Therapies
Acoustic Wave (Shockwave) Therapy in St. Louis: What It Treats and When It's Worth It
By Dr. Joe Sas, DC ·
Heel pain that's worst with your first steps in the morning. An elbow that aches every time you grip a paddle or a coffee mug. A shoulder or Achilles that's been "almost better" for months.
If that sounds familiar, you've probably tried rest, ice, stretching, maybe a brace or a cortisone shot. When a tendon problem drags on that long, it usually isn't stuck in "inflammation" anymore. The tissue has stalled in a half-healed state. That's exactly what shockwave therapy (also called acoustic wave therapy) is designed to restart.
What shockwave (acoustic wave) therapy actually is
We use Radial Shockwave Therapy. A handheld applicator sends strong acoustic pressure waves into the injured tissue. Those waves:
- Restart the healing response in tendons that have stalled
- Boost blood flow to tissue that doesn't get much of it, like the heel, Achilles and elbow tendons
- Calm pain signals in the area, which is why many people feel easier movement soon after a session
It's non-invasive, there are no needles or medication, and there's no downtime. You walk out and go about your day.
One note: you may have seen "acoustic wave therapy" advertised for erectile dysfunction or cellulite. We don't offer it for either. At Gateway, we use it only for muscle, tendon and joint pain.
Where it works best
These are the four conditions I see the best results with:
1. Plantar fasciitis (heel pain)
That stabbing heel pain with the first steps out of bed is the classic sign. Plantar fasciitis has some of the strongest research support for shockwave, especially when it hasn't cleared up with stretching, inserts and time. We pair it with calf and foot work and a look at how you walk and stand all day.
2. Tennis elbow and pickleball elbow
Pain on the outside of the elbow when you grip, lift or swing is an overloaded tendon. Shockwave helps get that tendon healing again, and we combine it with grip and forearm strengthening and a check of your neck and shoulder, since they can refer pain down the arm. More here: pickleball elbow, and how we fix it.
3. Shoulder tendon pain
Rotator cuff tendon irritation, including calcific tendinitis (calcium deposits in the tendon), often responds well. We test first to rule out a full tear or a problem coming from your neck.
4. Achilles tendon pain
Stiff, sore Achilles pain, worst in the morning or at the start of a run, is a common runner's and weekend-warrior problem. Shockwave works best alongside a progressive calf-loading program, so the tendon gets stronger and doesn't just feel better.
How we decide if it's right for you: test, don't guess
Shockwave isn't the answer for every pain, so we start with an exam:
- A history and orthopedic exam to confirm it's actually the tendon, and not a nerve, joint or referred problem
- A neck and spine check when the arm or shoulder is involved
- Motion Study X-Rays when we need a closer look at the spine
If shockwave fits, we'll tell you why. If it doesn't, we'll tell you that too.
What a session feels like
- Sessions are quick, usually just a few minutes on the treatment area
- You'll feel strong tapping. It can be uncomfortable over the sorest spot, and we adjust the intensity to you.
- Most plans are a short series of weekly sessions, combined with exercises and, when it helps, adjustments or cold laser
- We re-test along the way, measuring pain, strength and what you can do, so you know it's working
Who shouldn't have shockwave
Tell us if any of these apply. We may need to skip the area or choose a different treatment:
- Pregnancy
- Blood-thinning medication or a bleeding disorder
- Cancer, infection, or an open wound in the area
- A recent cortisone injection in the same spot
- A pacemaker or other implanted device near the area
- Children and teens with open growth plates near the area
Red flags: get checked right away
- A sudden "pop" at the back of the ankle, or you can't push off or stand on your toes (possible Achilles rupture)
- Heel or foot pain with numbness, burning or tingling, or pain at night that won't let up
- Redness, heat, swelling or fever around a joint
- Shoulder or arm pain with chest pain, shortness of breath or sweating. Call 911.
- Sudden loss of strength after a fall or injury
The bottom line
If a tendon problem has hung around for months, it's probably not going to heal just by resting it more. Shockwave therapy gives stalled tissue a reason to heal again, and it works best as part of a plan that fixes why it got overloaded in the first place.
Learn more about Radial Shockwave Therapy in St. Louis, see our sports injury care, or book an exam.