Shockwave Therapy for Knee Pain: Treating Patellar Tendonitis and More

Shockwave therapy for knee pain is a non-invasive treatment that delivers acoustic pressure waves into damaged tendons, ligaments, and soft tissues around the knee joint to trigger your body's natural healing response. Extracorporeal shockwave therapy (ESWT) is particularly effective for chronic conditions like patellar tendonitis (jumper's knee), iliotibial band syndrome, and quadriceps tendinopathy. If rest, ice, and physical therapy have not resolved your knee pain after several weeks, shockwave therapy may be the treatment that finally breaks the cycle.

Knee pain is the second most common musculoskeletal complaint in the United States. According to a 2022 report from the American Academy of Family Physicians, roughly 25 percent of adults experience knee pain at any given time, and that number has increased nearly 65 percent over the past 20 years (AAFP, 2022). Much of this knee pain comes from soft tissue injuries rather than structural joint damage, and that is where shockwave therapy excels.

How Does Shockwave Therapy Treat Knee Pain?

A shockwave therapy device sends rapid pulses of high-energy acoustic waves through the skin and into the affected tissue around the knee. The applicator is placed directly over the area of greatest tenderness, and 2,000 to 3,000 pulses are delivered per treatment zone. These waves produce three key effects:

• Neovascularization: The waves stimulate the growth of new blood vessels in the treatment area. Tendons around the knee, especially the patellar tendon, have poor blood supply compared to muscles. New blood vessel formation brings oxygen, nutrients, and growth factors to tissue that has been starved of healing resources.
• Collagen remodeling: Chronic tendon injuries are characterized by disorganized collagen fibers and scar tissue. Shockwave therapy creates controlled micro-damage that prompts the body to replace this dysfunctional tissue with properly aligned, healthy collagen.
• Pain reduction: The acoustic waves overstimulate pain nerve endings, which leads to a short-term numbing effect. Over multiple sessions, the reduction in tissue damage and inflammation leads to lasting pain relief.

A 2020 meta-analysis published in the British Journal of Sports Medicine reviewed 17 randomized controlled trials and concluded that ESWT significantly reduced pain and improved function in patients with patellar tendinopathy compared to placebo and other conservative treatments (BJSM, 2020).

Which Knee Conditions Respond Best to Shockwave Therapy?

Shockwave therapy works on soft tissue problems around the knee. It is not a treatment for bone-on-bone arthritis or torn meniscus, though it can help manage pain in the soft tissues surrounding arthritic joints. The conditions that respond best include:

• Patellar tendonitis (jumper's knee): Inflammation and degeneration of the tendon connecting the kneecap to the shinbone. Common in athletes who run, jump, or squat frequently.
• Iliotibial band syndrome: Pain on the outer side of the knee caused by friction of the IT band over the lateral femoral condyle. Runners and cyclists deal with this frequently.
• Quadriceps tendinopathy: Pain above the kneecap where the quadriceps tendon attaches. Often caused by overuse or sudden increases in training volume.
• Pes anserine bursitis: Inflammation of the bursa on the inner side of the knee, just below the joint line. Common in runners and people with osteoarthritis.
• Chronic patellofemoral pain (runner's knee): When caused by soft tissue dysfunction and tracking issues rather than cartilage damage, shockwave therapy can reduce pain and improve function.

"Knee pain that drags on for months is almost always a sign that the tissue has stopped healing on its own," says Dr. Austin Elkin, Doctor of Chiropractic at City of Palms Chiropractic in Fort Myers. "Shockwave therapy restarts that healing process. We are seeing patients get out of pain in weeks after dealing with knee problems that lasted over a year."

What Happens During a Shockwave Therapy Session for the Knee?

A typical session at our Fort Myers clinic takes about ten to fifteen minutes of active treatment. Here is what the process looks like:

• Assessment: Your provider locates the exact point of maximum tenderness by pressing around the knee. This pinpoints where the acoustic waves need to focus.
• Gel application: Ultrasound gel is applied to the skin over the treatment area. This allows the shockwave applicator to transmit energy into the tissue without friction.
• Treatment delivery: The applicator is pressed against the knee and activated. You will feel a rapid tapping or pulsing sensation. When the waves hit the most damaged area, you will feel a sharp but brief spike in discomfort. Most patients rate it between a three and five out of ten.
• Post-treatment: The gel is wiped off and you can stand and walk immediately. Some patients feel mild soreness at the treatment site for 24 to 48 hours, similar to a deep-tissue massage.

There is no anesthesia, no needles, and no downtime. You can drive yourself home and go back to work the same day. The only restriction is avoiding high-impact activities (running, jumping, heavy squatting) for 48 hours after each session to let the healing response take hold.

How Many Sessions Will Your Knee Need?

Most knee conditions require three to six shockwave sessions spaced one week apart. The exact number depends on the condition being treated and how long you have had it:

• Mild patellar tendonitis (less than 3 months): Three to four sessions
• Chronic patellar tendonitis (6+ months): Five to six sessions
• IT band syndrome: Three to five sessions
• Patellofemoral pain: Four to six sessions, often combined with biomechanical correction

Improvement is gradual. You may feel some relief after the first session, but the real structural healing happens over weeks two through six. Your provider will retest your pain levels and function at each visit to make sure you are progressing on track.

At City of Palms Chiropractic, we rarely treat the knee in isolation. Knee pain is often connected to problems higher up the chain. A misaligned pelvis, weak glutes, restricted hip mobility, or chronic low back issues can all change how forces travel through the knee during walking, running, and squatting. Pairing shockwave therapy with corrective care that addresses these underlying problems gives you the best chance at a lasting result.

Can Shockwave Therapy Help with Knee Osteoarthritis?

This is a common question, and the answer is nuanced. Shockwave therapy cannot regenerate lost cartilage or reverse the structural changes of osteoarthritis. What it can do is reduce pain in the soft tissues surrounding the arthritic joint, improve blood flow, and decrease inflammation.

A 2021 study in the journal Knee Surgery, Sports Traumatology, Arthroscopy found that patients with mild to moderate knee osteoarthritis who received ESWT reported significant pain reduction and improved function at both the three-month and six-month follow-ups compared to a sham treatment group (KSSTA, 2021). The treatment appears to work by reducing inflammation in the periarticular soft tissues and the synovial membrane that lines the joint.

If you have been told your knee arthritis is too advanced for conservative care, shockwave therapy alone may not be enough. But for early to moderate arthritis, it can be a valuable part of a maintenance care plan that keeps you active and delays the need for more aggressive interventions.

What Should You Do Between Shockwave Sessions?

How you take care of your knee between sessions directly affects your outcome. Managing the stress on your body and supporting tissue repair makes a real difference. Here are the most important things to do:

• Eccentric exercises: Your provider may prescribe decline squats or single-leg loading exercises that strengthen the patellar tendon during the rebuilding phase. These exercises work with the shockwave therapy to produce stronger, more resilient tissue.
• Skip the NSAIDs: Anti-inflammatory medications like ibuprofen and naproxen can blunt the healing response that shockwave therapy is designed to trigger. Use ice for pain management instead, and only take pain medication if your provider specifically recommends it.
• Stay active but modify: You do not need to stop all exercise. Switch to low-impact activities like swimming, cycling (on flat terrain), or walking during treatment. Avoid the specific activity that aggravates your knee until your provider clears you.
• Foam roll and stretch: Tight quadriceps, hamstrings, and calves increase the load on the knee. Spending five to ten minutes daily on soft tissue work around the knee (not directly on the sore tendon) helps maintain flexibility and reduce strain.

Get Your Knee Back to Full Function

Chronic knee pain does not have to keep you on the sidelines. Shockwave therapy at City of Palms Chiropractic in Fort Myers targets the damaged tissue that is causing your pain and gets your body healing again. Dr. Austin Elkin will evaluate your knee, identify the specific structures involved, and build a treatment plan that addresses both the local damage and any biomechanical issues feeding the problem. Call (239) 690-7794 or book your appointment online to get started.