ESWT for Athletes: A Practical, Evidence-Based Overview

Extracorporeal shockwave therapy (ESWT) is quickly becoming a go-to option in sports medicine—and for good reason. As the evidence base grows, more clinicians are using ESWT to help athletes recover from stubborn overuse injuries, especially tendinopathies and certain bone stress conditions.

A key point: ESWT isn’t a single, one-size-fits-all treatment. It’s a highly adjustable tool. Protocols can be customized in the clinic based on the athlete, the tissue involved, and the stage of injury.

Why ESWT is gaining traction in sports medicine

According to Schroeder, Tenforde, and Jelsing (2021), ESWT is gaining popularity because greater evidence supports its use for a wide range of musculoskeletal conditions in athletes. ESWT is also appealing because it can often be used during the season, with little to no time away from sport.

For athletes, that matters. When the calendar is tight, a treatment that can be integrated into training and rehab—without forcing weeks on the sidelines—can be a major advantage.

ESWT protocols: what can be adjusted?

One reason ESWT can look “different” from one clinic (or study) to another is that protocols include multiple variables, such as:

• Energy flux density (how much energy is delivered)

• Number of impulses (how many shockwaves are applied)

• Type of shockwave (focused vs. radial)

• Number, frequency, and duration of sessions

• Area of application (exact treatment location)

• Post-procedure therapy protocols (what you do after treatment)

Schroeder et al. (2021) emphasize that protocols vary across studies, and that optimal protocols for many indications are still being determined. In other words: ESWT is supported by evidence, but the field is still refining the “best” settings for each diagnosis.

What conditions can ESWT help treat in athletes?

Schroeder et al. (2021) report that ESWT can be used safely for a broad set of sports medicine injuries, including:

• Rotator cuff tendinopathy

• Lateral elbow epicondylopathy (tennis elbow)

• Greater trochanteric pain syndrome

• Hamstring tendinopathy

• Patellar tendinopathy

• Achilles tendinopathy

• Other tendinopathies

• Plantar fasciopathy

• Bone stress injuries

• Medial tibial stress syndrome (shin splints)

The common thread across many of these is that they can be persistent, training-limiting conditions—often slow to resolve with rest alone, and frustrating for athletes who want to stay active.

Can ESWT be used in-season?

Often, yes.

One of the practical advantages highlighted by Schroeder et al. (2021) is that ESWT can be appropriate for in-season athletes because it frequently requires no or minimal time away from sport and may provide rapid benefits.

That doesn’t mean athletes should ignore load management or keep training through worsening symptoms. But it does mean ESWT may fit into a performance-focused rehab plan more easily than some other interventions.

• ESWT works best when paired with physical therapy

• ESWT is not a replacement for rehab—it’s a complement.

Schroeder et al. (2021) recommend using ESWT in conjunction with physical therapy to support longer-term functional gains and optimize healing. Think of ESWT as something that may help “unlock” progress—while physical therapy builds the strength, capacity, and movement quality needed to keep the problem from returning.

Bottom line

ESWT is gaining popularity in sports medicine because it’s adaptable, increasingly evidence-supported, and often compatible with in-season training. It may be a safe and useful option for a wide range of athletic injuries—especially tendinopathies and some bone stress conditions—when it’s applied using an appropriate protocol and paired with a structured physical therapy plan.

Reference

Schroeder AN, Tenforde AS, Jelsing EJ. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Current Sports Medicine Reports. 2021;20(6):298-305. doi:10.1249/JSR.0000000000000851