Using Focused Shockwave Therapy to Desensitise Tendon Pain and Kickstart Rehab

Tendon injuries can be stubborn, especially for runners, athletes, and active patients. Chronic tendinopathy often lingers because the tendon pain itself limits your ability to strengthen and load it. This is where focused shockwave therapy (FSWT) comes into play — not as a magic cure, but as a tool to desensitise the tendon so real rehabilitation can begin.

Why Tendons Hurt

Chronic tendinopathy isn’t primarily an inflammatory problem. Instead, the tendon’s collagen becomes disorganised, weak, and hypersensitive. Pain is often disproportionate to structural damage, driven by:

• Increased nerve sensitivity in and around the tendon

• Local chemical irritants that “turn up the volume” on pain

• Protective muscle guarding that prevents normal loading

Because of this, even gentle strengthening can feel too painful, which slows healing.

How Focused Shockwave Therapy Helps

Focused shockwave therapy delivers high-energy acoustic waves precisely to the affected tendon. These waves create micro-mechanical forces in the tissue, triggering several beneficial responses:

1. Pain desensitisation Shockwaves reduce nerve sensitivity in the tendon and surrounding tissue, which lowers perceived pain. This is crucial — once pain decreases, the tendon can tolerate rehabilitative loading.

2. Cellular and collagen stimulation FSWT encourages tendon cells (tenocytes) to produce new collagen and reorganize existing fibres, supporting tendon remodelling over time.

3. Improved blood flow and tissue metabolism The therapy increases local circulation, helping the tendon repair micro-damage more effectively.

The Rehab Connection

Think of FSWT as unlocking the door to tendon rehab:

• Before treatment: Pain prevents loading → tendon remains weak → chronic pain persists

• After FSWT: Pain is reduced → patient can perform slow, progressive loading → tendon remodels and strengthens

Without desensitisation, most tendons stay “stuck” in a painful cycle, where exercise hurts more than it helps.

Typical Protocol

Focused shockwave therapy is usually applied in 3–5 sessions spaced 1–2 weeks apart, depending on the tendon and patient tolerance. Key points for rehab integration:

1. Start with isometric holds Even with reduced pain, tendon cells respond better to controlled loading first. Examples:

   • Calf raises for Achilles

   • Wall sits or partial squats for patellar tendon

2. Progress to slow, heavy eccentric loading Once isometrics are tolerated, gradually introduce slow, high-load exercises to remodel collagen.

3. Include tendon-specific energy storage drills After strength improves, reintroduce hopping, skipping, or sport-specific movements to restore elastic capacity.

FSWT doesn’t replace these steps — it enables them by lowering the pain barrier.

Who Benefits Most

• Patients with persistent tendon pain (>3 months)

• Runners or athletes who cannot tolerate strengthening

• Cases where standard rehab plateaued#

FSWT is particularly effective for:

• Achilles tendinopathy

• Patellar tendinopathy

• Hamstring tendinopathy

• Lateral elbow (tennis elbow) tendinopathy

Focused shockwave therapy isn’t a miracle cure — it’s a strategic tool. By reducing tendon pain, it allows patients to perform the rehabilitative loading exercises that actually strengthen and remodel the tendon.

In chronic tendinopathy, this combination of pain desensitisation + structured rehab is often the fastest way back to full function and pain-free running.