You just finished your shockwave therapy session. Your provider handed you an aftercare sheet (or maybe they didn’t), and now you’re wondering: Can I go for a run? Should I ice this? Is this soreness normal, or is something wrong?

Most clinic websites give vague post-treatment instructions. This guide gives you a clear, day-by-day recovery plan after extracorporeal shockwave therapy (ESWT) – what to expect, what to do, what to avoid, and when to call your provider.

The Day of Treatment: What to Expect

Soreness is normal. The treated area will likely feel tender, similar to a deep bruise or the soreness after an intense massage. This is the expected response – shockwave therapy works by triggering a controlled inflammatory reaction in damaged tissue, and that inflammation produces soreness.

Here’s what else you might notice on day one:

  • Redness at the treatment site (usually fades within a few hours)
  • Mild swelling in the treated area
  • A warm sensation over the treatment zone
  • Small red dots (petechiae) on the skin surface – these are tiny broken capillaries and are harmless

All of these are normal. They’re signs that the acoustic waves reached the target tissue and stimulated a biological response.

What to avoid on day one:

  • NSAIDs (ibuprofen, naproxen, aspirin). This is important. Anti-inflammatory medications may interfere with the very inflammatory healing cascade that your treatment was designed to trigger. A 2013 review in the British Medical Bulletin noted that NSAIDs can impair tendon healing, which is relevant for patients undergoing ESWT for tendinopathy (Dean et al., 2014, British Medical Bulletin).
  • Ice on the treatment area. Same reasoning as NSAIDs – icing suppresses inflammation. Some providers are less strict about this, but the precautionary approach is to skip the ice for 48 hours.
  • High-impact exercise involving the treated area. Walking is fine. Running, jumping, heavy lifting on that body part – wait.
  • Alcohol in excess. Moderate consumption is likely fine, but heavy drinking may impair the healing response.

Days 1-3: The Recovery Window

The first three days after treatment are when the initial inflammatory response is strongest. Here’s how to manage this window:

Activity level: Keep it low-impact for the treated area. If you had shockwave therapy for patellar tendinopathy, you can walk, swim, or cycle but should avoid jumping, squatting heavy, or running. If you had treatment on your foot, wear supportive shoes and avoid long walks on hard surfaces.

Pain management: If the soreness is bothersome, acetaminophen (Tylenol) is generally considered acceptable since it reduces pain without the anti-inflammatory effects of NSAIDs. Check with your provider about their specific recommendations.

Continue normal daily activities. You don’t need bed rest. Most patients return to work the same day. The treated area should feel less sore with each passing day.

Watch for these (they’re normal):

  • Soreness that peaks at 24-48 hours before fading
  • Mild bruising around the treatment site
  • Slight stiffness in the morning

Days 4-14: Gradual Return to Activity

This is when the real biological work begins. Below the surface, your body is forming new blood vessels (neovascularization) and beginning to remodel damaged collagen fibers. You can’t feel this happening, but you can support it.

Restart prescribed exercises. If your provider gave you rehabilitation exercises – stretching, eccentric loading, strengthening – days 4-7 is typically when you should begin or resume them. These exercises complement shockwave therapy by providing the mechanical stimulus that damaged tendons need to remodel properly.

Gradually increase activity. By days 7-10, most patients can return to their normal exercise routine, including moderate-impact activities. Use pain as your guide: if an activity causes sharp pain (not just mild soreness) in the treated area, back off and try again in a few days.

Stay hydrated and eat well. This sounds generic, but tissue repair requires protein, vitamin C, and adequate hydration. You don’t need supplements, but don’t neglect basic nutrition during your treatment course.

If you’re an athlete working toward returning to sport after a tendon injury, discuss your training timeline with your provider. The return-to-activity plan should be condition-specific, not one-size-fits-all.

What’s Normal vs. What’s Not

Knowing the difference between expected post-treatment effects and warning signs will save you unnecessary anxiety – or a delayed call to your provider.

Normal (no action needed):

  • Mild to moderate soreness for 24-72 hours
  • Skin redness that fades within hours
  • Small bruises or petechiae at the treatment site
  • Temporary increase in your usual symptoms (e.g., slightly more heel pain for a day or two)
  • Mild swelling

Call your provider if you experience:

  • Severe pain that worsens significantly after 48 hours instead of improving
  • Numbness or tingling that persists beyond the treatment day
  • Skin breakdown, blistering, or open wounds at the treatment site
  • Signs of infection (increasing redness, warmth, drainage, fever)
  • A sudden “pop” or acute worsening of symptoms (extremely rare, but warrants evaluation)

These complications are uncommon. A systematic review by Schmitz et al. reported that serious adverse events from ESWT are rare, with most side effects limited to temporary pain, swelling, and skin reddening (Schmitz et al., 2015, British Journal of Sports Medicine).

The NSAID Debate: Why Providers Disagree

You’ll find varying opinions on post-ESWT NSAID use. Here’s why.

The conservative view (and the more common recommendation): avoid NSAIDs for at least 2-4 weeks during your ESWT treatment course. The reasoning is straightforward – ESWT works by triggering inflammation, and NSAIDs suppress inflammation. Taking them could theoretically reduce the treatment’s effectiveness.

The less restrictive view: the evidence directly linking NSAID use to reduced ESWT outcomes is limited, and some providers feel short-term NSAID use for severe post-treatment pain is acceptable.

The safest approach: follow your specific provider’s instructions. If they say avoid NSAIDs, avoid them. If soreness is significant, use acetaminophen instead. And if you’re currently taking daily NSAIDs for another condition, discuss this with your provider before starting ESWT – they may need to adjust your treatment plan.

If you’re preparing for an upcoming session, check out our full guide on how to prepare for your shockwave therapy appointment.

The Bottom Line

Post-shockwave therapy recovery is straightforward: expect 24-72 hours of soreness, avoid NSAIDs and ice, stay active at a low-impact level, and gradually return to full activity by days 7-14. The treatment triggers a biological healing process that continues working long after you leave the clinic, so the most important thing you can do is not interfere with it. Follow your provider’s specific aftercare instructions, and don’t hesitate to call if something feels wrong.

Explore Shockwave Therapy Condition Guides

References

  1. 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

  2. Schmitz C, Császár NB, Milz S, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br J Sports Med. 2015;49(9):590-595. 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.