Shockwave Therapy in St. Louis

The mechanism is mechanotransduction — cells converting a mechanical signal into a biological response. A controlled pressure pulse applied to degenerative tissue produces several effects at once.

Local blood flow increases, and over a course of treatment new small vessels form in tissue that had become poorly perfused. Perfusion is often the limiting factor in why a chronic tendon problem is not healing: tendon has a marginal blood supply at the best of times.

There is also a measurable effect on pain signaling. Repeated stimulation appears to reduce substance P, one of the neuropeptides involved in transmitting and sustaining pain locally, which is part of why the analgesic effect can outlast the treatment course.

Where calcific deposits are present — most commonly in the shoulder — the mechanical energy can also help break them down so the body can reabsorb them.

Shockwave is most useful where a soft-tissue problem has become chronic and has not responded to rest, activity modification or rehabilitation:

• Plantar fasciitis and heel pain, including cases that have persisted for many months — see also serious foot pain
• Tendinopathy at the elbow, patellar tendon, and Achilles
• Calcific tendinitis of the shoulder
• Greater trochanteric pain at the outer hip
• Chronic myofascial pain where trigger point injection has helped but not held

The evidence base is strongest for plantar fasciitis and for calcific shoulder tendinitis. For other indications it is reasonable but less established, and we will tell you which category yours falls into rather than presenting them all as equivalent.

Ultrasound gel is applied and the handpiece is placed over the target area. Treatment takes a few minutes per site. You will feel the pulses — most patients describe it as a deep tapping or thumping that is uncomfortable at higher intensities but tolerable, and intensity is adjusted to what you can manage.

No anesthesia is used, and that is deliberate: your feedback about where the discomfort concentrates helps locate the target accurately. You drive yourself home and return to normal activity the same day.

A course is typically three to five sessions spaced about a week apart. Improvement is usually gradual over the weeks following the course rather than immediate, because what is being stimulated is a repair process rather than a numbing effect.

It does not repair a complete tear. A ruptured tendon is a structural problem requiring a structural answer, and stimulating repair in tissue that is no longer in continuity does not work.

It is also not a first-line treatment. For a soft-tissue injury of recent onset, the appropriate sequence is relative rest, load management and rehabilitation. Shockwave is for the problem that has already failed that sequence.

It is generally avoided over an area of active infection, over a known malignancy, in the presence of a significant bleeding disorder or on anticoagulation without discussion, and over growth plates in skeletally immature patients. Tell us your full history.