How long does a shockwave therapy appointment take?

The actual treatment portion typically takes 15-20 minutes. However, your first appointment may run 30-45 minutes total because your provider will review your history, examine the treatment area, and explain the procedure before starting. Follow-up sessions are usually shorter since the evaluation has already been done.

Do I need a referral for shockwave therapy?

In most cases, no. Many physical therapists, chiropractors, sports medicine physicians, and podiatrists offer shockwave therapy and can evaluate you directly. Some insurance plans may require a referral from your primary care physician if they cover the treatment, but since ESWT is often a cash-pay service, referrals are usually not needed.

Should I eat before my shockwave therapy appointment?

Yes, eat a normal meal before your session. Unlike procedures that require sedation, shockwave therapy is performed without anesthesia, so there are no fasting requirements. Being well-hydrated and well-nourished may actually help with your comfort level during treatment and support the healing process afterward.

How to Prepare for Your First Shockwave Therapy Appointment

Your shockwave therapy appointment is booked. Maybe you’re feeling a mix of anticipation and nerves – especially if you’ve been dealing with chronic pain and this feels like one of your last options before something more invasive. That’s completely normal.

The good news: extracorporeal shockwave therapy (ESWT) is a straightforward outpatient procedure that requires minimal preparation. But a little advance planning can make your session more comfortable, more effective, and less stressful. Here’s exactly what to do before, during, and after your first appointment.

Before Your Appointment

Stop NSAIDs 48-72 Hours Before

This is the single most important preparation step. Stop taking non-steroidal anti-inflammatory drugs – ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin – at least 48 hours before your session. Ideally, stop 72 hours prior.

Why? Shockwave therapy works by triggering a controlled inflammatory response in damaged tissue. NSAIDs suppress inflammation, which may blunt the therapeutic effect. Research has shown that anti-inflammatory use can impair tendon healing processes (Dean et al., 2014, British Medical Bulletin). If you take daily aspirin for a heart condition, talk to your prescribing physician before stopping – don’t make that decision on your own.

Acetaminophen (Tylenol) is generally acceptable for pain management during this window since it works through a different mechanism.

Gather Your Records

Bring any relevant imaging and documentation to your appointment:

X-rays, MRI reports, or ultrasound images of the affected area
A list of treatments you’ve already tried and how long you tried each one (physical therapy, cortisone injections, orthotics, bracing, etc.)
Names and dosages of current medications – including supplements
Insurance card (if applicable) and payment method

Having this information ready saves time and helps your provider make better decisions about your treatment protocol. If your imaging is older than 6 months, your provider may want to order updated studies before starting treatment.

Dress for Access

Wear clothing that allows easy access to the treatment area. This sounds obvious, but it trips people up:

Foot or ankle treatment: Wear shoes and socks that are easy to remove. Skip the lace-up boots.
Knee treatment: Wear shorts or loose pants that roll up above the knee.
Shoulder treatment: Wear a tank top or a shirt you can easily slide off one shoulder.
Hip treatment: Loose-fitting shorts or athletic pants work best.
Elbow treatment: Short sleeves or a top with sleeves that roll up past the elbow.

You typically don’t need to change into a gown for shockwave therapy. Your provider just needs direct skin access to the treatment site.

During Your First Session

The Evaluation

Your first appointment will start with an evaluation. Your provider will:

Review your medical history, imaging, and treatment history
Physically examine the treatment area (palpation, range of motion, special tests)
Confirm the diagnosis and identify the specific treatment target
Explain the procedure, expected sensations, and treatment plan
Discuss the number of sessions they recommend and why

This is your chance to ask questions. Here are some worth asking:

What type of device do you use? (Focused ESWT or radial pressure wave)
How many pulses and at what energy level will you use?
How many sessions do you typically recommend for my condition?
What should I avoid after treatment?
What’s the expected timeline for seeing results?

If you’re curious about whether the treatment will hurt, this is the time to bring it up. A good provider will be honest about what to expect and will adjust their approach based on your comfort level.

The Treatment

Here’s the step-by-step of what happens during the actual procedure:

Positioning. Your provider will position you so the treatment area is accessible and comfortable – lying on a table, sitting in a chair, or standing, depending on the body part.
Gel application. Ultrasound coupling gel is applied to the skin over the treatment area. This helps transmit the acoustic waves efficiently.
Localization. Your provider places the handpiece on the gel-covered area and may spend a moment finding the exact point of maximum tenderness.
Energy ramp-up. Treatment starts at a lower energy level. You’ll feel tapping or pulsing sensations. Over the first minute or two, energy is gradually increased.
Full treatment. At the target energy level, the provider delivers the prescribed number of pulses (typically 2,000-4,000 depending on the condition and device). This portion takes about 10-15 minutes. Communicate with your provider throughout – let them know if the pain becomes too intense.
Completion. The gel is wiped off, and you’re done. No bandages, no sutures, no recovery room.

The whole treatment portion takes about 15-20 minutes. You can walk out immediately afterward.

After Your First Session

The immediate post-treatment period is covered in detail in our post-treatment recovery guide, but here are the essentials:

Mild soreness is expected for 24-72 hours. It usually peaks the day after treatment.
Continue avoiding NSAIDs for at least 48 hours after the session.
Skip the ice pack. Many providers recommend avoiding ice on the treated area to preserve the inflammatory healing response.
Light activity is fine. Walking, daily tasks, and low-impact movement are all okay. Avoid high-impact exercise involving the treated area for 48-72 hours.
Schedule your next session before you leave. Sessions are typically spaced 1-2 weeks apart, so locking in the next appointment keeps you on track.

If you’re being treated for hip bursitis or another lower-extremity condition, wear comfortable, supportive shoes for the rest of the day.

Look for experienced ESWT providers who offer thorough first-visit evaluations and evidence-based treatment protocols.

The Bottom Line

Preparing for shockwave therapy is straightforward: stop NSAIDs 48-72 hours before, bring your imaging and medical records, wear accessible clothing, and come ready with questions for your provider. The session itself is quick (15-20 minutes of treatment time), requires no anesthesia, and lets you walk out immediately afterward. A little preparation goes a long way toward making your first experience comfortable and productive.

Explore Shockwave Therapy Condition Guides

References

Dean BJF, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570-576. PubMed

Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice. Shockwave therapy outcomes vary by individual and condition. Consult a qualified healthcare provider to determine if shockwave therapy is appropriate for your situation.