Chronic Tendon or Heel Pain? How Shockwave Therapy Actually Works
Shockwave Therapy for Tennis Elbow and Plantar Fasciitis: Does It Work?
You have tried the rest, the stretches, the loading program. Your tennis elbow or plantar fasciitis is not settling. Shockwave therapy is one of the most effective evidence based tools we have for stubborn tendon and heel pain, and at PHYZFIT Bexley North we deliver it without a separate surcharge — it is included with your standard physio consult when clinically indicated. Here is exactly how it works and when it makes sense.
Short Answer
Shockwave therapy (extracorporeal shockwave therapy or ESWT) delivers high energy sound waves into stubborn tendon and fascia tissue to stimulate healing, reduce pain and break down calcification. It has strong evidence for chronic plantar fasciitis (over 3 months) and chronic tennis elbow when standard loading programs have not settled the issue. Typical protocol is 3 to 6 sessions once per week. At PHYZFIT Bexley North, shockwave is included in your standard physio consult with no separate surcharge, which is unusual across Sydney where clinics typically charge $80 to $150 per shockwave session on top of the consult fee.
Below we walk you through how shockwave works, the evidence for tennis elbow and plantar fasciitis, what treatment looks like, and how our team at PHYZFIT uses it.
PHYZFIT Bexley North Advantage
Shockwave therapy is included in your standard physio consult at our Bexley North clinic. Most Sydney clinics charge $80 to $150 per session as an additional surcharge on top of the physio fee. If you need 3 to 6 sessions, that adds up quickly. With us, you pay one standard consult fee per session, full stop.
What exactly is shockwave therapy?
Extracorporeal shockwave therapy (ESWT) uses a handheld device to deliver high energy acoustic (sound) pulses through the skin into deeper soft tissue. Despite the intimidating name, no electricity is involved. It is a mechanical acoustic wave, similar in principle to the technology used to break down kidney stones in medicine.
Two main types are used in physiotherapy:
- Radial shockwave (rESWT): the more common type in physio clinics. Spreads energy outward across a wider area. Well suited to superficial tendons like tennis elbow, patellar tendon, Achilles and plantar fascia
- Focused shockwave (fESWT): concentrates energy at a specific depth. Used more in specialist sports medicine settings for deeper structures
At PHYZFIT Bexley North we use a professional grade radial shockwave device suitable for the most common musculoskeletal indications.
How does shockwave actually help chronic tendon and heel pain?
The acoustic pulses do several things at the tissue level:
- Stimulate a controlled inflammatory response in stubborn chronic tendons that have stopped healing. This kick starts the tissue remodelling process
- Increase local blood flow to promote nutrient delivery and waste removal
- Trigger the release of growth factors (VEGF, IGF) that drive tissue repair
- Reduce pain signalling by desensitising local nerve endings
- Break down calcification in calcific tendinopathies
- Stimulate collagen production to strengthen the tendon or fascia over 6 to 12 weeks
Notice that shockwave is not "just pain relief". It actively drives the biological repair process in tissues that have stalled. That is why the effect is not immediate — most patients notice the meaningful change 6 to 12 weeks after the course is completed, not on the day of treatment.
The evidence for tennis elbow and plantar fasciitis
🎾 Tennis Elbow (Lateral Epicondylalgia)
Multiple randomised controlled trials and meta analyses show shockwave produces meaningful improvements in pain and function for chronic tennis elbow (over 3 months) that has not responded to standard loading and hands on treatment.
Success rates in the studies sit around 65 to 85 percent at 12 weeks post treatment, with benefits generally maintained at 6 and 12 month follow up.
Best combined with: heavy slow resistance loading program, ergonomic modifications, hands on treatment. Not recommended as a standalone.
🦶 Plantar Fasciitis
Shockwave for chronic plantar fasciitis (over 3 months) has some of the strongest evidence of any treatment for the condition. Multiple systematic reviews rate it as first line intervention for chronic cases.
Success rates in the studies sit around 70 to 88 percent at 3 months post treatment, with sustained benefit at 12 months.
Best combined with: plantar fascia and calf loading program, footwear review, orthotic support if indicated. Not recommended as a standalone.
Shockwave also has good to moderate evidence for Achilles tendinopathy, gluteal tendinopathy (trochanteric bursitis), patellar tendinopathy, calcific rotator cuff tendinopathy, and stubborn heel spurs. We use it across all of these at PHYZFIT.
Chronic tendon pain not settling with loading alone?
Book an assessment at Bexley North and see if shockwave is the missing piece.
What does a shockwave session actually feel like?
Most patients describe the experience like this:
- You lie down and the physio applies ultrasound gel to the treatment area
- The handpiece is held on the sore spot and delivers rapid mechanical pulses
- The sensation ranges from a firm tapping to a deep uncomfortable ache
- Intensity is dialled to your tolerance and progressed each session
- Each treatment lasts 3 to 5 minutes per area
- Some post treatment soreness for 24 to 48 hours is normal (like the day after a hard workout)
It is uncomfortable, not unbearable. Most patients say it hurts more in the first session and gets easier as the tissue desensitises.
The PHYZFIT shockwave protocol
- Sessions: typically 3 to 6, delivered once per week
- Length: 3 to 5 minutes of shockwave per area, within a standard 30 to 45 minute physio consult
- Delivered alongside hands on treatment, loading program review, and load management education
- Rest guidance: avoid maximal loading for 24 to 48 hours after each session, keep light movement
- Expected timeline: peak benefits generally appear 6 to 12 weeks after the final session as the tissue remodelling completes
- Included in your consult fee — no separate surcharge at Bexley North
⚠ Shockwave is not suitable if you have
- An active infection over the treatment area
- Malignancy (cancer) in the treatment area
- Are pregnant (avoided over the pelvis and lower back)
- Are on strong blood thinners without medical clearance
- Have a pacemaker (if focused shockwave is being considered)
- Have had a recent cortisone injection in the same area (usually wait 4 to 6 weeks)
- Are under 18 (growth plates)
Who benefits most from shockwave therapy?
Ideal candidates include:
- Chronic tendinopathy or plantar fasciitis lasting more than 3 months
- Symptoms not improving with a good structured loading program and hands on care
- Motivated to continue the loading program alongside shockwave (this is not a passive fix)
- Wanting to avoid cortisone injections, especially for Achilles tendon or plantar fascia where injection carries meaningful risks
- Considering a referral for cortisone or surgery — shockwave is worth a proper trial first for stubborn cases
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah, Hurstville, Marrickville, Newtown, Enmore, Dulwich Hill and Petersham. Shockwave is delivered at our Bexley North clinic only.
Frequently asked questions about shockwave therapy
Shockwave is included in your standard physio consult at PHYZFIT Bexley North when clinically indicated. There is no additional surcharge. Most Sydney clinics charge $80 to $150 per shockwave session on top of the physio fee, so across a typical 3 to 6 session course, you can save $240 to $900 with us.
Most patients need 3 to 6 sessions delivered once per week. Some stubborn cases benefit from a top up course 3 to 6 months later. We reassess after 3 sessions to check progress.
Peak benefits typically appear 6 to 12 weeks after the final session, not on the day. Shockwave drives biological tissue remodelling which takes time. Some patients notice earlier changes but the durable benefit builds over weeks.
It is uncomfortable, not unbearable. Most patients describe it as a firm tapping to a deep achy sensation. Intensity is dialled to your tolerance. First session usually hurts most; subsequent sessions get easier as the tissue desensitises.
Yes. Shockwave works best paired with a progressive loading program. Shockwave stimulates the tissue repair response; loading drives the tissue to remodel stronger. Passive treatment alone rarely produces durable results in tendinopathy.
Because shockwave is delivered as part of your physio consult at PHYZFIT, it is claimable under Medicare Chronic Disease Management plans, private health Extras through HICAPS on the day, Workers Compensation, CTP and NDIS (plan managed and self managed only).
Ready for Us to Help You With Your Pain?
If chronic tennis elbow or plantar fasciitis is not settling with standard care, book a physiotherapy assessment at PHYZFIT Bexley North with Ari Moushis, Sam Nunan or Julian De Rosa. We will assess if shockwave is right for you and start on day one, with no separate surcharge.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.