Shockwave therapy for tennis elbow (lateral epicondylitis) is well researched — but the way it’s delivered in trials doesn’t always reflect real clinical practice.
Across ~19 studies, most protocols use just 3 sessions, typically with lower energy and predominantly radial shockwave. These approaches are standardised for research design, which is important — but may not represent the full biological dose needed for tendon adaptation.
In real life, this often looks very different.
In my clinical experience, most patients need 6–8 sessions, and sometimes up to 10+ in more persistent cases. Treatment is progressed based on response, not fixed numbers, and always combined with appropriate loading and rehabilitation.
I also tend to use focused shockwave alongside EMTT, allowing a more targeted and individualised approach.
Research gives us the starting point — but clinical outcomes depend on how we apply it.
We treat the patient, not just the protocol.
