As a runner, few injuries are more dreaded than a stress fracture. That nagging pain that doesn’t go away, followed by the devastating diagnosis – a crack or break in one of your bones from the relentless pounding of mile after mile. Suddenly, your training comes to a grinding halt as you’re forced into a walking boot and multiple weeks or even months off running.

Bone stress injuries can utterly derail a runner’s season and shatter their training goals. The worst part is feeling powerless, limited to just resting and waiting for the injury to heal on its own. When weeks go by without improvement, some runners even require surgery to finally overcome the issue.

But what if there was a way to actually accelerate and promote healing of stress fractures and bony injuries? A recent study took a closer look at using a non-invasive therapy called focused shockwave therapy to treat these troublesome injuries in runners. The results are grabbing the attention of sports medicine professionals and runners alike.

Study: Beling et al (2023)- Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners

This retrospective case series study looked at using focused shockwave therapy to treat bone stress injuries (BSI) in runners. BSI are common overuse injuries in long-distance running and can take a long time to heal and keep runners out of their sport.

The researchers reviewed the medical records of 40 runners who received focused shockwave therapy for a bone stress injury between 2018-2022. On average, the runners received 5 shockwave treatment sessions (range 3-7) prior to return to run and some required additional booster treatments during return to run progression, with an average of 5 ± 2 focused shockwave treatments total.

Treatment Characteristics

All sessions were provided, using an electromagnetic-focused shockwave device (Duolith, Storz Medical, Tagerwilen, Switzerland) at the site of BSI. Focused shockwave therapy (fSWT) was performed using anatomical bony landmarks and clinical focusing techniques over sites of maximal pain without the use of anaesthesia. Further, additional radial shockwave was provided to address myofascial components of pain.

Patients started fSWT at a median of 36 days (range 3 days to 8 years) following BSI diagnosis, and most treatments with ESWT were initiated within 3 months (72%). However, nearly one-third were treated for delayed healing or non-union.The average energy flux density was 0.37 ± 0.09 mJ/mm2, with a minimum of 0.20 mJ and a maximum of 0.55 mJ/mm2. Patients received an average of 3122 ± 857 (range 1000 to 5000) pulses per session. An orthopaedic surgery consult was obtained in 8 out of 15 stress fractures (53%).

The key findings of the study were
  • 98% of the runners (39 out of 40) were able to return to running pain-free after shockwave therapy. Only one runner with a severe navicular stress fracture required surgery.
  • Runners with more recent bone stress injuries were able to return to running faster (average 12 weeks) compared to those with delayed healing or non-unions (average 20 weeks).
  • The severity of the bone stress injury on MRI scans did not seem to affect return to running times.
  • No major complications were reported from the shockwave treatments.

The authors conclude that focused shockwave therapy appears to be a safe and effective treatment option for helping runners recover from bone stress injuries, especially for injuries that are not healing properly with just rest alone. More research is still needed, but these results are promising.

Focused shockwave therapy accelerates bone healing

Shockwave therapy has been used for decades, to help heal fractures that stubbornly refuse to mend. Both human and animal studies have shown that focused shockwave is safe and effective in promoting bone healing in cases, which don’t respond to traditional approach (Cheng & Wang, 2015; Kieves et al, 2015)

But this is one of the first studies to analyse its effectiveness specifically for BSI in runners. For healthcare professionals treating runners, the benefits are manifold. Focused shockwave therapy offers a non-invasive, efficient, and targeted solution to address bone stress injuries promptly, enabling athletes to return to their training regimen swiftly and safely. By stimulating the body’s natural healing mechanisms and promoting tissue regeneration, this modality not only alleviates pain but also enhances overall recovery outcomes.

Location of Bone Stress Injuries

According to the trial, the sites of bone stress injuries in the runners that were treated with shockwave therapy included:

  • Posteromedial tibia

  • Metatarsal shafts and heads

  • Metatarsal bases

  • Cuboid

  • Fibula

  • Calcaneus

  • Anterior tibial cortex

  • Femoral shaft

  • Lesser trochanter

  • Inferior pubic ramus

  • Navicular

  • Sacrum

The most common locations were the posteromedial tibia and the metatarsals of the foot. Half of the injuries were low grade using MRI criteria, including grade 1 (22%) or grade 2 (29%), while the other half were high grade, including grade 3 BSI (12%) or grade 4 stress fractures (37%). BSI classified using anatomical location was low risk for 32 patients and high risk for 9 patients.


The clinical application of focused shockwave therapy presents a transformative paradigm in the management of bone stress injuries among runners. This cutting-edge non-invasive approach not only accelerates the healing process but also mitigates the need for prolonged rest or invasive surgical interventions. Further, by reducing downtime and minimising the risk of complications associated with surgery, focused shockwave therapy stands as a compelling alternative, revolutionizing the approach to managing bone stress injuries in the athletic community.

As stewards of athlete health, embracing this innovative technique empowers healthcare professionals to optimize patient care, ensuring that runners can pursue their passion with resilience and confidence.

Interested in learning on how to apply shockwave therapy in BSI in runners?

Join us on the 1 day Running Rehab Masterclass using shockwave therapy.

The course will cover the use of both radial and focused shockwave therapy, as well as Extracorporeal Magneto-Transduction Therapy (EMTT), and will also address relevant management strategies such as load management, strength training, and gait retraining.

These strategies are important components of a multi-modal approach to the treatment of running injuries. During the course, attendees will have the opportunity to gain practical experience in the use and application of these modalities in the treatment of common running injuries.

This is a great opportunity for practitioners looking to expand their knowledge and skills in the management of running injuries using shockwave therapy.

You must have owned a Storz Medical shockwave device for more than six months to be eligible for this course.

Shockwave Therapy in Running Injury Rehab

Learn how to integrate shockwave therapy into the rehabilitation of common running injuries such as plantar fasciitis, Achilles tendinopathy, medial tibial stress…

running injuries


Benoy Mathew, MSc, MCSP,

Advanced Practice Physio/MSK Sonographer,

Head of MSK Education, Venn Healthcare

Twitter: @function2fitnes Instagram: @function2fitness