Non-invasive shock waves can be a valuable therapeutic strategy that can be achieved after careful diagnostic evaluation. With Dr. Maria Cristina D’Agostino, orthopedist and traumatologist of Humanitas, we face myths and clarify doubts about areas of use, types, and diseases for which shock waves are useful and beneficial.


1) Shock waves can be used in medicine only in urological applications – False.

Shock waves were first introduced in medicine in the early nineties for the treatment of kidney stones (lithotripsy), but in the years immediately following their scope of use has rapidly expanded to pathologies of the musculoskeletal system and other apparatuses (extracorporeal shock waves).


2) Shock waves are ionizing radiation? – False.

Impact waves are acoustic waves, and therefore of a mechanical nature, which do not therefore present the risk characteristics associated with radioactivity.


3) Shock waves can be used in orthopedics to treat many tendon and bone diseases – True.

Currently, the main field of application of extracorporeal shock waves is represented by tendon pathologies (especially if in chronic phase and refractory to other therapies), as well as disorders of bone regeneration (pseudoarthrosis and consolidation delays).


4) Shock waves are suitable for tendon diseases only in the presence of calcifications? – False.

Shock waves can be indicated for tendon and similar pathologies, even in the absence of calcifications.


5) The purpose of extracorporeal shock waves is treatment for the dissolution of calcifications in musculoskeletal areas – False.

The objective of the therapy (and ultimately the therapeutic effect linked to the action of shock waves) is not of a direct trauma type, that is, it does not cause tissue damage, nor does it cause the crushing of calcifications by direct rupture.

A very delicate mechanical action is applied (a sort of micro-massage on cells and tissues), able to stimulate some biological reactions, including anti-inflammatory, anti-edemigenous and pain-relieving effects, as well as improving microcirculation locally. It is possible that in some cases calcification will be absorbed, but this is done in a secondary way, through a biochemical mechanism.


6) Shock waves can be a viable alternative to surgery – True.

In some cases, both for bone consolidation disorders and for some tendon pathologies, shockwave treatment can save the patient from surgery, and in any case does not preclude, if necessary, the possibility of undergoing surgery.


7) Shock waves can be combined with other therapies of different types – True.

Treatment with shock waves does not interfere with other types of therapy that may be appropriate to combine such as physical, and even rehabilitative type; indeed, the combination with therapeutic rehabilitation and any nutraceuticals (so-called “food supplements”), can be a winning strategy to treat tendon diseases.

In addition, shockwave treatment can also be indicated in case of pain, persistent edema and joint stiffness after surgery, allowing for faster functional recovery.


8) There is only one type of shock wave – False.

There are basically two types of “waves”: extracorporeal focal shock waves and radial (or ballistic) waves. The latter are generated with a “pneumatic” mechanism and with the aid of a compressor. They are particularly suitable for the treatment of trigger points, muscle contractures and tendon diseases.

For both types of shock waves, in clinical practice it is essential to have a proper diagnostic framework, expertise and experience in the execution and use of appropriate instrumentation before proceeding to treatment.


9) Shock waves are dangerous because they cause tissue injury – False.

If correctly applied, with expertise, with adequate instrumentation, after adequate “training” and after the correct diagnostic framework, the extracorporeal shock waves represent a safe method with few important side effects.

If incorrectly applied, they can also cause severe bruising.


10) Shock waves are painful during application – False.

The treatment, if correctly performed, with adequate instrumentation and expertise in the execution, is generally well tolerated. In cases of bone treatment where higher energies are required, local anesthesia can be administered to make the application more tolerable.


11) In recent years, indications for shockwave treatment have expanded beyond tendon and bone diseases – True.

The discovery that shock waves can exert a stimulus towards tissue regeneration and repair has broadened the scope of their therapeutic applications to include Regenerative Medicine. Wounds and sores of difficult resolution, losses of substance of post-traumatic origin (even in the days immediately following the trauma), as well as painful scars of different origin can be successfully treated.


12) Shock waves are repeatable – True.

In case of partial benefit, the treatment may be repeated, as it has no significant side effects; the repetition of the treatment, where indicated, may generate further benefits over time.


13) Shock waves can temporarily “awaken” pain between treatments – True.

The exacerbation of pain that already exists between one course of therapy and another is possible and it is not an alarming sign: it can be a simple temporary reaction to stimulation, which triggers healing processes.


14) The effect of shock waves is immediate – False.

The therapeutic action of shock waves is linked to a series of complex biological reactions, which take time to manifest themselves, so it is necessary to wait several weeks to appreciate the beneficial effect.