Shockwave therapy is uncomfortable but generally tolerable for most people. The sensation is often described as a rapid tapping or snapping against the skin, and the intensity builds gradually during each session. Pain during treatment is actually expected and even considered part of how the therapy works, which is why clinical guidelines recommend against using numbing agents beforehand.
What It Feels Like During Treatment
The device delivers pulses of pressure waves directly to the point of maximum pain in your injured tissue. Each pulse feels like a firm flick or deep tapping sensation, and most sessions involve hundreds to a few thousand of these pulses over 5 to 15 minutes. The discomfort ranges from mildly annoying to moderately painful depending on how much energy is used, where you’re being treated, and your personal pain tolerance.
Practitioners typically start at low energy levels and gradually increase the intensity based on what you can handle. This ramp-up approach gives your body time to adjust. You’re an active participant in the process: if a pulse hits a particularly tender spot, that feedback actually helps the clinician know they’re targeting the right area. The treatment is guided by your pain response, so communication during the session matters.
Why Numbing Isn’t Recommended
You might assume a local anesthetic would make the experience easier, but research shows it can actually undermine the treatment. A study examining the interaction between local anesthesia and shockwave therapy found that numbing agents blocked the activation of pain-sensing nerve fibers that appear to play a role in the therapy’s biological effects. When those nerve fibers were blocked, key physiological responses to the shockwaves were prevented entirely.
This is why best-practice guidelines from the American Academy of Physical Medicine and Rehabilitation specifically recommend applying shockwave therapy without anesthetics. The discomfort you feel is part of the mechanism, not just an unfortunate side effect. It also serves a practical purpose: your pain response helps the clinician locate and focus on the injured tissue.
How Energy Levels Affect Pain
Shockwave devices operate across a wide range of energy settings, and the higher the energy, the more it hurts. Research confirms a direct, dose-dependent relationship: increasing the energy output leads to increasing pain. Treatments are categorized as low, medium, or high energy, and many protocols aim for the maximum level a patient can tolerate, since higher energy levels tend to produce better outcomes for conditions like plantar fasciitis.
There are also two main types of shockwave devices. Focused shockwave therapy concentrates energy deep into a specific point, while radial shockwave therapy spreads energy more broadly from the skin’s surface. Both can cause discomfort, and in one clinical trial comparing the two for shoulder tendon injuries, similar numbers of patients reported moderate pain during treatment with either type. The machines sound different and feel slightly different, but neither is dramatically more comfortable than the other during the session itself.
Which Body Areas Hurt More
Pain during treatment varies by location. Shockwave therapy is used across a long list of conditions, including plantar fasciitis, Achilles tendinopathy, tennis elbow, patellar tendon pain, hip bursitis, carpal tunnel syndrome, low back pain, and shoulder injuries. In every case, the device is applied directly to the most painful spot, which means the treatment inherently targets tissue that’s already sensitive.
Areas with less soft tissue padding between the skin and the injured structure, like the heel or the outside of the elbow, tend to be more uncomfortable than areas with more muscle coverage. Bony prominences and superficial tendons generally produce a sharper sensation. That said, most people find the discomfort manageable, particularly because sessions are short and the intensity is within their control.
Soreness After Treatment
The discomfort doesn’t end entirely when the session stops. In the days following treatment, swelling and redness in the treated area are common. Your pain may actually feel temporarily worse before it improves. This is a normal part of the healing response the shockwaves are designed to trigger, and it typically subsides within a day or two.
Other reported side effects are uncommon but include skin redness and, rarely, bruising. In one clinical trial, a small number of patients experienced moderate pain after their sessions, one patient fainted, and one reported a headache. Serious complications are rare when the therapy is applied according to established guidelines and contraindications are respected.
How to Make Sessions More Comfortable
The most effective strategy is simply communicating with your practitioner. Since the standard approach is to start low and increase intensity gradually, you have real-time input into how much energy is applied. If a particular level becomes too much, saying so allows the clinician to back off slightly and continue at a tolerable intensity. Most people find that after the first minute or two, the sensation becomes more predictable and easier to manage.
Treatments are typically spaced a week apart, and most protocols involve three to five sessions total. Many patients report that later sessions feel less intense than the first, partly because the tissue is healing and partly because they know what to expect. The temporary discomfort during and after treatment is a tradeoff most people accept, given that a full course of shockwave therapy takes only a few weeks and requires no incisions, medication, or downtime.