Shockwave therapy is considered safe for most people, with no serious complications reported in the vast majority of clinical studies. The most common side effects are mild and temporary: skin redness, swelling, and minor bruising at the treatment site, all of which resolve on their own. That said, certain medical conditions make shockwave therapy risky or off-limits entirely, so the safety picture depends partly on your health history.
What Shockwave Therapy Does to Your Body
Shockwave therapy delivers pulses of mechanical energy into tissue. Your cells convert that mechanical stimulus into biological signals that promote healing. Specifically, the treatment triggers your body to grow new blood vessels in the treated area, remodel collagen, and shift the inflammatory response from its early, destructive phase into a later, repair-oriented phase. Fibroblasts, the cells responsible for building and maintaining connective tissue, are the primary targets of these pressure waves.
This process explains both why the therapy works and why it’s generally well tolerated. The energy levels used in therapeutic applications are relatively low. For context, the energy used in shockwave therapy for erectile dysfunction is roughly 10% of what conventional devices use to break up kidney stones. The goal isn’t to destroy tissue but to stimulate it.
Common Side Effects
The side effects most people experience are localized and short-lived. Skin redness, mild swelling, and subcutaneous bruising (small patches of discoloration under the skin) are the reactions reported most frequently in orthopedic applications. These typically resolve without any intervention within a few days. Some people also experience temporary soreness or discomfort at the treatment site, similar to what you might feel after deep tissue massage.
In studies of low-intensity shockwave therapy for erectile dysfunction, the safety profile has been even more favorable. A 12-month trial found zero treatment-related adverse events among participants. Multiple studies in this area have echoed that finding, reporting no adverse events at all.
Rare but Serious Complications
Serious complications from shockwave therapy are extremely uncommon, but they have been documented in isolated case reports. One case involved osteonecrosis (bone tissue death) in the head of the upper arm bone after treatment for calcific tendinitis of the shoulder, likely caused by disruption of the bone’s blood supply. Ulnar nerve irritation has also been reported. A single case of severe contact dermatitis with significant skin damage was described in the medical literature as the first of its kind.
These cases are notable precisely because they are rare. Large reviews of the therapy consistently describe it as having no relevant severe complications in typical use. Still, these reports illustrate why treatment should be performed by a trained provider who understands proper energy settings and anatomical targeting.
Who Should Avoid Shockwave Therapy
The International Society for Medical Shockwave Treatment maintains a list of contraindications that divides them into absolute (never do it) and relative (proceed with caution) categories.
Shockwave therapy should not be used at all in these situations:
- Active infection at the treatment site, such as osteomyelitis
- Malignant tumors near the treatment area (for focused shockwave)
- Pregnancy
High-energy treatments carry additional restrictions. They should not be directed at lung tissue, the brain or spinal cord, or the growth plates in children and adolescents whose skeletons are still developing. People with severe clotting disorders also fall into this category, since bruising and hematoma formation are among the therapy’s known effects, and impaired clotting could make those effects significantly worse.
Several other factors require careful consideration rather than automatic exclusion. If you have a cardiac pacemaker or other implanted device, your provider needs to account for that. Current use of blood thinners or anti-inflammatory medications matters too, since these can increase bruising risk or potentially interfere with the inflammatory healing response the therapy is designed to trigger. Recent corticosteroid injections in the treatment area are another flag worth discussing with your provider.
Radial vs. Focused Shockwave Safety
There are two main types of shockwave therapy, and their safety profiles are comparable but not identical in how they interact with tissue. Focused shockwave therapy concentrates all its energy at a specific depth and point within the body. This precision makes it effective for deep, localized problems like nonhealing fractures, but the high energy density at the focal point often requires local anesthesia during treatment.
Radial shockwave therapy disperses energy more broadly as the waves travel outward from the skin surface. Because the energy spreads out rather than concentrating, radial devices typically operate at low to medium energy levels and have less intense impact on tissues. A systematic review and meta-analysis comparing the two types found both treatments were similarly safe, though the authors noted the evidence quality supporting that comparison was low.
What FDA Clearance Covers
In the United States, the FDA has cleared specific shockwave devices for limited indications. One notable clearance is for the treatment of proximal plantar fasciitis (heel pain where the plantar fascia attaches to the heel bone), with or without a heel spur, in adults 18 and older. This clearance applies specifically to patients who have had symptoms for six months or more and haven’t responded to conservative treatments.
Many of the other uses you’ll see marketed, including treatment for tendinopathies, erectile dysfunction, and cellulite, are considered off-label in the U.S. Off-label doesn’t mean unsafe or ineffective, but it does mean the FDA hasn’t independently reviewed the safety and effectiveness data for those specific applications.
What to Expect After Treatment
Recovery from a shockwave therapy session is minimal for most people. You can generally return to normal activities the same day, though your provider may recommend avoiding strenuous exercise involving the treated area for a short period. One important practical detail: you should avoid anti-inflammatory medications and ice for about two weeks before and two weeks after treatment. This might seem counterintuitive when you’re dealing with pain, but the therapy works by initiating a controlled inflammatory response. Suppressing that inflammation with NSAIDs or ice can undermine the healing process the treatment is designed to kickstart.
Most treatment protocols involve multiple sessions, typically spaced one to two weeks apart. Mild soreness between sessions is normal and generally not a sign of anything going wrong. Persistent or worsening pain, significant swelling, or skin changes beyond minor redness are worth reporting to your provider promptly.