Running is one of the most popular forms of exercise worldwide, but it comes with a downside—injuries. Studies suggest that up to 79% of runners experience an overuse injury in a given year (van Gent et al., 2007). For physiotherapists, osteopaths, sports therapists, and other healthcare professionals, managing these cases is a weekly reality. Common presentations include shin splints, plantar fasciitis, patellar tendinopathy, and Achilles problems—conditions that can be stubborn, frustrating, and slow to resolve.
Traditional management often relies on relative rest, progressive loading, and corrective exercises. While these remain cornerstones of rehabilitation, patients are increasingly looking for treatments that accelerate healing, reduce pain, and minimise downtime. This is where shockwave therapy has emerged as a valuable tool.
What is Shockwave Therapy?
Shockwave therapy is a non-invasive treatment that delivers high-energy acoustic waves into injured tissues. These waves stimulate biological responses that promote tissue regeneration and repair. The therapy can be delivered in two forms:
- Radial Shockwaves: Best suited for more superficial or widespread conditions such as plantar fasciitis or shin splints.
- Focused Shockwaves: Penetrate deeper tissues with precision, making them ideal for proximal hamstring injuries, patellar tendinopathy, or gluteal tendinopathy.
Mechanistically, shockwave therapy has been shown to:
- Increase blood flow and angiogenesis (new vessel formation).
- Stimulate collagen production.
- Break down calcifications and scar tissue.
- Reduce pain by modulating nociceptor activity.
The result? Accelerated tissue healing, reduced pain, and improved function, without invasive procedures or extended rest periods.
Evidence for Running-Related Injuries
The clinical evidence supporting shockwave therapy is growing, with multiple high-quality trials and systematic reviews backing its role in musculoskeletal medicine.
A large cohort study from Harvard Medical School (Mitchkash et al., 2020) found that 79% of runners with lower-extremity overuse injuries responded favourably to shockwave therapy, including both proximal (hip and hamstring) and distal (foot and ankle) injuries.
However, outcomes are not simply about turning the device on. Protocol design including energy settings, frequency, treatment duration, and integration with exercise rehabilitation is critical. When applied correctly, shockwave therapy can make a meaningful difference in helping patients return to running safely and quickly.
Let’s break this down by condition.
1. Plantar Fasciitis
Plantar fasciitis is one of the most common injuries in runners, responsible for sharp heel pain that can be disabling. Traditional treatments (stretching, orthotics, taping) often take months to relieve symptoms.
Shockwave therapy has been shown to provide significant pain reduction and functional improvement, even in chronic cases. Radial waves stimulate blood flow and reduce inflammation, while focused waves can precisely target the degenerative tissue in the fascia.
Key evidence: A systematic review by Dedes et al. (2020) confirmed shockwave therapy as one of the most effective non-surgical options for plantar fasciitis, often outperforming corticosteroid injections in long-term outcomes.
2. Achilles Tendinopathy
Achilles tendinopathy is a stubborn condition that often lingers despite careful loading programmes. Runners with this injury frequently face prolonged rest, slow recovery, and recurrent pain.
Shockwave therapy offers a promising adjunct. It stimulates cellular repair within the tendon, reduces pain sensitivity, and improves tendon structure when combined with eccentric loading exercises.
Key evidence: Rompe et al. (2009) found that patients with chronic Achilles tendinopathy treated with shockwave therapy plus eccentric training had significantly better outcomes than those with exercise alone.
3. Shin Splints (Medial Tibial Stress Syndrome)
Shin splints are among the leading reasons novice runners abandon training programmes. Characterised by diffuse pain along the medial tibia, they stem from repetitive loading and biomechanical stress.
Shockwave therapy can reduce inflammation, improve vascularity, and facilitate earlier return to running.
Key evidence: Moen et al. (2012) demonstrated that shockwave therapy led to faster return to activity compared to rest and conventional treatment in athletes with medial tibial stress syndrome.
4. Patellar Tendinopathy (Jumper’s Knee)
Common in runners and jumping athletes, patellar tendinopathy presents as anterior knee pain aggravated by load. Scar tissue, poor tendon healing, and chronic pain cycles often make management difficult.
Focused shockwave therapy can target degenerative regions within the tendon, helping break down scar tissue and stimulate regeneration.
Key evidence: Wang et al. (2007) showed significant improvements in pain and function in athletes with chronic patellar tendinopathy following shockwave treatment.
5. Hip and Gluteal Tendinopathies
Hip pain in runners is often linked to gluteal tendinopathy, bursitis, or impingement syndromes. These conditions can be particularly disabling and slow to resolve.
Focused shockwave therapy is valuable in this region, as it can penetrate deeply to stimulate healing in hard-to-reach tissues.
Key evidence: Rompe et al. (2009) also reported positive results for greater trochanteric pain syndrome (a common gluteal tendinopathy), showing superior outcomes compared to corticosteroid injections at 4-month follow-up.
6. Proximal Hamstring Tendinopathy
One of the most challenging running-related injuries, proximal hamstring tendinopathy is notorious for its chronicity and resistance to treatment. Rehabilitation often requires months of graded loading, making adjunctive therapies valuable.
Key evidence: Cacchio et al. (2011) demonstrated that shockwave therapy was safe and significantly more effective than traditional physiotherapy alone in patients with chronic proximal hamstring tendinopathy.
Clinical Application: Making Shockwave Work
While the evidence is strong, results hinge on how shockwave therapy is applied. For clinicians, this means:
- Assessment first: Identify the underlying cause—biomechanical issues, training errors, or muscular imbalances should still be addressed.
- Protocol matters: Evidence-based dosing (energy, frequency, and number of sessions) is essential. Too much or too little energy can reduce effectiveness.
- Integration with rehab: Shockwave is not a stand-alone cure. Combining it with load management, progressive exercise, and patient education yields the best results.
- Aftercare: Avoid NSAIDs immediately after treatment, encourage graded return to running, and monitor loading progressions.
Why Patients Value Shockwave Therapy
For runners, the appeal of shockwave therapy lies in:
- Non-invasive treatment: No needles, surgery, or prolonged rest.
- Quick sessions: Typically 10–20 minutes, with minimal downtime.
- Rapid improvement: Many patients notice reduced pain within 2–4 sessions.
- Return to sport: Enables quicker, safer return to running compared to conservative management alone.
Curious to learn more?
To get up to speed with shockwave therapy for running injuries, physiotherapists and other clinicians can attend a course like “Shockwave Therapy for Running Injuries” offered by physiotherapist and extended scope practitioner, Benoy Mathew clinical who is also clinical lead at Venn Healthcare.
This course will cover the basics of shockwave therapy, its applications for running injuries, and how to incorporate it into treatment plans for patients. Attending this course can be a valuable tool in helping your patients recover from running injuries. With the right shockwave protocol and aftercare, shockwave therapy can be a game-changer for running injuries, giving your patients the relief they need to get back to doing what they love.
References:
Cacchio, A., Rompe, J. D., Furia, J. P., & Saggini, R. (2011). Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. American Journal of Sports Medicine, 39(1), 146–153. https://doi.org/10.1177/0363546510379324
Dedes, V., Tzirogiannis, K., Polikandrioti, M., & Panoutsopoulos, G. (2020). Radial extracorporeal shockwave therapy versus conventional physiotherapy for the treatment of plantar fasciopathy: A systematic review and meta-analysis. Physiotherapy Theory and Practice, 36(10), 1087–1098. https://doi.org/10.1080/09593985.2018.1551457
Mitchkash, M., McGowan, K., Meehan, W., & d’Hemecourt, P. (2020). Shockwave therapy for lower extremity running injuries: A large case series in runners. Harvard Medical School Musculoskeletal Review. [Conference abstract / cohort report].
Moen, M. H., Rayer, S., Schipper, M., Weir, A., Tol, J. L., & Backx, F. J. (2012). Shockwave treatment for medial tibial stress syndrome in athletes: A prospective controlled study. British Journal of Sports Medicine, 46(4), 253–257. https://doi.org/10.1136/bjsm.2010.081992
Rompe, J. D., Furia, J. P., & Maffulli, N. (2009). Eccentric loading compared with shockwave treatment for chronic insertional Achilles tendinopathy: A randomized, controlled trial. Journal of Bone and Joint Surgery, 90(1), 52–61. https://doi.org/10.2106/JBJS.F.01494
Rompe, J. D., Segal, N. A., Cacchio, A., Furia, J. P., Morral, A., & Maffulli, N. (2009). Home training, local corticosteroid injection, or radial shockwave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine, 37(10), 1981–1990. https://doi.org/10.1177/0363546509334374
van Gent, R. N., Siem, D., van Middelkoop, M., van Os, A. G., Bierma-Zeinstra, S. M., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. British Journal of Sports Medicine, 41(8), 469–480. https://doi.org/10.1136/bjsm.2006.033548
Wang, C. J., Ko, J. Y., Chan, Y. S., Weng, L. H., Hsu, S. L., & Chen, J. M. (2007). Extracorporeal shockwave therapy for chronic patellar tendinopathy. American Journal of Sports Medicine, 35(6), 972–978. https://doi.org/10.1177/0363546506298870
