Focused Shockwave Therapy (ESWT) Brisbane

Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).

Focused shockwave therapy (ESWT) delivers a true acoustic shock wave that converges at a set depth inside the tissue. Because the energy concentrates at depth, this is the form used when the target is a tendon, joint, ligament or bone, most often for long-standing tendinopathies that have not settled with other care. The clinic in Milton, Brisbane, uses a STORZ Medical focused shockwave system.

STORZ Medical DUOLITH SD1 focused shockwave system — The STORZ Medical DUOLITH focused shockwave system.

What it can help with

Plantar fasciitis
Calcific & non-calcific rotator cuff tendinopathy
Tennis & golfer's elbow
Greater trochanteric pain syndrome
Proximal hamstring tendinopathy
Achilles tendinopathy

Suitability depends on the individual diagnosis and is assessed at consultation.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pressure waves to an area of injured tendon, soft tissue or bone. The mechanical stimulus is thought to promote local healing responses (including cell signalling, new blood-vessel formation and tissue remodelling) in tissues that have stalled in their recovery.

ESWT is most established for chronic tendinopathies that have persisted despite first-line measures such as activity modification, physiotherapy and time. It is non-invasive, performed in the clinic, and usually does not require an anaesthetic.

Shockwave is generally used as part of a wider plan that continues to address the underlying load and movement. Whether ESWT suits a particular problem depends on the diagnosis, which is assessed at consultation.

The shockwave therapy overview compares focused and radial shockwave side by side.

How it works

Focused shockwave and radial pressure waves are different, though both are often called "shockwave" and are sometimes grouped together. The difference is physical. A focused system (piezoelectric, electromagnetic or electrohydraulic) generates a true acoustic shock wave that converges at a focal point set at a defined depth within the tissue. So energy is concentrated where the target is. A radial (ballistic) pressure wave device generates a pressure wave with its maximum intensity at the applicator surface, spreading out and weakening with depth, which is why the international shockwave society notes it is more accurate to call it a pressure wave than a shock wave. In practice, focused devices suit deeper or more precisely localised targets; radial devices are more superficial and broad-field.

The leading theory of how the energy helps, for both, is mechanotransduction. Cells sense the acoustic energy and convert it into biological signals. Proposed effects that recur across the literature include release of nitric oxide and growth factors, new blood-vessel formation (angiogenesis), improved local blood flow, reduced sensitisation of pain nerves, and stimulation of tissue remodelling. In laboratory and animal studies there is also evidence for improved peripheral nerve regeneration and remyelination, which is part of the rationale for using shockwave in some nerve-related conditions. These mechanisms are well described in principle; the exact device, dose and protocol that work best for a given condition are still being refined.

A focused system allows the energy to be directed to deeper targets such as tendon attachments.

What the evidence shows

ESWT has a substantial and growing evidence base for chronic tendinopathy. Multiple systematic reviews and meta-analyses support its use for upper-limb tendinopathy and rotator cuff tendinopathy, and it is widely used where conservative treatment (load management, physiotherapy and time) has not resolved symptoms. A 2024 meta-analysis of 18 randomised controlled trials found ESWT effective in relieving pain across upper-limb tendinopathy, including rotator cuff disease and lateral epicondylitis. Reported adverse effects are generally minor and short-lived, such as transient local soreness or redness. Evidence quality varies by condition, and ESWT is typically one part of a broader rehabilitation plan.

Sources: ESWT for upper-limb tendinopathy, systematic review & meta-analysis (Frontiers in Medicine, 2024) , Focused vs radial shockwave in carpal tunnel syndrome, updated systematic review & meta-analysis (J Clin Med, 2023) , ISMST clinical guidelines for ESWT (2024), focused vs radial, indications & contraindications (PDF)

What to expect

Focused shockwave therapy is delivered as a course of about 4 to 6 sessions, usually spaced around a week apart, with the exact number and settings matched to the condition and the response. Each session takes a short time, and most people need no anaesthetic and have no formal downtime, though some short-lived local soreness afterwards is common. Focused shockwave delivers energy to a defined depth within the tissue, while radial (pressure-wave) devices spread energy more superficially. The treatment plan and the current cost are discussed at consultation.

Conditions reviewed for this treatment

The evidence for a treatment can be different for every diagnosis. The conditions below reach a discussable level in the diagnosis-specific review. This is not a recommendation for any individual. Suitability still depends on the diagnosis, what has already been tried, and the benefits, risks, costs and alternatives.

Frequently asked questions

What is the difference between focused and radial shockwave?

Focused shockwave concentrates acoustic energy at a defined depth in the tissue, whereas radial shockwave spreads a pressure wave more superficially from the skin surface. So focused is used when the target is a tendon, joint, ligament or bone, and radial mostly for muscle and fascia.

Does shockwave therapy hurt?

Treatment can be uncomfortable while the pulses are applied, and the intensity is adjusted to a tolerable level. Mild local soreness for a day or two afterwards is common and settles on its own.

How many sessions are needed?

ESWT is usually given as a course of 4 to 6 sessions about a week apart. The exact number depends on the condition and the response, and is planned at consultation.

Is there any downtime?

Most people have no downtime and can return to normal daily activity. Higher-impact or heavy-loading activity may need easing back for a short period.

Is it covered by Medicare?

There is no specific Medicare item number for shockwave therapy itself, but it is delivered as part of a musculoskeletal treatment program during a standard GP consultation, so the appointment is billed under the standard time-based GP consultation item numbers, which attract a Medicare rebate. Appointments are not bulk billed, so an out-of-pocket gap applies. Current fees and rebates are confirmed beforehand.

When will it be clear whether it has worked?

Improvement from ESWT typically develops over several weeks, often continuing after the course has finished. A review is arranged to assess the response.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

You must have your own regular GP before booking. This service works alongside your GP for focused care. Booking requirements.

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