{"id":12294,"date":"2026-09-25T10:43:30","date_gmt":"2026-09-25T10:43:30","guid":{"rendered":"https:\/\/msinsight.dk\/evidence-for-shockwave-therapy\/"},"modified":"2026-09-25T11:18:25","modified_gmt":"2026-09-25T11:18:25","slug":"evidence-for-shockwave-therapy","status":"publish","type":"page","link":"https:\/\/msinsight.dk\/en\/evidence-for-shockwave-therapy\/","title":{"rendered":"Evidence for Shockwave Therapy"},"content":{"rendered":"\t\t
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MS Insight \u00b7 Professional Article<\/p>\n\t\t\t\t\t

Shockwave Therapy\u2014What Does the Evidence Say?<\/h1>\n\t\t\t\t\t

Is shockwave therapy scientifically proven\u2014or just another treatment that\u2019s being marketed more than the research can support? Here\u2019s an honest overview of what the studies actually show.<\/p>\n\t\t

\n \t\t\t\n\tBook a free 15-minute consultation \u2192\n<\/a>\n\t\t\t\t\t\n\tRead about shockwave therapy\n<\/a>\n\t\t\n<\/div>\n
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By Michael Str\u00f8m<\/p>\n\t\t\t\t\t

Clinical shockwave specialist and international instructor<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n

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In a nutshell<\/p>\n\t\t

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21 RCTs<\/p>\n\t\t\t\t\t

and 1,357 men in the 2025 Cochrane review on erectile dysfunction<\/p>\n\t\t\n<\/div>\n

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3 EAU guidelines<\/p>\n\t\t\t\t\t

mention shockwave therapy: erectile dysfunction, Peyronie\u2019s disease, and chronic pelvic pain<\/p>\n\t\t\n<\/div>\n

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No single treatment<\/p>\n\t\t\t\t\t

The effect depends on the diagnosis, technology, energy, and protocol<\/p>\n\t\t\n<\/div>\n\t\t\t

The evidence is real\u2014but it isn\u2019t equally strong across all areas.<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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Is shockwave therapy scientifically proven?<\/h2>\n\t\t\t\t\t

The short answer is: Yes.<\/strong> Shockwave is an evidence-based medical technology that has been studied in randomized controlled trials, sham studies, systematic reviews, and meta-analyses.<\/p>\n\t\t\t\t\t

But there is one important detail that is often overlooked in the discussion: Shockwave is not a single treatment.<\/strong><\/p>\n\t\t\t\t\t

Different devices produce different types of acoustic energy. Studies use varying energy levels, numbers of shockwaves, treatment areas, and patient groups. Therefore, two studies can both examine \u201cshockwave\u201d and yet, in practice, be examining quite different treatments.<\/p>\n\t\t\t\t\t

This also partly explains why some studies show clear results, while others show little or no effect.<\/p>\n\t\t\t\t\t

For example, a large Cochrane review from 2025 identified 21 randomized studies involving a total of 1,357 men with erectile dysfunction. The researchers found an overall positive signal but rated the certainty of the evidence as low, in part because the treatment protocols and outcomes varied considerably across the studies. Cochrane 2025<\/a><\/p>\n\t\t\t\t\t

The European Association of Urology (EAU) also includes low-intensity shockwave therapy in its guidelines for erectile dysfunction and shockwave therapy in the assessment of both Peyronie\u2019s disease and chronic pelvic pain. The recommendations vary because the evidence differs from one diagnosis to another. EAU guideline<\/a><\/p>\n\t\t\t\t\t

\u201cWhich type of shockwave works, at what dose, for which condition\u2014and in which patient?\u201d<\/p>\n\t\t\n<\/div>\n\n<\/section>\n

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Overview<\/p>\n\t\t\t\t\t

If you just want the key points<\/h2>\n\t\t\t\t\t

The evidence isn\u2019t equally strong across all areas. This overview is a practical guide\u2014not a substitute for the detailed research further down the page.<\/p>\n\t\t\n<\/div>\n

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Field<\/p>\n\t\t\t\t\t

What does the research show?<\/p>\n\t\t\n<\/div>\n

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Erectile dysfunction (ED)<\/p>\n\t\t\t\t\t

Many RCTs. A consistent but moderate clinical signal\u2014especially for vasculogenic ED.<\/p>\n\t\t\n<\/div>\n

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Peyronie\u2019s disease<\/p>\n\t\t\t\t\t

Best evidence for pain relief. A new study from 2026 shows interesting results regarding curvature.<\/p>\n\t\t\n<\/div>\n

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CP\/CPPS and chronic pelvic pain<\/p>\n\t\t\t\t\t

Several sham-controlled studies show a reduction in pain and symptom burden.<\/p>\n\t\t\n<\/div>\n

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Orthopedics<\/p>\n\t\t\t\t\t

One of the most extensive areas of research, but results vary by diagnosis.<\/p>\n\t\t\n<\/div>\n

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Myofascial pain<\/p>\n\t\t\t\t\t

Meta-analyses show an effect on pain and function.<\/p>\n\t\t\n<\/div>\n

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Neurology<\/p>\n\t\t\t\t\t

Growing body of clinical research, including studies on spasticity.<\/p>\n\t\t\n<\/div>\n

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Nerve Regeneration<\/p>\n\t\t\t\t\t

Very interesting preclinical research, but not yet at the same level of evidence in humans.<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n

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The Technology<\/p>\n\t\t\t\t\t

Not all shockwaves are created equal<\/h2>\n\t\t\t\t\t

Imagine two clinics. Both offer \u201cshockwave therapy.\u201d One clinic has one device and one type of generator. The other can choose from several different ways to generate and focus the acoustic energy.<\/p>\n\t\t\t\t\t

On paper, both offer shockwave therapy. Technologically, however, the treatments do not have to be the same.<\/strong><\/p>\n\t\t\t\t\t

There are three principles of focused shockwave\u2014and, in addition, radial<\/h3>\n\t\t\n<\/div>\n
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Focused<\/p>\n\t\t\t\t\t

Electrohydraulic<\/h3>\n\t\t\t\t\t

Generates the shock wave through an electrical discharge in a fluid and then focuses the energy.<\/p>\n\t\t\n<\/div>\n

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Focused<\/p>\n\t\t\t\t\t

Electromagnetic<\/h3>\n\t\t\t\t\t

Generates the wave electromagnetically and focuses it on a defined treatment area.<\/p>\n\t\t\n<\/div>\n

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Focused<\/p>\n\t\t\t\t\t

Piezoelectric<\/h3>\n\t\t\t\t\t

Uses a series of piezoelectric elements that are activated simultaneously and focus the energy on a specific area.<\/p>\n\t\t\n<\/div>\n

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Radial<\/p>\n\t\t\t\t\t

Radial pressure wave<\/h3>\n\t\t\t\t\t

Operates with a different physical pressure profile and typically delivers its highest energy more superficially.<\/p>\n\t\t\n<\/div>\n\n<\/div>\n

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This does not mean that one technology is always best. It means that the term \u201cshockwave\u201d alone does not provide enough information about the treatment.<\/p>\n\t\t\t\t\t

Why does this matter to you as a patient?<\/h3>\n\t\t\t\t\t

Because tissues and conditions are not the same. A patient with vascular erectile dysfunction does not necessarily have the same treatment goal as a patient with a Peyronie\u2019s plaque. A painful pelvic floor is different from a calcified tendon. And a superficial muscular structure is different from tissue located several centimeters inside the body.<\/p>\n\t\t\t\t\t

Therefore, it does not necessarily make sense for everyone to be treated with the same machine, the same applicator, the same energy level, and the same protocol.<\/p>\n\t\t\t\t\t

Cochrane and the EAU specifically point out significant differences in the treatment parameters and technologies used in shockwave studies. EAU<\/a><\/p>\n\t\t\n<\/div>\n\n<\/section>\n

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My Approach<\/p>\n\t\t\t\t\t

Why do I work with multiple types of shockwave therapy?<\/h2>\n\t\t\t\t\t

It is precisely in this area that my approach at MS Insight differs from that of a traditional clinic that has invested in a single shockwave system.<\/p>\n\t\t

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Technology<\/p>\n\t\t\t\t\t

System at the clinic<\/p>\n\t\t\n<\/div>\n

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Electrohydraulic<\/p>\n\t\t\t\t\t

MTS Medical<\/p>\n\t\t\n<\/div>\n

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Electromagnetic<\/p>\n\t\t\t\t\t

Storz Medical<\/p>\n\t\t\n<\/div>\n

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Piezoelectric<\/p>\n\t\t\t\t\t

Elvation Medical \/ Piezowave<\/p>\n\t\t\n<\/div>\n

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Electromagnetic flat coil<\/p>\n\t\t\t\t\t

Longest Medical<\/p>\n\t\t\n<\/div>\n

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Radial<\/p>\n\t\t\t\t\t

Used as a supplement when appropriate<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\t\t\t

This does not provide me with scientific evidence to claim that my results are automatically better than those of a clinic with a single device. But it does give me greater clinical flexibility: treatment does not have to be designed around the specific device the clinic owns.<\/p>\n\t\t\n<\/div>\n

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\u201cI don\u2019t have to try to make the patient fit the machine. Instead, I can choose the technology, applicator, and protocol based on the problem I\u2019m facing.\u201d<\/p>\n\t\t\t\t\t

Michael Str\u00f8m \u00b7 MS Insight<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n

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Experience isn\u2019t just about having performed many treatments<\/h3>\n\t\t\t\t\t

I have been working intensively with shockwave therapy since 2016. Since 2020, I have trained doctors and other healthcare professionals internationally in more than 25 countries, and I currently work as a clinical consultant and instructor for MTS Medical and Elvation Medical. From 2019 to 2024, I worked as a clinical consultant, instructor, and reference for Storz Medical.<\/p>\n\t\t\t\t\t

My experience, therefore, does not come solely from operating a single specific machine. I have worked with various generator principles, applicators, energy levels, and manufacturers\u2014and at the same time, I have had to teach others why and when to use the different technologies.<\/p>\n\t\t\t\t\t

For me, advanced shockwave therapy isn't about using as much energy as possible. It's about understanding the tissue, understanding the technology, and choosing the most rational combination . And sometimes, the most important decision is that shockwave therapy isn't the right treatment.<\/strong><\/p>\n\t\t\n<\/div>\n

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2016<\/p>\n\t\t\t\t\t

Intensive shockwave therapy<\/p>\n\t\t\n<\/div>\n

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25+ countries<\/p>\n\t\t\t\t\t

International training since 2020<\/p>\n\t\t\n<\/div>\n

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MTS & Elvation<\/p>\n\t\t\t\t\t

Clinical consultant and instructor today<\/p>\n\t\t\n<\/div>\n

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Storz Medical<\/p>\n\t\t\t\t\t

Consultant, instructor, and reference 2019\u20132024<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n

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Diagnosis Before Technology<\/p>\n\t\t\t\t\t

Before shockwave therapy comes the question: Why do you have this problem?<\/h2>\n\t\t\t\t\t

If a man has erectile dysfunction, the cause may be vascular, neurological, metabolic, medical, hormonal, psychogenic, or a combination of these.<\/p>\n\t\t\t\t\t

If a man has Peyronie\u2019s disease, it may be important to understand plaque, calcification, curvature, pain, and erectile function.<\/p>\n\t\t\t\t\t

In cases of chronic pelvic pain<\/a>, muscles, fascia, peripheral nerves, and the pain system may be involved to varying degrees.<\/p>\n\t\t\t\t\t

That\u2019s why I don\u2019t necessarily start with the question , \u201cWhere should we apply shockwave therapy?\u201d<\/em> I start with, \u201cWhat appears to be causing the problem?\u201d<\/strong><\/p>\n\t\t\t\t\t

A relevant clinical examination and ultrasound may therefore be part of the evaluation before we decide whether shockwave therapy makes sense and, if so, how the treatment should be organized.<\/p>\n\t\t

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Not sure if shockwave therapy is right for you?<\/p>\n\t\t\t\t\t

Book a free, confidential 15-minute consultation with Michael.<\/p>\n\t\t\n<\/div>\n\t\t\t\n\tBook a free consultation \u2192\n<\/a>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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Erectile Dysfunction<\/p>\n\t\t\t\t\t

Does shockwave therapy work for erectile dysfunction?<\/h2>\n\t\t\t\t\t

Low-intensity shockwave therapy is being studied primarily in men with vasculogenic erectile dysfunction\u2014that is, where insufficient blood supply is a major part of the problem.<\/p>\n\t\t\t\t\t

The fundamental mechanism of action differs from that of Viagra, sildenafil, or tadalafil. PDE5 inhibitors pharmacologically support the erectile mechanism while the medication is active in the body. Shockwave therapy, on the other hand, is being studied for its potential to influence aspects of underlying tissue and vascular function.<\/p>\n\t\t\t\t\t

The EAU currently assesses that LiSWT may provide a mild improvement in erectile function in men with vasculogenic ED and issues a weak recommendation for selected patients. EAU ED guideline<\/a><\/p>\n\t\t\t\t\t

Shockwave therapy is just one of several possible approaches. If you\u2019re experiencing symptoms and want to understand the diagnosis, causes, and various treatment options, you can read my complete guide to treating erectile dysfunction<\/a>.<\/p>\n\t\t\t\t\t

What do the key studies show?<\/h3>\n\t\t\n<\/div>\n
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Cochrane review \u00b7 21 RCTs \u00b7 1,357 men<\/p>\n\t\t\t\t\t

Cochrane 2025<\/h3>\n\t\t\t\t\t

In the short term, the average improvement in erectile function scores was 3.89 points greater after active treatment than after sham treatment. However, Cochrane rated the evidence as having low certainty due to, among other things, inconsistency, uncertainty, and methodological limitations.<\/p>\n\t\t\t\t\t

What\u2019s interesting:<\/strong> There is an overall positive signal\u2014but the studies do not necessarily treat patients in the same way.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Double-blind \u00b7 sham-controlled \u00b7 67 men<\/p>\n\t\t\t\t\t

Vardi et al. 2012<\/h3>\n\t\t\t\t\t

The patients received 12 sessions of active low-intensity shockwave therapy or sham treatment. The study examined both erectile function and penile hemodynamic measures.<\/p>\n\t\t\t\t\t

Why is this interesting?<\/strong> The researchers examined not only subjective erectile function but also physiological measures.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Electromagnetic \u00b7 double-blind \u00b7 sham<\/p>\n\t\t\t\t\t

Kim et al. 2020<\/h3>\n\t\t\t\t\t

96 patients were included, and 81 completed the study. The median change in IIEF-EF was +5.1 in the shockwave group versus \u22122.2 in the sham group.<\/p>\n\t\t\t\t\t

Why is this interesting?<\/strong> The technology and treatment design are relatively clearly defined.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Danish RCT \u00b7 126 men \u00b7 linear low-energy<\/p>\n\t\t\t\t\t

Fojecki et al. 2017<\/h3>\n\t\t\t\t\t

The researchers were unable to demonstrate the desired clinical benefit at the primary endpoint.<\/p>\n\t\t\t\t\t

Why is this important?<\/strong> A negative study is crucial for understanding that technology, energy, number of pulses, target, and patient selection may play a role.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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Peyronie\u2019s disease<\/p>\n\t\t\t\t\t

What about Peyronie\u2019s disease?<\/h2>\n\t\t\t\t\t

The use of shockwave therapy for the treatment of Peyronie\u2019s disease<\/a> has been studied for many years, but the results depend on what one is trying to improve. Pain, plaque, curvature, and erectile function are different outcomes and must be assessed separately.<\/p>\n\t\t\t\t\t

The EAU currently concludes that the existing controlled research, taken as a whole, shows an effect on penile pain but no certain effect on plaque or curvature. EAU Peyronie\u2019s disease guideline<\/a><\/p>\n\t\t\n<\/div>\n

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Placebo-controlled RCT \u00b7 102 men<\/p>\n\t\t\t\t\t

Hatzichristodoulou et al. 2013<\/h3>\n\t\t\t\t\t

Patients received six weekly treatments with 2,000 shockwaves per session. Among patients with pain, pain decreased in 85% of the shockwave group compared to 48% in the placebo group. No significant reduction in curvature was documented.<\/p>\n\t\t\t\t\t

Why is this interesting?<\/strong> It shows that pain and curvature can respond differently to the same treatment.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Prospective study \u00b7 112 men \u00b7 Italy<\/p>\n\t\t\t\t\t

Saitta et al. 2026<\/h3>\n\t\t\t\t\t

The patients received three treatments with 3,000 shock waves per session at 0.11\u20130.17 mJ\/mm\u00b2. 90% of the patients with pain experienced pain relief, while 57.1% showed improvement in curvature. Among the responders, the average improvement was approximately 30 degrees.<\/p>\n\t\t\t\t\t

Important limitation:<\/strong> The study did not include a sham or control group. Therefore, the entire change cannot be attributed to shockwave therapy with certainty.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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Pelvic Pain<\/p>\n\t\t\t\t\t

Chronic pelvic pain and CP\/CPPS<\/h2>\n\t\t\t\t\t

CP\/CPPS is a complex condition. Men may experience pain around the perineum, penis, testicles, or pelvic floor, problems after ejaculation, and various urinary symptoms. In many cases, the symptoms are not caused by a classic bacterial infection of the prostate.<\/p>\n\t\t\t\t\t

The EAU guideline describes several randomized, sham-controlled studies showing improvements in pain, quality of life, and the NIH-CPSI following extracorporeal shockwave therapy. EAU Chronic Pelvic Pain<\/a><\/p>\n\t\t\n<\/div>\n

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Randomized \u00b7 double-blind \u00b7 placebo<\/p>\n\t\t\t\t\t

Zimmermann et al. 2009<\/h3>\n\t\t\t\t\t

Men with chronic pelvic pain syndrome were treated perineally with ESWT. Among other things, the researchers found improvements in pain and quality of life compared to the control group.<\/p>\n\t\t\t\t\t

Why is this interesting?<\/strong> An early landmark study outside the field of traditional orthopedics.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Systematic review and meta-analysis<\/p>\n\t\t\t\t\t

Mykoniatis et al. 2021<\/h3>\n\t\t\t\t\t

Five sham-controlled RCTs and one other randomized study were included. Pain, the total NIH-CPSI score, and quality of life were significantly better after active LiSWT than after sham treatment immediately after treatment, as well as at one and three months. The long-term effect was less certain.<\/p>\n\t\t\t\t\t

Why is this important?<\/strong> The positive findings are consistent across several randomized studies.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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The Big Picture<\/p>\n\t\t\t\t\t

Shockwave therapy extends far beyond men\u2019s sexual health<\/h2>\n\t\t\t\t\t

If you only encounter shockwave therapy in the context of treating erectile dysfunction, you might get the impression that it is a relatively new \u201cpotency treatment.\u201d That is a misleading view.<\/p>\n\t\t\t\t\t

Much of the research literature comes from the fields of orthopedics, rehabilitation, and pain management.<\/p>\n\t\t\n<\/div>\n

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Meta-analysis \u00b7 27 RCTs \u00b7 myofascial pain<\/p>\n\t\t\t\t\t

Avenda\u00f1o-L\u00f3pez et al. 2024<\/h3>\n\t\t\t\t\t

The analysis found overall improvements in pain, pressure pain threshold, and function, but also significant variation between protocols and patient groups.<\/p>\n\t\t\t\t\t

Relevance:<\/strong> The clinical application of shockwaves for pain extends beyond classic tendon disorders.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

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Recent meta-analyses \u00b7 20+ RCTs<\/p>\n\t\t\t\t\t

Calcific rotator cuff<\/h3>\n\t\t\t\t\t

Research shows that energy level and protocol may influence outcomes, including pain, function, and calcium resorption.<\/p>\n\t\t\t\t\t

Principle:<\/strong> Shockwave therapy should be understood as a measured physical intervention\u2014not simply as a machine that is turned on or off.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

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The Biology Behind It<\/p>\n\t\t\t\t\t

What happens inside the cells? Mechanotransduction<\/h2>\n\t\t\t\t\t

Mechanotransduction means that a physical or mechanical stimulus is converted into biological signals inside the cell. In very simple terms, the process looks like this:<\/p>\n\t\t

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Shockwave<\/p>\n\t\t\t\t\t

\u2192<\/p>\n\t\t\t\t\t

Mechanical stimulus<\/p>\n\t\t\t\t\t

\u2192<\/p>\n\t\t\t\t\t

The cell detects the stimulus<\/p>\n\t\t\t\t\t

\u2192<\/p>\n\t\t\t\t\t

Biochemical signaling<\/p>\n\t\t\t\t\t

\u2192<\/p>\n\t\t\t\t\t

Biological response<\/p>\n\t\t\n<\/div>\n\n<\/div>\n

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Human endothelial cells \u00b7 laboratory study<\/p>\n\t\t\t\t\t

Hatanaka, Ito et al. 2016<\/h3>\n\t\t\t\t\t

Following low-energy shockwave treatment, the researchers observed, among other things, increased expression of VEGF and eNOS, as well as activation of ERK and Akt. They also demonstrated that mechanosensors such as \u03b21-integrin and caveolin-1 played a role in the signaling process.<\/p>\n\t\t\t\t\t

Why is this important?<\/strong> The study shows that shockwave therapy does not merely affect the tissue mechanically\u2014the cells respond biologically to the stimulus.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n

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What about nerves?<\/h3>\n\t\t\t\t\t

Nerve regeneration is a very interesting field, but the clinical evidence in humans is not at the same level as for many musculoskeletal conditions.<\/p>\n\t\t\n<\/div>\n

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Animal model \u00b7 peripheral nerve regeneration<\/p>\n\t\t\t\t\t

Hausner et al. 2012<\/h3>\n\t\t\t\t\t

Animals that received low-energy ESWT after nerve grafting showed faster early functional recovery and more myelinated nerve fibers during parts of the regeneration phase than the control group.<\/p>\n\t\t\t\t\t

Interpretation:<\/strong> Biologically plausible\u2014no clinical evidence for the treatment of human neuropathy.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Diabetic ED model \u00b7 animal study<\/p>\n\t\t\t\t\t

Qiu et al. 2013<\/h3>\n\t\t\t\t\t

Diabetes reduced erectile function, nNOS-positive nerve fibers, endothelial cells, and smooth muscle. After shockwave therapy, several parameters were partially improved, and the researchers found evidence consistent with the recruitment of the body\u2019s own progenitor cells.<\/p>\n\t\t\t\t\t

Why is this interesting?<\/strong> The study establishes a biological link between vascular function, nerve tissue, smooth muscle, and erectile function.<\/p>\n\t\t\t\t\t

View the study on PubMed \u2192<\/a><\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/section>\n

\n
\n
\n \t\t\t

The Research<\/p>\n\t\t\t\t\t

Why can research findings vary so much?<\/h2>\n\t\t\t\t\t

When two studies show different results, one should consider these variables, among others:<\/p>\n\t\t\n<\/div>\n

\n
\n
\n \t\t\t

Variable<\/p>\n\t\t\t\t\t

Why might this be important?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Generator principle<\/p>\n\t\t\t\t\t

Electrohydraulic, electromagnetic, and piezoelectric systems generate energy differently<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Focused or radial<\/p>\n\t\t\t\t\t

Different physical energy profiles<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Energy<\/p>\n\t\t\t\t\t

Low and high energy are not the same biological stimulus<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Number of shockwaves<\/p>\n\t\t\t\t\t

The total mechanical dose varies<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Applicator\/focus<\/p>\n\t\t\t\t\t

The energy can be distributed differently<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Treatment area<\/p>\n\t\t\t\t\t

An incorrect target can reduce the relevant stimulus<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Number of sessions<\/p>\n\t\t\t\t\t

Studies use very different protocols<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Follow-up<\/p>\n\t\t\t\t\t

Biological effects may develop over weeks or months<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Patient selection<\/p>\n\t\t\t\t\t

The same symptom can have different underlying causes<\/p>\n\t\t\n<\/div>\n\n<\/div>\n

\n \t\t\t\"\"\/\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n
\n
\n
\n \t\t\t

Glossary<\/p>\n\t\t\t\t\t

What do RCT, sham, and meta-analysis actually mean?<\/h2>\n\t\t\n<\/div>\n
\n
\n \t\t\t

RCT<\/p>\n\t\t\t\t\t

Randomized Controlled Trial<\/h3>\n\t\t\t\t\t

Patients are randomly assigned to either the treatment or control group. This reduces the risk that differences between the groups are due to other factors.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Sham<\/p>\n\t\t\t\t\t

Sham-controlled study<\/h3>\n\t\t\t\t\t

The patient receives a treatment that resembles the active treatment but lacks the actual therapeutic shockwave energy. This is particularly important in cases of pain and sexual function, where expectations can influence the outcome.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Review<\/p>\n\t\t\t\t\t

Systematic review<\/h3>\n\t\t\t\t\t

Researchers systematically attempt to identify and evaluate all relevant research in a given field.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Meta-analysis<\/p>\n\t\t\t\t\t

Meta-analysis<\/h3>\n\t\t\t\t\t

Results from multiple studies are combined statistically. However, if the included studies are very different, the overall conclusion also becomes more uncertain.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Preclinical<\/p>\n\t\t\t\t\t

Experimental studies<\/h3>\n\t\t\t\t\t

Examine biological mechanisms in, for example, cells or animal models. They can explain how shockwave therapy works biologically, but cannot, on their own, prove clinical efficacy in humans.<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n

\n
\n
\n \t\t\t

The Literature<\/p>\n\t\t\t\t\t

13 studies worth knowing about<\/h2>\n\t\t\t\t\t

From large-scale reviews and randomized controlled trials to basic research in cell biology and animal models. Click on a study to view it on PubMed.<\/p>\n\t\t\n<\/div>\n

\n
\n \t\t\t

Study<\/p>\n\t\t\t\t\t

Field<\/p>\n\t\t\t\t\t

Why is it interesting?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Ergun et al., Cochrane 2025<\/a><\/p>\n\t\t\t\t\t

ED<\/p>\n\t\t\t\t\t

21 RCTs and 1,357 men; overall positive, but low-certainty evidence.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Vardi et al., 2012<\/a><\/p>\n\t\t\t\t\t

ED<\/p>\n\t\t\t\t\t

Landmark sham-RCT with clinical and physiological endpoints.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Kim et al., 2020<\/a><\/p>\n\t\t\t\t\t

ED<\/p>\n\t\t\t\t\t

Electromagnetic focused shockwave with a significant difference compared to sham.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Fojecki et al., 2017<\/a><\/p>\n\t\t\t\t\t

ED<\/p>\n\t\t\t\t\t

Negative RCT\u2014important for understanding protocol variation.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Hatzichristodoulou et al., 2013<\/a><\/p>\n\t\t\t\t\t

Peyronie\u2019s<\/p>\n\t\t\t\t\t

Positive effect on pain, but not on curvature.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Saitta et al., 2026<\/a><\/p>\n\t\t\t\t\t

Peyronie\u2019s<\/p>\n\t\t\t\t\t

Very interesting results regarding pain and curvature, but no control group.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Zimmermann et al., 2009<\/a><\/p>\n\t\t\t\t\t

CP\/CPPS<\/p>\n\t\t\t\t\t

Double-blind, placebo-controlled RCT.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Mykoniatis et al., 2021<\/a><\/p>\n\t\t\t\t\t

CP\/CPPS<\/p>\n\t\t\t\t\t

Systematic review\/meta-analysis of randomized studies.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Avenda\u00f1o-L\u00f3pez et al., 2024<\/a><\/p>\n\t\t\t\t\t

Myofascial pain<\/p>\n\t\t\t\t\t

27 randomized studies.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Hatanaka et al., 2016<\/a><\/p>\n\t\t\t\t\t

Mechanotransduction<\/p>\n\t\t\t\t\t

VEGF, eNOS, Akt, ERK, and mechanosensors.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Qiu et al., 2013<\/a><\/p>\n\t\t\t\t\t

ED mechanisms<\/p>\n\t\t\t\t\t

Endothelium, smooth muscle, and nerve tissue in a diabetic model.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

Hausner et al., 2012<\/a><\/p>\n\t\t\t\t\t

Nerve<\/p>\n\t\t\t\t\t

Accelerated early peripheral nerve regeneration in an animal model.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

EAU<\/a><\/p>\n\t\t\t\t\t

Guidelines<\/p>\n\t\t\t\t\t

Clinical guideline assessment of ED, Peyronie\u2019s disease, and chronic pelvic pain.<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n

\n
\n \t\t\t

Conclusion<\/p>\n\t\t\t\t\t

So\u2014does shockwave therapy work?<\/h2>\n\t\t\t\t\t

Yes\u2014but that\u2019s a worse question than it initially sounds like.<\/strong><\/p>\n\t\t\t\t\t

Shockwave therapy is not an experimental technology without a scientific basis. There is a significant body of research ranging from cell biology and animal models to randomized clinical trials, meta-analyses, and international guidelines.<\/p>\n\t\t\t\t\t

However, the research also shows very clearly that the effect depends on the diagnosis, patient selection, technology, target, energy, and protocol.<\/p>\n\t\t

\n \t\t\t

Key Message<\/p>\n\t\t\t\t\t

Shockwave is a biologically and clinically validated treatment platform, but the evidence and treatment efficacy vary significantly across different indications and protocols.<\/p>\n\t\t\n<\/div>\n\t\t\t

Perhaps the most important question, therefore, is not: Does the clinic offer shockwave therapy? But rather:<\/h3>\n\t\t
\n
\n \t\t\t

01<\/p>\n\t\t\t\t\t

What type of shockwave therapy does the clinic use?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

02<\/p>\n\t\t\t\t\t

Why did the practitioner choose that particular technology?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

03<\/p>\n\t\t\t\t\t

Which structure are they trying to influence?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

04<\/p>\n\t\t\t\t\t

How are the energy source and protocol selected?<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

05<\/p>\n\t\t\t\t\t

And have you even tried to understand the root cause of the problem?<\/p>\n\t\t\n<\/div>\n\n<\/div>\n\t\t\t

Those are exactly the questions I use as a starting point in my work at MS Insight.<\/strong><\/p>\n\t\t\n<\/div>\n\n<\/section>\n

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\n \t\t\t

MS Insight<\/p>\n\t\t\t\t\t

Why MS Insight Takes a Different Approach to Shockwave<\/h2>\n\t\t\t\t\t

The more technological options you have, the more important it becomes to know when to use them\u2014and when not to.<\/p>\n\t\t\n<\/div>\n

\n \t\t\t

I\u2019ve deliberately designed the clinic so that I\u2019m not tied to a single manufacturer or a single generator principle. I work with electrohydraulic, electromagnetic, and piezoelectric focused shockwave, as well as radial technology.<\/p>\n\t\t\t\t\t

This allows me to view the technology from multiple angles\u2014not just \u201chow do I use this machine?\u201d, but \u201cwhich technology makes the most sense for this tissue, this depth, and this clinical issue?\u201d.<\/p>\n\t\t\t\t\t

I combine this with clinical assessment and relevant ultrasound imaging when it can help me understand, for example, tissue, plaque, calcification, or other structural conditions.<\/p>\n\t\t

\n \t\t\t\n\tBook a free 15-minute consultation \u2192\n<\/a>\n\t\t\t\t\t\n\tRead about shockwave therapy\n<\/a>\n\t\t\n<\/div>\n\n<\/div>\n\n<\/div>\n\n<\/section>\n
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FAQ<\/p>\n\t\t\t\t\t

Frequently Asked Questions About Shockwave and Evidence<\/h2>\n\t\t\t\t\t

Short answers to the questions I\u2019m most frequently asked about the research behind shockwave therapy.<\/p>\n\t\t\n<\/div>\n

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\n \n \n \t\t\t

Is shockwave therapy scientifically proven?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

Yes. There are randomized controlled trials, sham-controlled trials, systematic reviews, and meta-analyses for several indications. The strength of the evidence varies significantly across diagnoses and protocols.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

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Is shockwave therapy proven effective for erectile dysfunction?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

There are many RCTs, and the EAU assesses that low-intensity shockwave therapy may provide a mild improvement in erectile function in selected men with vasculogenic ED. However, the recommendation for its use remains weak.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

Is shockwave therapy effective for Peyronie\u2019s disease?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

The strongest controlled evidence currently pertains to pain relief. The EAU does not recommend ESWT alone for the primary purpose of reducing curvature. However, a new prospective study from 2026 found interesting improvements that should be verified in controlled studies.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

Are focused and radial shockwaves the same thing?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

No. Their acoustic and physical properties differ, and results from one technology should therefore not be automatically applied directly to the other.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

Are electrohydraulic, electromagnetic, and piezoelectric focused shockwaves the same?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

All three can create focused shockwaves, but they generate and distribute energy differently. That is one of the reasons why I work with all three principles at MS Insight.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

Is more energy always better?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

No. The dose must be appropriate for the tissue, the target, and the protocol. \u201cMore\u201d does not automatically equal \u201cbetter.\u201d<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

Can shockwaves regenerate nerves?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

Preclinical studies have shown an effect on peripheral nerve regeneration, but this is not the same as documented treatment of human neuropathy.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n

\n \n \n \t\t\t

How many shockwave treatments are needed?<\/p>\n\t\t\n<\/span>\n

\n \n<\/div>\n\n<\/summary>\n
\n \t\t\t

There is no single universal number. Research protocols vary depending on diagnosis, technology, energy level, and treatment goals.<\/p>\n\t\t\n<\/div>\n\n<\/details>\n\n<\/div>\n