue
- Reduce pain sensitivity
- Encourage stalled healing processes to restart
In simpler terms, shockwave therapy tells your body:
“Pay attention here. Something needs to change.”
But it does not:
- Strengthen weak tissue
- Correct overload
- Fix movement habits
- Replace rehabilitation
This distinction is critical.
Is Shockwave Therapy a Cure or Just Pain Relief?
Shockwave therapy can provide pain relief, sometimes quickly, but pain relief alone is not the same as healing.
Think of shockwave treatment like rebooting a system.
If the underlying issue causing overload remains unchanged, the pain often returns.
That’s why some people feel better temporarily, while others improve long-term.
Why Shockwave Therapy Works for Some People but Not Others
In my experience, shockwave treatment tends to work best when three conditions are met:
1. The Pain Is Load-Related
Most tendon pain isn’t caused by a single injury, it develops when tissue capacity can’t keep up with daily demands.
Examples:
- A runner increasing mileage too quickly
- Long hours standing or walking at work
- Sudden return to gym training
Shockwave may calm pain, but capacity still needs rebuilding.
2. Shockwave Is Combined with Rehabilitation
This is where outcomes differ the most.
When pain reduces after a shockwave treatment:
- Exercises become tolerable
- Strength can be rebuilt
- Load can be reintroduced safely
This creates a window of opportunity, and rehab determines whether that window is used well.
3. Daily Load Is Addressed
Even the best treatment won’t hold if:
- Training volume stays the same
- Footwear isn’t appropriate
- Work demands overload the same tissue daily
This is why physiotherapy-led shockwave treatment focuses on what you do between sessions, not just the machine itself.
How Long Does Shockwave Therapy Take to Work?
This varies, but most people notice changes over 3–6 weeks, not overnight.
Common experiences include:
- Mild soreness after sessions
- Gradual reduction in pain sensitivity
- Improved tolerance to activity
True tissue adaptation takes time, especially for chronic tendon conditions.
Does Shockwave Therapy Heal the Tendon or Just Reduce Pain?
Shockwave helps create the conditions for healing, but healing itself depends on:
- Progressive loading
- Strengthening
- Movement control
- Recovery
Without these, shockwave mainly acts as short-term pain modulation.
Is Exercise Still Needed After Shockwave Therapy?
Yes, and this is one of the most important points.
Exercise:
- Rebuilds tissue capacity
- Improves resilience
- Reduces recurrence
Shockwave reduces the barrier to movement. Exercise creates lasting change.
When Is Shockwave Therapy Not Effective?
Shockwave treatment may be less suitable when:
- Pain is primarily nerve-related
- The issue is acute inflammation rather than chronic irritation
- Load management isn’t possible
- The goal is “quick relief only” without rehab
This is why assessment matters before starting treatment.
How Many Shockwave Sessions Do I Really Need?
There’s no universal number.
Typically:
- 3–6 sessions are required
- Progress is reviewed continuously
- Treatment is adjusted based on response
More sessions don’t automatically mean better results.
What Should I Avoid Doing After Shockwave Treatment?
After sessions, we usually advise:
- Avoid sudden spikes in activity
- Follow your rehab plan
- Don’t treat pain relief as a green light to overload
Recovery still needs structure.
Can Shockwave Therapy Fail If I Don’t Do Rehab Exercises?
Yes, and this is one of the most common reasons for the outcomes plateau.
Shockwave opens the door. Rehab determines whether progress lasts.
The Bottom Line: Shockwave Is a Tool, Not the Hero
Shockwave treatment can be incredibly effective when used in the right context.
At Physio & Sole Clinic, we see the best outcomes when shockwave therapy is:
- Clinically indicated
- Integrated with physiotherapy
- Tailored to lifestyle, sport, and work demands
If you’re considering shockwave treatment, the most important question isn’t how many sessions you need, it’s what comes with it.
Ready to Find Out If Shockwave Is Right for You?
If you’re dealing with ongoing tendon or muscle pain and aren’t sure whether shockwave treatment is enough on its own, a proper assessment makes all the difference.
Book an assessment with our physiotherapists to understand the real driver of your pain and whether shockwave therapy fits into your recovery plan.
