Shockwave vs Injections vs Rest — An Honest Comparison
When a tendon injury has been present for long enough that rest alone is not shifting it, most people end up considering a handful of options.
Rest, injections and shockwave therapy are the three that come up most often in clinic, either because a patient has already tried one and is wondering about the others, or because they want to understand the differences before deciding.
Here is an honest, evidence-based comparison of all three: what each does, when it is most appropriate, and what the short- and long-term outcomes look like.
Reduce load
Most useful during the early stages of an acute injury when tissue initially needs protection and time to settle.
Reduce symptoms
Corticosteroid injections can provide significant short-term pain relief, but the longer-term picture is more complicated.
Stimulate repair
Uses acoustic energy to stimulate biological repair processes in persistent tendon and soft-tissue problems.
Rest
Rest is the correct starting point for a genuinely acute injury — something that happened recently and needs time for initial tissue healing.
In the first few weeks following a tendon strain, appropriate load reduction protects the tissue from further damage and allows the initial inflammatory phase to do its work.
The limitation of rest as a standalone strategy for chronic tendon injuries is well documented.
Tendons that have been painful and symptomatic for three months or more are typically in a degenerative, rather than actively inflammatory, state. The tissue has not healed; it has adapted to a chronic low-load state.
Further rest in this context does not prompt regeneration; it maintains the status quo.
The key limitation: rest can reduce pain because the tendon is no longer being loaded. That does not necessarily mean the tendon has rebuilt its capacity to tolerate training again.
Steroid (corticosteroid) injections
Corticosteroid injections are one of the most widely offered interventions for tendon pain in primary care, and they produce real short-term pain relief.
In the three to four weeks following an injection, many patients notice significant improvement.
The longer-term picture is less positive. Multiple systematic reviews and clinical guidelines now note that the pain relief from steroid injections is typically short-lived for tendinopathies, and that repeat injections carry a genuine risk of structural tendon damage.
Corticosteroids reduce collagen synthesis — which is what tendons are made of — and repeated injections can weaken tendon tissue over time, increasing the risk of partial or complete tendon rupture.
Faster pain relief
Steroid injection may provide strong symptom relief during the first few weeks after treatment.
The picture changes
The benefit may reduce with time, particularly when the underlying tendon problem has not been rehabilitated.
A 2024 systematic review comparing shockwave therapy and steroid injections for lateral epicondylitis — tennis elbow — found that injections provided significantly greater pain relief at one month, but at three months the outcome reversed in favour of shockwave therapy.
This pattern — better short-term results with injection, better long-term results with shockwave — is seen across multiple tendinopathies.
The practical implication is that a steroid injection before a specific event or occasion can be a reasonable short-term management tool. As a repeated or primary treatment strategy for chronic tendinopathy, the evidence does not support its use.
Important distinction: at We Fix Feet, we also offer Ostenil joint injection therapy for joint-specific conditions. This uses a different mechanism from corticosteroid injection and does not carry the same collagen-related risks.
Shockwave therapy
Shockwave therapy works via a different mechanism from both rest and injection.
Rather than suppressing the pain response or simply reducing load, it delivers focused acoustic energy to damaged tendon tissue to stimulate the body's own repair processes: collagen production, new blood vessel formation, and the breakdown of calcification where that is a factor.
What shockwave is trying to achieve
Encourage biological processes involved in tendon repair and remodelling.
Stimulate local responses associated with healing and tissue recovery.
Shockwave may help address calcification where this forms part of the underlying tendon problem.
The effect is not immediate; this is the most important expectation to set correctly.
Most patients notice sustained improvement during and after their course of sessions, with the full effect continuing to develop for six to eight weeks after the final session.
The result is genuine tissue improvement rather than pain suppression.
The evidence base for shockwave in chronic tendinopathy is well established for several conditions: plantar fasciitis, calcific shoulder tendinopathy, Achilles tendinopathy and lateral epicondylitis.
For plantar fasciitis specifically, the quality of the evidence is high and consistently positive.
Why we combine treatment with rehabilitation
The combination of shockwave therapy with structured rehabilitation — rather than shockwave as a standalone treatment — produces the most durable outcomes.
Shockwave restarts the healing process; rehabilitation rebuilds the tendon's load capacity, preventing it from breaking down again when training resumes.
You can read more about shockwave therapy at We Fix Feet and our approach to sports therapy and rehabilitation .
How to decide
A few questions help clarify which approach is most appropriate.
Questions worth asking
-
How long has the pain been present?
Under six weeks: rest and rehab first; shockwave is not typically appropriate for acute injuries. Over three months with incomplete recovery from rest alone, shockwave therapy is worth assessing. -
Has a steroid injection been used recently?
If within the last six weeks, there is a minimum waiting period before shockwave can be used safely. -
Is the goal short-term symptom management or resolving the
underlying problem?
A steroid injection serves the first goal; shockwave serves the second. -
Is there a structural or biomechanical factor contributing to
the problem?
Movement patterns, biomechanics and training-load errors may all need addressing alongside treatment if the improvement is going to last.
The right option depends on the injury, how long it has been present and what you are trying to achieve. That is why an assessment comes before deciding on a treatment.
Find out more
Not sure which approach your injury needs?
The first step is understanding what tissue is involved, how long the problem has been present and why it has not recovered. Our team can assess your injury and explain whether rest, rehabilitation, shockwave or another treatment pathway is most appropriate.
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