Who Should NOT Get Shockwave Therapy? Safety, Contraindications & What to Know

Shockwave therapy has an outstanding safety record. In over 30 years of clinical use across Europe and more than a decade of widespread use in the United States, serious adverse events are extraordinarily rare. For the right patient, it is one of the safest pain treatments available.

But “right patient” matters. Like any medical treatment, shockwave therapy has contraindications — medical conditions or circumstances that either make it unsafe or that require special consideration. Understanding these isn’t about scaring you away from shockwave; it’s about ensuring you get care that’s appropriate for your specific situation.

Absolute Contraindications: Who Should Not Receive Shockwave Therapy

The following conditions are absolute contraindications — meaning shockwave therapy should not be performed in these cases:

• Blood clotting disorders or anticoagulant therapy: Patients on blood thinners (warfarin, heparin, newer anticoagulants like rivaroxaban) or those with bleeding disorders may be at risk for bruising or bleeding at the treatment site. Discuss your medications with our provider before scheduling.
• Treatment directly over malignant tumors: Shockwave should never be applied directly over a known tumor site, as it could theoretically stimulate tumor cell activity.
• Treatment over implanted electronic devices: Pacemakers, spinal cord stimulators, or other implanted electronic devices near the treatment site are a contraindication. This does not mean shockwave can’t be used anywhere on the body — just not in proximity to the device.
• Pregnancy: Shockwave therapy is contraindicated during pregnancy as a precautionary measure, particularly in the pelvic and lumbar regions.
• Open wounds or active skin infections: Treatment cannot be applied over broken skin or active infection at the treatment site.
• Children with open growth plates: Shockwave near the growth plates of skeletally immature patients is contraindicated.

Relative Contraindications: Proceed With Caution

These are situations that require discussion with your provider before treatment:

• Recent cortisone injections: If you’ve had a steroid injection in the last 6–12 weeks, shockwave may be less effective or may need to be timed carefully.
• Acute inflammation or swelling: Shockwave works best for chronic conditions, not acute inflammatory phases. If you’re in the first few days of a flare, waiting a week before starting treatment is often wise.
• Nerve damage or neuropathy in the treatment area: Reduced sensation can make it harder for patients to give feedback about intensity, requiring more conservative settings.
• Certain medications: Beyond anticoagulants, some NSAIDs taken around the time of treatment may blunt the inflammatory response that shockwave is designed to trigger. Your provider will advise on timing.

The Safety Record You Should Know About

In clinical practice, the most common side effects of shockwave therapy are mild and temporary: redness or bruising at the treatment site (lasting 1–3 days), soreness in the treated area (24–48 hours), and occasionally mild swelling. These are expected reactions and signs that the treatment is stimulating the tissue appropriately.

Serious adverse events — nerve damage, tendon rupture, severe tissue injury — are exceptionally rare and almost always associated with treatment errors (incorrect technique, inappropriate settings, or treating despite contraindications). When delivered by a trained provider using appropriate protocols, shockwave therapy is one of the safer medical procedures available.

How We Screen Patients at Peak Performance

At Peak Performance Shockwave Therapy in North Miami, every patient begins with a thorough consultation. We review your medical history, current medications, prior treatments, and imaging (X-rays, MRI if available). We assess the specific area to be treated and confirm there are no contraindications before beginning any protocol.

If you have a condition that makes you a relative contraindication, we don’t automatically say no. We have a conversation, perhaps coordinate with your primary care physician or specialist, and determine whether a modified approach can be used safely.

Are You a Good Candidate?

The vast majority of patients seeking shockwave therapy for chronic musculoskeletal pain — plantar fasciitis, Achilles tendinopathy, tennis elbow, rotator cuff tendinopathy, knee pain — are excellent candidates with no contraindications. If you’re healthy, not pregnant, not on anticoagulants, and have a tendon-based condition that hasn’t responded fully to other treatments, you are likely someone who can benefit.

We serve North Miami, Aventura, Miami Shores, Biscayne Park, and the entire 10-mile radius around the 33161 zip code. Your free consultation is the first step — and it costs you nothing to find out.