Chiropractic Use of Shockwave Therapy
Welcome, fellow chiropractors and evidence-loving clinicians! Today, we’re going to dive into a topic that might just ruffle a few feathers: the idea that shockwave therapy is not a magic wand. That’s right, your beloved shockwave machine won’t solve all the world’s musculoskeletal problems. Shocking, I know!
You’ve probably heard the jokes; some folks think that if you just blast a tendon or muscle with enough shockwaves, you can fix everything from plantar fasciitis to their morning coffee jitters. And don’t get me wrong: shockwave therapy is a fantastic tool. Studies from high-impact journals have demonstrated its effectiveness in treating chronic tendinopathies, bone injuries, and specific nerve-related issues. It's like having a superhero in your toolbox, but even superheroes have their kryptonite.
When Shockwave Isn’t Indicated
So, let’s get into those scenarios where shockwave is not your go-to hero. Here are four prime examples: (1)
1. Open Growth Plates in Children
Using shockwave therapy on an active growth plate injury is a poor idea because shockwave is designed to stress the tissue to kick-start healing purposely, and growth plates are already delicate areas that are naturally healing and growing; adding extra mechanical stress can increase pain, irritate the injury, and potentially interfere with normal bone growth, which is why rest, activity modification, and gradual rehabilitation are far safer and more appropriate choices for young athletes.
Sorry, but no zapping those young growth plates. We want those kiddos to grow up strong and healthy without any interference. Shockwave and developing bone growth plates are not a match made in heaven.
2. Active Infections or Tumors
If there’s an infection or any kind of malignancy, step away from the shockwave. We don’t want to stimulate anything that shouldn't be stimulated.
3. Clotting Disorders or Anticoagulant Therapy
If someone is on blood thinners and undergoes shockwave therapy, the primary concern is excessive bleeding into the tissues. Shockwave works by delivering mechanical pressure that intentionally stresses tissue, and when the blood’s ability to clot is reduced, that stress can lead to unwanted side effects, including:
Excessive bruising or hematoma formation under the skin or within a muscle.
Prolonged soreness or swelling that lasts longer than expected.
Localized bleeding that may not be immediately visible but can increase pain or delay recovery.
Delayed healing response, because regular tissue repair relies in part on controlled inflammation and clot formation.
4. Severe Vascular or Nerve Disorders
If there’s severe vascular disease or specific nerve issues, shockwave might not be the safest bet. We want to be gentle with those tissues.
I fully recognize that there are emerging and adjunctive uses of Shockwave Therapy that are not yet wholeheartedly supported by the highest levels of evidence. While I list severe vascular or neurologic disorders as traditional contraindications, critics are right to point out that the evidence around conditions like diabetic neuropathy is evolving—so as the research changes, our clinical application can thoughtfully evolve with it to better serve patients with debilitating conditions, which is why I’ve also included references for your review and a short list of three diagnoses where shockwave therapy has consistently demonstrated benefit. (2-4)
My Favorite Use: Gluteal Tendinopathy
Now that I’ve listed the conditions for which shockwave is not indicated, let’s discuss one of my favorite uses for it: Gluteal Tendinopathy. In my clinic, I’ve seen fantastic results using shockwave therapy on patients with stubborn gluteal tendon issues. It’s not just about the shockwave, of course: we combine it with manual therapy, manipulation, and correcting any functional imbalances that led to the issue in the first place. But shockwave is a great way to kickstart these patients’ road to recovery. It’s like giving their healing process a little turbo boost.
I have been using Shockwave extensively over the last several months, so I have added a new button to my plan section in the EHR to bill for shockwave and include a description in my SOAP note. Check it out in your User Settings.
Chiropractic Use of Shockwave
Shockwave therapy is a powerful and effective tool when used in the right clinical scenarios, with a substantial body of research from respected journals supporting its use for conditions such as chronic tendinopathies and plantar fasciitis. Our research team continually reviews and adds new evidence each month, now supporting the use of shockwave across more than 150 conditions. As an evidence-based chiropractor, be sure to reference the Condition Reference section in ChiroUp for the specific conditions you treat to confirm when shockwave is indicated. When applied thoughtfully, it’s an excellent addition to your clinical toolkit: just remember it’s not a one-size-fits-all solution: use it where the evidence supports it, and avoid it where it doesn’t.
In fact, a recent Delphi analysis revealed that this visual for conditions shockwave is indicated for: (1)
Based on expert consensus data in sports medicine and musculoskeletal care, shockwave therapy is strongly recommended for a wide range of chronic tendon, bone stress, and select soft-tissue conditions, with agreement rates consistently exceeding 85–100% across expert panels.
The most substantial support exists for chronic tendinopathies, including plantar fasciopathy, insertional and midportion Achilles tendinopathy, patellar tendinopathy, common extensor and medial epicondylopathy, proximal and distal hamstring tendinopathy, and gluteus medius/minimus tendinopathy, where consensus endorsement approaches or reaches 100%.
Shockwave therapy is also supported for calcific rotator cuff tendinopathy, greater trochanteric pain syndrome, and low-grade partial tendon tears, particularly when symptoms are persistent and conservative care alone has failed.
Additionally, there is strong consensus supporting its use in bone-related pathology, including delayed union fractures, non-union fractures, bone stress injuries, and medial tibial stress syndrome, especially in cases lasting longer than three months.
Across these conditions, shockwave therapy is viewed not as a standalone cure, but as an effective adjunct within a multimodal treatment strategy, reinforcing its role as a high-value intervention when applied to the right condition, at the right stage of healing, and in combination with appropriate rehabilitation and load management. Shockwave therapy is a powerful adjunct, but its effectiveness is amplified when combined with manual therapy, exercise, and thoughtful activity modification. Just as we emphasize throughout ChiroUp, clinical success is rarely about one “best” treatment, but about identifying the right recipe of interventions tailored to each unique patient presentation.
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Rhim H.C., et al. (2025). Recommendations for use of extracorporeal shockwave therapy in sports medicine: an international modified Delphi study. British Journal of Sports Medicine, 59(18), 1287-1301.
Spinoso, A. , Settineri, R. , McLaren, C. and Nicolson, G. (2023) Treatment of Peripheral Neuropathy: Combination Therapy Using LED Light, Extracorporeal Shockwave Therapy, Platelet Rich Plasma, and an Oral Dietary Supplement. International Journal of Clinical Medicine, 14, 250-259.
Yang L, Li X, Li S, Yang J, Meng D. Effect of extracorporeal shock wave therapy on nerve conduction: a systematic review and meta-analysis. Front Neurol. 2024;15:Article ID 1298456. doi:10.3389/fneur.2024.1298456.
Ruiz-Muñoz M, Rueda-Zapata L, Martinez-Barrios F-J, Nováková T, Lopezosa-Reca E, Gonzalez-Sanchez M, Fernandez-Torres R, Galan-Mercant A. Efficacy of Extracorporeal Shockwave Therapy in the Management of Chronic Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis. Medical Sciences. 2025; 13(4):219.
