Shockwave Therapy San Diego — Piezowave 2

What Is Shockwave Therapy?

Shockwave therapy is a non-invasive treatment that delivers high-energy acoustic pressure waves deep into injured or degenerative tissue. These waves create a controlled mechanical stimulus that triggers the body's natural repair processes — accelerating healing in areas where circulation is poor and chronic inflammation has stalled recovery.

The Piezowave 2 is one of the most advanced focused and radial shockwave systems available in clinical practice. It delivers precise, programmable wave energy to targeted tissue depths, making it effective for both superficial tendon issues and deeper musculoskeletal structures.

Shockwave has been in clinical use for over 30 years, with a strong evidence base across orthopedics, sports medicine, and physical rehabilitation. It's the treatment of choice for many conditions that have failed to respond to rest, corticosteroid injections, or conventional physical therapy.

Piezowave 2 shockwave therapy treatment at Sheppard Spine and Sports Solana Beach

Conditions Treated

What Shockwave Therapy Can Treat

Shockwave is particularly effective for chronic overuse injuries and calcific conditions that haven't responded to other conservative treatments.

Foot & Ankle

Plantar Fasciitis One of the best-researched applications for shockwave — especially chronic cases lasting more than 3 months that have failed stretching and orthotics
Heel Spurs (Calcaneal Enthesopathy) Calcific deposits at the plantar fascia attachment to the heel bone — directly addressed by the piezoelectric shockwave's ability to disrupt calcifications
Achilles Tendinopathy Both mid-body and insertional Achilles tendon degeneration — shockwave stimulates collagen remodeling in the degenerative tissue
Posterior Tibial Tendinopathy Chronic dysfunction of the tendon supporting the arch — often contributing to adult flatfoot

Elbow & Shoulder

Tennis Elbow (Lateral Epicondylitis) Chronic tendinopathy of the common extensor origin — highly responsive to shockwave after conservative treatment plateaus
Golfer's Elbow (Medial Epicondylitis) Degeneration of the flexor-pronator tendon attachment at the medial epicondyle
Calcific Rotator Cuff Tendinitis Calcium deposits within the supraspinatus or infraspinatus tendons — shockwave is specifically approved for breaking down calcific deposits non-surgically
Shoulder Impingement Syndrome Chronic subacromial pain and tendon irritation from mechanical compression

Hip, Knee & Thigh

Patellar Tendinopathy (Jumper's Knee) Degenerative changes in the patellar tendon from repetitive loading — common in volleyball, basketball, and running athletes
Greater Trochanteric Pain Syndrome Chronic lateral hip pain from gluteal tendinopathy and trochanteric bursitis — shockwave targets the tendon insertion directly
IT Band Syndrome Lateral knee friction syndrome — shockwave addresses the underlying tendinopathic changes in the distal IT band
Proximal Hamstring Tendinopathy Insertional tendon degeneration at the ischial tuberosity — a notoriously difficult injury to resolve without targeted therapy

Spine & Soft Tissue

Myofascial Trigger Points Deep, painful knots in muscle tissue — shockwave disperses trigger points more effectively than dry needling in many clinical comparisons
Chronic Low Back Pain Paraspinal muscle dysfunction and fascial restrictions contributing to persistent lumbar pain
Stress Fracture Rehabilitation Shockwave stimulates bone metabolism and osteoblast activity, supporting healing of stress reactions and early-stage stress fractures
Scar Tissue & Post-Surgical Fibrosis Acoustic waves soften and remodel dense fibrous tissue — useful for reducing post-operative adhesions and mobility restrictions

Not sure if shockwave is right for your condition? Our providers will evaluate your history and imaging to determine if Piezowave 2 is appropriate — and how it fits alongside your other care at the clinic. Call (858) 350-6290 to schedule a consultation.

The Treatment

How a Session Works

01

Assessment

Your provider identifies the target tissue through palpation and reviews your history and imaging. Treatment parameters — wave energy, frequency, and depth — are set specifically for your condition and tissue characteristics.

02

Treatment

A coupling gel is applied to the skin. The Piezowave 2 handpiece is positioned over the treatment area and acoustic pulses are delivered directly into the tissue. A typical session takes 5–15 minutes depending on the area being treated.

03

Recovery

Most patients return to normal activity immediately. Mild soreness in the treated area is common for 24–48 hours as the tissue responds to the stimulus. Most chronic conditions require 3–6 sessions spaced 5–7 days apart for optimal results.

The Mechanism

Why Shockwave Works

Shockwave doesn't just mask pain — it triggers the biological processes that produce genuine tissue repair.

Neovascularization

Acoustic waves stimulate the formation of new blood vessels in the treated tissue. Chronic tendon injuries are often poorly vascularized — new blood supply delivers oxygen and growth factors that kick-start repair where it had stalled.

Collagen Remodeling

Shockwave accelerates fibroblast activity, stimulating the production of new, organized collagen. In tendinopathic tissue where collagen fibers are disorganized and degenerated, this remodeling effect restores structural integrity and load-bearing capacity.

Calcification Disruption

The piezoelectric mechanism is particularly effective at breaking down calcium deposits. Acoustic energy mechanically fragments calcific material and triggers phagocytosis — the body's process of absorbing and removing the debris — eliminating the source of pain without needles or surgery.

Pain Desensitization

Shockwave reduces the density of substance P — a neuropeptide that sensitizes pain receptors — in the treated tissue. This produces both immediate pain relief and longer-term desensitization of chronically sensitized nerve fibers.

Growth Factor Release

The mechanical stimulus triggers release of TGF-β1, IGF-1, and other growth factors involved in tissue repair. These signaling molecules recruit stem cells and activate satellite cells in muscle tissue, accelerating the regenerative response.

Trigger Point Release

Radial shockwaves disperse myofascial trigger points by disrupting the localized energy crisis within contracted sarcomeres. The resulting improvement in local circulation and muscle fiber function provides lasting relief from referred pain patterns.

Your Treatment Journey

What to Expect

1

Initial Consultation

Your provider reviews your history, imaging, and previous treatments. Shockwave is most effective when the specific tissue target and stage of injury are well understood. We determine whether Piezowave 2 is appropriate, and how it complements your existing care plan — including NUCCA, ART, or laser therapy if you're receiving those services.

2

During Treatment

You'll feel a rhythmic percussion against the skin — often described as a strong tapping or pulsing. Intensity is adjusted based on your tolerance and the tissue being treated. Some patients feel immediate reduction in pain after the first session; others notice improvement over the 2–3 days following treatment as the biological response builds.

3

After Your Session

Mild soreness in the treated area is normal and typically resolves within 24–48 hours. We recommend avoiding anti-inflammatory medications (NSAIDs) immediately after treatment — the inflammatory response shockwave triggers is part of the healing mechanism you want to support, not suppress.

4

Treatment Course

Most chronic conditions respond well to 3–6 sessions spaced approximately one week apart. Acute or more straightforward injuries may require fewer sessions. Your provider will re-evaluate progress after each session and adjust the protocol accordingly. Many patients report significant improvement by sessions 3–4.

5

Long-Term Results

Because shockwave works by stimulating genuine tissue repair — not just blocking pain signals — results tend to be durable. The tissue remodeling process continues for 8–12 weeks after your final session as new collagen matures and organizes. Most patients maintain their improvement long-term, particularly when underlying biomechanical issues are addressed concurrently.

The Piezowave 2 System

The Piezowave 2 by Richard Wolf is a premium clinical shockwave system that delivers both focused and radial acoustic waves — giving our providers precise control over treatment depth and energy distribution.

Unlike basic pneumatic shockwave devices, the Piezowave 2 uses piezoelectric technology to generate true focused waves that can be targeted to specific tissue depths — particularly useful for deeper structures like the supraspinatus tendon, deep hip rotators, or the plantar fascia attachment.

The system is FDA-cleared and widely used in professional sports medicine settings across the US and Europe.

System Capabilities

Focused & radial wave modes in a single system
Adjustable penetration depth — 0 to 35mm
Precise energy output control (0.01–0.55 mJ/mm²)
High-frequency pulse rates up to 8 Hz
FDA-cleared for musculoskeletal indications
Suitable for both acute and chronic conditions
Used by professional sports teams and elite clinics worldwide

Is Shockwave Therapy Right for You?

Shockwave therapy is most effective for chronic, overuse-driven conditions — particularly those involving tendon degeneration, calcific deposits, or myofascial trigger points. It's an excellent option when you have:

Pain lasting longer than 3 months
Previously tried rest, ice, stretching, or physical therapy without lasting relief
Calcific deposits confirmed on imaging
A desire to avoid cortisone injections or surgery
A tendon or fascial condition affecting daily activity or athletic performance

Shockwave is generally not appropriate during pregnancy, over open growth plates in adolescents, over active infection or tumor sites, or in patients on blood thinners. Your provider will screen for contraindications at your initial consultation.

Piezowave 2 shockwave therapy handpieces — focused and radial applicators

Piezowave 2 Shockwave Therapy