Excitement surrounds a new international consensus that is shaping the future of how sports medicine professionals approach shockwave therapy. In this landmark effort, 41 global experts across 13 countries have come together through a Delphi study to define clear, evidence-based recommendations for the use of Extracorporeal Shockwave Therapy (ESWT) in treating sports injuries.

The consensus emphasizes protocol consistency, clinical safety, and evidence-based dosing as the key to improving outcomes and advancing the credibility and widespread adoption of ESWT in sports medicine.

For clinical insights, be sure to read the study in its entirety, “Recommendations for the Use of Extracorporeal Shockwave Therapy in Sports Medicine: An International Modified Delphi Study” written by international experts including, Hye Chang Rhim,¹ Mani Singh,² Nicola Maffulli,³ Amol Saxena,⁴ Carlos Leal,⁵ Ludger Gerdesmeyer,⁶ Kristina Quirologico,⁷ John P Furia,⁸ Johannes Zwerver,⁹ Chun-De Liao,¹⁰ Daniel Moya,¹¹ Shih-Wei Huang,¹² David M Robinson,¹ Johnny Jarnagin,¹ Joseph Ruiz,¹ Kayle E Noble-Taylor,¹³ Hazem Alkhawashki,¹⁴ Brice W Blatz,¹⁵ Joanne Borg-Stein,¹ Lauren Borowski,¹⁶ Jay Bowen,¹⁷ Michael Chin,¹⁸ Robert M Conenello,¹⁹ Michael Fredericson,²⁰ Brian W Fullem,²¹ Karin Gravare Silbernagel,²² Karsten Hollander,²³ Elena J Jelsing,²⁴ Paul Langer,²⁵ Kenneth Mautner,²⁶ Adele Meron,²⁷ Robert Monaco,²⁸ Rowan V Paul,²⁹ Sara Raiser,³⁰ James W Ratcliff,³¹ Steven Sampson,³² Wolfgang Schaden,³³ Jay Spector,³⁴ Wei Sun,³⁵ Isaac P Syrop,³⁶ Kenji Takahashi,³⁷ Benedict Tan,³⁸ James F Wyss,³⁹ Dan Zin,⁴⁰ Jennifer Soo Hoo,⁴¹ Adam S Tenforde,¹.

This rigorous study establishes expert-driven guidance, all with the goal of optimizing patient care and improving return-to-play outcomes.

ESWT Treatment Parameters and the International Delphi Consensus

This panel of 41 international experts delivered definitive recommendations on ESWT for musculoskeletal injuries in athletes. The Delphi recommendations help clinicians deliver reproducible, high-quality care by aligning treatment parameters and best practices.

With athletes increasingly seeking non-invasive, regenerative options that minimize downtime and accelerate healing, the findings of this Delphi study (the first of its kind on Shockwave Therapy) couldn't be more timely. These findings are crucial to accelerate return-to-sport timelines and enhance recovery for athletes of every age, from high school to collegiate to pro, ESWT, including both focused shockwave and radial pressure wave applications, is quickly becoming a go-to modality for clinicians aiming to deliver faster recovery and better outcomes.

Medical professionals looking to elevate their treatment protocols can now turn to this groundbreaking consensus to confidently integrate ESWT into their sports medicine toolbox. Leaders in the field and participants of this Shockwave Delphi study—to include CuraMedix Key Opinion Leaders (KOLs) Dr. Brice Blatz, Dr. Michael Chin, Dr. Robert Conenello, Dr. Amol Saxena, and Dr. Adam Tenforde—are helping pave the way, ensuring that evidence, not guesswork, defines how we move forward with regenerative care in sports medicine.

Athletes, by their very nature, push limits physically and mentally. Whether plagued by an overuse injury or a lingering chronic condition, they demand fast, effective solutions to get back in the game. Today’s athletes are raising the bar on treatment expectations for recovery—they want only the most advanced treatment that allows them to continue training with minimal disruption to physical activity. That’s why Shockwave is rapidly emerging as a first-line option in sports medicine, offering a robust, evidence-based tool to accelerate healing and optimize return-to-play outcomes.

Understanding the Science Behind the ESWT Treatment

Extracorporeal Shockwave Therapy (ESWT) triggers a cascade of biological effects, awakening the body’s natural healing response at the cellular and tissue level. It's a non-invasive, regenerative technology that goes far beyond symptom relief.

Two primary forms are used:

1. Focused Shockwave (ESWT) Delivers deeper, targeted, and precise energy and is ideally suited for tendons, bone, and deep tissue.
2. Radial Pressure Wave (EPAT®) is ideal for broader areas closer to the skin's surface; it’s a stand-out treatment for superficial conditions like plantar fasciitis or lateral epicondylitis.

Both technologies stimulate mechanotransduction, converting mechanical energy into cellular signals that promote:

• Collagen synthesis
• Dynamic cell regeneration
• Pain relief achieved via hyperstimulation
• Neovascularization
• Inflammation reduction

Backed by Level 1 evidence, ESWT is an efficacious healing accelerator that minimizes the need for injections or surgery.

For athletes, that means:

• Minimal to no downtime
• Comfortable treatment sessions of 10–15 minutes, or less
• 4–6 weekly sessions
• Relief often after the first visit

Fast, non-invasive, and patient-friendly, ESWT treatment is designed for athletes who won’t settle for sitting on the sidelines.

Best-in-class results with ESWT can be achieved, yet it takes more than merely switching the device on. Utilizing Knobology, the art and science of fine-tuning the settings for the patient and the condition, is critically important. Nuanced energy levels, frequency, applicator choice, and treatment depth all influence outcomes. Precision is the cornerstone, especially when treating complex, high-demand areas like the upper extremities. Let’s dive into how ESWT treatment can improve shoulder, elbow, and wrist injuries.

ESWT Treatment for Upper Extremity Sports Injuries

Upper extremity injuries are commonplace among athletes, especially in sports involving repetitive motion, overhead activity, or high-intensity arm use. ESWT treatment offers a non-invasive, evidence-based approach to managing these conditions, often with faster recovery times and diminished reliance on pain medication or injections.

Clinical studies support the use of ESWT in treating a range of upper extremity issues, including:

• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golfer’s elbow)
• Calcific tendinitis of the shoulder
• Rotator cuff tendinopathy
• Wrist tendinopathies and soft tissue irritation

These conditions frequently respond well to a course of focused shockwave or radial pressure wave or a combination, depending on the depth and chronicity of the tissue involved. Athletes often report decreased pain and improved function rather quickly.

Precision is also imperative when treating the lower extremities, which require unique power, consistency, and protocol-driven application to support high-impact recovery.

ESWT Treatment for Lower Extremity Injuries in Athletes

Lower extremity injuries are among sports medicine's most common and performance-limiting conditions. From runners and field athletes to court sports and endurance competitors, ESWT treatment has proven highly effective in treating a range of lower limb issues. It offers a noninvasive path to recovery that supports early return to play.

Clinically supported lower extremity applications include:

• Plantar fasciitis
• Achilles tendinopathy
• Patellar tendinopathy (jumper’s knee)
• Proximal hamstring tendinopathy
• Greater trochanteric pain syndrome
• Bone stress injuries of the foot, tibia, and femur

Focused shockwave is often the preferred approach for bone and deep tendinopathies, while radial pressure wave  can be highly effective for broader, superficial areas like the plantar fascia or iliotibial band.

ESWT treatment and best practices typically involve weekly treatments over 4–6 weeks, with progressive load integration and sport-specific modifications. The resulting outcomes are reduced downtime, improved tissue quality, and faster progress throughout the rehab continuum.

While reliance on ESWT is clearly established in adult athletes, its role in treating younger patients with developing bodies is gaining attention, especially because youth sports have become more competitive and take place year-round.

ESWT Treatment in the Pediatric and Adolescent Athlete

As youth sports become more intense and year-round, overuse injuries are increasingly common in younger athletes. While data is still emerging, ESWT is emerging with promise as a non-invasive, regenerative option safe for treating young athletes and conditions like Osgood-Schlatter, Sever’s disease, and early-stage tendinopathies.

International experts like emphasize the importance of adapting protocols for the developing musculoskeletal system—using lower energy settings and conservative dosing. Early results are highly encouraging, with many young athletes experiencing reduced pain and quicker return to play without adverse effects.

ESWT is often used in conjunction with activity modification, physical therapy, and load management in younger athletes. The outcomes are certainly encouraging. As clinical evidence continues to expand, more physicians are looking to integrate ESWT into everyday practice—not just for elite athletes but across the full spectrum of musculoskeletal care.

ESWT Treatment: Implementation Strategies for Clinical Practice

Integrating ESWT into your practice starts with the proper training and setup. Hands-on instruction from experts helps clinicians quickly master protocols and device use.

Focus on the best practices for integration and keep it simple:

• Train your clinical team on settings, safety, and targeting. Share your excitement for the technologies.
• Optimize ergonomics for efficiency and comfort.
• Standardize protocols by region and condition. 
• Set realistic patient expectations and offer complementary modalities to enhance outcomes.

Start by treating common conditions like chronic tendinopathies and plantar fasciitis, and expand as your expertise and confidence are established.

Conclusion: The Evolving Role of the ESWT Treatment in Return-to-Play Decisions

The future of sports medicine is here, and the landscape is shifting to address sports injuries by advancing healing timelines while eliminating the need for extended downtime with regenerative Shockwave (ESWT and EPAT).

Shockwave treatment is becoming a cornerstone of modern sports medicine as athletes push for faster, safer recoveries. Its evidence-backed benefits, from pain relief to tissue regeneration, make it a valuable addition to any physician’s armamentarium

To stay ahead, clinicians should seek training, explore clinical studies, and consider integrating ESWT into their return-to-play strategies. The future of recovery is already here—are you ready to be one of the leaders?