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Shockwave Therapy

Dr. Berry was one of the first doctors in Southern California to offer shockwave therapy.


Shockwave therapy is a relatively new treatment option in orthopedic and rehabilitation medicine. The effect of shockwaves was first documented during World War II when the lungs of castaways were noted to be damaged without any superficial evidence of trauma. It was discovered the shockwaves created by depth charges were responsible for the internal injuries. This created a great deal of interest and research into the biological effects of shockwaves on living tissue. The first medical treatment developed from this research was lithotripsy. This allowed focused shockwaves to essentially dissolve kidney stones without surgical intervention. Today, over 98% of all kidney stones are treated with this technology. The use of shockwaves to treat tendon related pain began in the early 1990s.


A clinical shockwave is nothing more than a controlled explosion that creates a sonic pulse, much like an airplane breaking the sound barrier. The primary effect of a shockwave is a direct mechanical force. The exact mechanism by which shockwave therapy acts to treat tendon pathology is not known. The leading explanation is based on the inflammatory healing response. It is felt the shockwaves cause microtrauma to the diseased tendon tissue. This results in inflammation, which allows the body to send healing cells and increase the blood flow to the injured site.


Shockwave Therapy offers a cutting edge treatment for Tendonitis, Bursitis and Fasciitis. It is an FDA approved, noninvasive procedure that can be used to treat Tendonitis, Plantar Fasciitis, Bursitis, Calcific Tendonitis, Rotator Cuff Syndrome, Tennis Elbow and Golf Elbow. Shockwave Therapy is used as an alternative to Physical Therapy and uses a stream of pulsed sound waves to break up old scar tissue and promote blood flow back to the effected area. Many have shown a positive response versus placebo treatment and others have shown no benefit over placebo. No studies have reported any significant side effects when utilized for orthopedic conditions. Contraindications to shockwave therapy include bleeding disorders and pregnancy.

There are two main types of shockwave machines, low and high energy. High-energy treatments are administered in the operating room with regional or general anesthesia. Low-energy treatments are administered in the clinic and do not require anesthesia or injections. Dr. Berry currently uses a low-energy to mid range machine by placing the probe on the area of greatest tenderness and the shockwaves are delivered over 10-20 minutes. Occasionally, patients will relate mild transient discomfort at the treatment site. Patients are usually treated with 3-5 sessions separated by a week. Between treatments, patients are able to perform all normal daily activities. Some patients report immediate pain relief but the healing response usually requires 6-8 weeks.

This patient was limping for two weeks with severe pain from shin splints!

Conditions Treatable with ACT

  1. Lateral epicondylitis/ lateral epicondylalgia - Tennis elbow
  2. Calcific Tendonitis - Rotator Cuff Tendonitis
  3. Epicondylitis - Golfer’s Elbow
  4. Myofascial Trigger Point - Chronic Deep Tissue Muscle Pain
  5. Patellar Tendonitis – Jumper’s Knee Tendonitis
  6. Trochanteric – Hip Tendonitis
  7. Achillodynia - Achilles Tendonitis
  8. Tibial Stress Syndrome – Shin Splints
  9. Plantar Fasciitis – Heel Spur
  10. Scar Tissue Treatment
  11. Morton' Neuroma
  12. Iliotibial Band Syndrome
  13. Non Healing Ulcers
  14. Hamstrings Tendonitis
  15. Neck, Shoulder, Back & Hip Pain

What to expect during your treatment?

Patient Care

  1. Dr. Berry will identify the treatment site or sites.
  2. He will then will apply a thin coat of coupling gel. This gel helps to translate the acoustic sound waves generated by the therapy head to the body.
  3. Next he will start the treatment at a very low output setting and increase the power to a level that you help define and is best suited for your condition. The output level and acoustic wave frequency rate may vary from location to location based on the depth and type of tissue being treated.
  4. As Dr. Berry moves the therapy source around the treatment area, you
    may feel a deep, dull ache that is familiar to you as being like the feeling
    your condition produces. The clinician will ask you to report when you feel
    the ache and will adjust the output of the device to the appropriate level for your treatment. They may also ask you to confirm that the therapy source is still creating the ache and may adjust the location of the treatment based on your feedback. If at anytime the treatment becomes uncomfortable, mention this to the clinician and they will adjust the output level.
  5. After the treatment is completed, the coupling gel will be removed and
    you can return to your normal activities. You may experience some minor
    aches or discomfort after treatment. It is not unusual for patients to notice flushed or reddened skin around the treatment site.

How long does pain management treatment take?

  • A typical treatment takes between 10 and 20 minutes
  • Normally, 1-2 treatments per week are performed
  • A total of 3-5 treatments may be necessary before lasting improvement is achieved
  • With acute pain, a single session is often successful

Are there known side-effects of shockwave therapy?

Treatment side-effects are limited to reddened skin and/or minor soreness at the treatment site.

Mechanism of Action

Shockwave therapy aids in healing by stimulating the body’s regeneration process. The sound waves (low-energy waves) work much like a therapeutic deep tissue massage, releasing proteins that accelerate healing.

Energy is released as a sound wave at tissue interfaces where the density of the tissue or impedance of the sound waves changes. These changes of impedance occur where soft tissue, tendons, ligaments, cartilage, and bone meet. These sound waves help break down pathological deposits of calcification in soft tissues.

The energy released by a shockwave treatment appears to produce cellular reaction that causes the release of various substances leading to increased blood supply to the treated tissue, resulting in tissue regeneration in tendons, joints, and bone. The results of these events can lead to increased circulation, range of motion and pain relief, are key components in the healing process.


  • Alleviation of musculoskeletal pain
  • Improves mobility
  • Non-invasive
  • Reduces the need for pain medications
  • Outpatient treatment
  • Short therapy time of approx. 10-20 min.
  • Patient-guided focused therapy



Effects & Principle of Extracorporeal Shock Waves Therapy

Biological Mechanism of Musculoskeletal Shockwave
Cheng-Jen Wang, MD, Feng-Sheng Wang, PhD and Kuender D. Yang, MD, PhD

Manifestation Pattern of the Extracorporeal Shock Wave Therapy; Using Mechanotransduction
H. G. Neuland1, H. J. Duchstein2

Diagnosis and Therapy of Myofascial Pain Syndrome with Focused Shock Waves (ESWT)
Dr. H. Müller-Ehrenberg, Dr. G. Licht

A neural model for chronic pain and pain relief by extracorporeal shock wave treatment
Othmar J. Wess

A new application of shockwave therapy for the causal treatment of musculoskeletal pain and problems in Sports Medicine
by Dr. Wolgang Bauermeister

Indications & Therapeutic Applications
of Extracorporeal Shock Waves Therapy

Shockwave therapy for chronic Achilles tendinopathy
Sten Rasmussen, Dr. Marianne Christensen, Iben Mathiesen, and Ole Simonsen. From Department of Orthopedic Surgery, Aalborg Hospital, Arthus University, Aalborg, Denmark

Extracorporeal Shock Wave Therapy in the Treatment of Calcific Tendinitis of the Rotator Cuff
Mauel Sabeti-Aschraf, MD, Alexandra Goll, MS, and Klemens Tried, MD From the Department for Orthopaedics, Vienna Medical School, Vienna, Austria

This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders
Robert Fridman, DPM* Jarrett D. Cain, DPM, MSc† Lowell Weil, Jr., DPM, MBA† Lowell Weil, Sr., DPM†

Shock Wave Therapy for Patients with Lateral Epicondylitis of the Elbow
Ching-Jen Wang, MD, and Han-Shiang Chen, MD

ow-Energy Extracorporeal Shock Wave Therapy as a Treatment for Greater Trochanteric Pain Syndrome
John P. Furia, Oct 2010

Revolutionary medical treatment comes to Surrey
Press Release, Jan 2010

Home Training, Local Corticosteroid Injection, or Radial Shock Wave Therapy for Greater Trochanter Pain Syndrome
Jan D. Rompe

Repetitive shock wave therapy for lateral elbow tendinopathy (tennis elbow): a systematic and qualitative analysis
Jan D. Rompe, and Nicola Maffulli

A neural model for chronic pain and pain relief by extracorporeal shock wave treatment
Othmar J. Wess

Extracorporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder
National Institute for Clinical Excellence

Radial Shock Wave Therapy in Calcifying tendinitis of the Rotator Cuff – A Prospective Study
P. Magosch, S. Lichtenberg, P. Habermeyer

Shock Waves In Top Sports

Treatment of Painful Heel
L. Gerdesmeyer, L. Weil Sr., M. Maier, H. Lohrer, C. Frey, K. Feder, J.Stienstra, M. Russlies, K. Neitzel, M. Schmitt-Sody, B. Scurran

Pain relief by extracorporeal shockwave therapy: an update on the current understanding
Christoph Schmitz • Rocco DePace

Treatment for Osteonecrosis of the Femoral Head
Comparison of Extracorporal Shock Waves with Core Decompression and Bone-Grafting, C-J Wang et al, J Bone Joint Surg 87, 2005

Orthopedic trigger point shock wave therapy with focused and radial shock waves:
Orthopedic trigger point shock wave therapy with focused and radial shock waves: a review of the current situation M. Gleitz, U. Dreisilker, R. Raedel

Shock Wave Therapy for Patients with Lateral Epicondylitis of the Elbow
Ching-Jen Wang et al, The American Journal of Sports Medicine, 2002

Extracorporeal Shock Wave Therapy (ESWT) in Orthopaedics and Traumatology
O. Wess, Storz Medical AG, Kreuzlingen, Switzerland

Extracorporeal shock wave therapy (ESWT) - Shock waves can do more than simply crash stones!
Prof. Dr. Dr. R.P. Wirsching, Dr. F. Wirtz

Extracorporal Shock Wave Therapy in the Treatment of Chronic Tendinopathies
Perspective on Modern Orthopaedics, 14(4), 2006

Improvement of Active Ankle Joint Dorsiflexion by the Use of Extracorporeal Pulse Activation Therapy (EPAT) in Patients with Chronic Achilles Tendinosis: A New Approach.
Dr. med. Markus Gleitz, ISMST Newsletter, May 2008

ESWT versus Surgical Treatment in Calcifying Tendinitis and Non Calcifying Tendinitis of the Supraspinatus Muscle
M. Haake, European Journal of Orthopaedic Surgery Traumatology , 2001

ESWT in the Treatment of Calcific Tendinitis of the Rotator Cuff
Manuel Sabeti-Aschraf, The Americal Journal of Sports Medicine, Vol. 33 No.9/2005

Abstracts ISMST 10th International ISMST Congress Toronto 2007

ESWT of myofascial trigger points, 2003-2008
Dr. Markus Gleitz

Effectiveness of Radial Shock-Wave Therapy for Calcific Tendinitis of the Shoulder:
Single-Blind, Randomized Clinical Study

Extracorporeal shock wave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder

Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis
Greve et al., Clinics

Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis : Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study
Gerdesmeyer et al., Am J Sports Med

Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain
Chow and Cheing, Clinical Rehabilitation

Eccentric Loading Versus Eccentric Loading Plus Shock-Wave Treatment for Midportion Achilles Tendinopathy – A Randomized Controlled Trial
Rompe et al., Am J Sports Med

Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial.
Rompe et al., Am J Sports Med

Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial.
Rompe et al., Am J Bone Joint Surg

Low-energy extracorporeal shock wave as a treatment for medial tibial stress syndrome.
Rompe et al., Am J Sports Med

Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.

Rompe et al., Am J Sports
Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome.
Furia et al., Am J Sports Med

Radial extracorporeal shockwave therapy compared with supervised exercises in patients with subacromial pain syndrome: a single blind randomised study.
Engebretsen et al., Brit Med J

New publication by EMS researchers on the current understanding of pain relief by extracorporeal shock wave therapy
Schmitz, De Pace, Urological Research

ISMST Newsletter Volumn 1, Issue 1

ISMST Newsletter Volumn 2, Issue 1

ISMST Newsletter Volumn 3, Issue 1

ISMST Newsletter Volumn 4, Issue 1

ISMST Newsletter Volumn 5, Issue 1

ISMST Newsletter Volumn 6, Issue 1

ISMST Newsletter Volumn 7, Issue 1

Useful Links

ISMST - International Society for Medical Shockwave Treatment

ATRAD - Association for Radial Pain Therapy