Is Shockwave Therapy Safe? What the Evidence Actually Says
Before committing to any treatment, it is reasonable to start by knowing whether it is safe.
Shockwave therapy has become one of the more widely used non-surgical options for persistent tendon and soft-tissue injuries, but the term creates a first impression that warrants some unpacking.
Here is a clear account of what the evidence says about safety, what the known side effects are, and who should not have it.
The safety record in clinical use
Extracorporeal shockwave therapy has been used in clinical settings for musculoskeletal conditions since the 1990s, and the evidence base on its safety is now substantial.
It is used by NHS services for certain conditions, including plantar fasciitis when conservative treatment has not produced adequate results, and it is recommended in clinical guidelines from bodies such as NICE for specific tendinopathy presentations.
The overall picture from clinical research is that serious adverse events associated with shockwave therapy for musculoskeletal conditions are rare.
Non-invasive
There is no incision involved in delivering the treatment.
No injection
Treatment is delivered through the skin using acoustic energy rather than an injection.
No medication
No systemic medication is involved in the shockwave treatment itself.
The treatment is non-invasive: no injection, no incision, no anaesthetic — which removes a significant category of procedural risk. There are no systemic medication side effects because no drugs are involved.
What side effects are commonly reported?
✓ Redness
Temporary redness can occur around the area where the treatment head has been applied.
✓ Mild swelling
Some people notice temporary local swelling after treatment.
✓ Soreness
The treated tissue can feel sore during the hours or day following a session.
✓ Mild bruising
Temporary bruising at the treatment site is occasionally reported.
These are temporary local responses at the treatment site and typically resolve without intervention. None of these constitutes a serious adverse event.
Who should not have shockwave therapy?
Like any treatment, shockwave therapy has contraindications — situations where it is not appropriate.
Pregnancy
Shockwave therapy is not used during pregnancy, as a precautionary measure.
Blood-thinning medication
Patients on anticoagulant therapy — warfarin, direct oral anticoagulants such as apixaban or rivaroxaban — have an increased risk of tissue bleeding at the treatment site. Shockwave is generally not recommended for this group.
Recent steroid injection
A corticosteroid injection in the six weeks preceding shockwave therapy increases the risk of tendon damage, because the steroid already compromises tendon structure and shockwave applied to compromised tissue carries more risk. The standard guidance is a minimum six-week gap between steroid injection and shockwave.
Malignancy in the treatment area
Shockwave is not used over an area where a diagnosis of cancer, primary or metastatic, is known or suspected.
Active infection or open wound
Treatment is not performed on an area of active skin infection or an open wound.
Thrombosis
Confirmed or suspected deep vein thrombosis in the relevant limb is a contraindication.
Children and adolescents
Shockwave is not typically used over growth plates in patients who have not reached skeletal maturity.
Why the assessment matters
- Review your current health and medical history.
- Check medication and previous treatment history.
- Confirm whether any relevant contraindications apply.
- Confirm the diagnosis and tissue being treated.
- Decide whether shockwave is appropriate for your specific condition.
At We Fix Feet, a clinical assessment prior to treatment includes a check for all relevant contraindications. If any apply, we will discuss alternative approaches.
The evidence on effectiveness and safety together
One thing worth noting about the clinical evidence on shockwave therapy: studies examining both safety and effectiveness tend to show that the conditions under which adverse events are most likely to occur are the same as those in which clinical guidelines indicate the treatment should not be used.
In other words, the contraindication framework does the safety work it is supposed to do when followed correctly.
The evidence for effectiveness is condition-specific.
Plantar fasciitis
The strongest evidence base is for plantar fasciitis, where multiple systematic reviews and meta-analyses support the use of shockwave as an effective treatment for chronic cases.
Other tendinopathies
The evidence for Achilles tendinopathy, calcific tendinopathy and lateral elbow tendinopathy — tennis elbow — is also positive, though the degree of certainty varies across conditions.
For a broader look at how shockwave compares with other treatment options, including steroid injections and structured physiotherapy rehabilitation, read our guide to which foot pain treatments work best .
What about the type of shockwave device?
There are different types of shockwave devices: radial, which distributes energy more broadly near the surface, and focused, which delivers energy more precisely to a defined depth.
Broader energy distribution
Radial treatment distributes energy more broadly around superficial tissue structures.
More precise depth targeting
Focused shockwave can deliver energy more precisely to a defined depth, making it useful when targeting deeper tissue structures.
The safety profiles are similar, but focused shockwave can be targeted more precisely at deeper tissue structures.
At We Fix Feet, we use appropriate technology for the condition and tissue depth involved.
The practical bottom line
Assessment is part of treatment safety
Shockwave therapy, when applied correctly and within its established contraindication framework, has a strong safety record as a non-invasive treatment for chronic tendon and soft-tissue conditions.
It is not a risk-free procedure; no treatment is, but serious adverse events in the context of musculoskeletal shockwave therapy are genuinely uncommon.
The important caveat is that "applied correctly" includes a proper clinical assessment beforehand.
An assessment determines whether the diagnosis is accurate, whether there are any contraindications, and whether shockwave is the most appropriate treatment for the specific condition — or whether something else would yield better results.
Is shockwave therapy suitable for you?
The safest starting point is a proper assessment. Our team can confirm the diagnosis, review any relevant contraindications and explain whether shockwave — or another treatment approach — is appropriate for your condition.
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