The Science

Sound waves that tell your tissue to repair itself.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pressure waves through the skin to the injured tissue beneath. No incisions, no injections. The waves create controlled microtrauma at the treatment site, which sounds alarming and is actually the point. That signal triggers the body's repair cascade: increased blood flow, collagen synthesis, and the breakdown of calcific deposits that have accumulated in chronically injured tendons.

Most tendon conditions stop responding to rest and conventional treatment because the tissue has entered a degenerative state rather than an inflammatory one. There's no active healing happening; the body has essentially given up on it. Shockwave restarts that process.

Conditions Treated

What shockwave actually fixes

ESWT is most effective for chronic tendon conditions that have stopped responding to conventional treatment — the ones where you've tried PT, injections, and rest, and nothing's holding.

01 —

Plantar Fasciitis

The most common shockwave application — and one of the most successful. Especially effective for chronic cases that haven't responded to orthotics, stretching, or cortisone. The mechanism usually involves more than just the plantar fascia itself. It is also one of the most common running injuries we see.

02 —

Achilles Tendinopathy

Both insertional and mid-portion. The Achilles is often managed wrong — shockwave works, but so does identifying the calf and hip mechanics that were loading it abnormally in the first place. We do both. It takes a particular beating from sled and running volume; more on that on our Hyrox page.

03 —

Calcific Shoulder

Calcium deposits in the rotator cuff that haven't responded to other treatment. Shockwave breaks down calcification more effectively than almost anything else available — and without the recovery of surgery.

04 —

Patellar Tendinopathy

Jumper's knee. Runners and cyclists in particular. The patellar tendon is often a load-transfer problem from the hip — shockwave addresses the tendon while we address the mechanism driving it.

05 —

Greater Trochanteric Pain

Hip bursitis and gluteal tendinopathy — conditions that are often misdiagnosed and frequently undertreated. Shockwave has a strong evidence base here that most practitioners aren't fully using.

06 —

Tennis & Golfer's Elbow

Lateral and medial epicondylalgia. Chronic cases that haven't resolved with stretching, PT, or injections. Shockwave stimulates tissue repair in ways that other modalities simply don't reach.

Why It's Different Here

The machine
is the easy part. Knowing where
to point it isn't.

You get a diagnosis before you get a treatment

For existing patients, shockwave integrates into your ongoing care at your regular visit rate. New to ProActive? Book a Shockwave Intake — a focused evaluation to confirm shockwave is appropriate for your presentation, rule out contraindications, and establish a baseline, plus your first treatment. If you want the complete diagnostic picture, start with a Body Intelligence Assessment™ instead. Either way, we don't apply shockwave without understanding what we're treating.

The doctor who diagnosed you runs the device

Most shockwave in San Francisco is administered by a physical therapy aide or a tech following a protocol. At ProActive, Dr. Cohen administers every session himself. He adjusts the probe placement, pressure, and frequency in real time based on tissue response — not a laminated card on the wall. Twenty years of hands-on diagnostic experience changes what you notice and how you respond to it.

Olympic Training Center credentialing — applied to your injury

Dr. Cohen's shockwave work began at the Olympic Training Centers, where the standard for outcomes is unusually unforgiving — athletes have qualifying events and competition schedules that don't allow for months of wait-and-see. That protocol, applied to every patient regardless of athletic level, is what you're getting here.

Shockwave as part of a system, not a standalone service

ESWT is one tool in a larger diagnostic approach. For most tendon conditions, the best outcomes come from combining shockwave with the structural corrections that were creating the load in the first place. We don't offer shockwave in isolation — we offer it as part of a treatment protocol designed around your specific pattern.

What to Expect

What a shockwave course
actually looks like

Step 01 —

Your First Appointment

Two options. If you want the full diagnostic picture — movement screen, postural analysis, the works — book a Body Intelligence Assessment™. Dr. Cohen will identify not just the injured tissue but the pattern driving the load: where your system is compensating, what's been offline, and why the problem keeps returning. If you already know shockwave is what you're after, book a Shockwave New Patient appointment: a focused 20-minute evaluation to confirm the treatment is appropriate for your presentation, rule out contraindications, and get your first session in.

Step 02 —

First Shockwave Session

Dr. Cohen administers the treatment directly. Probe placement, energy level, and pulse frequency are calibrated to the tissue findings. The session takes 15–20 minutes. We'll be honest: it's uncomfortable — think tattoo pain, worse in some spots than others, ranging from intense pressure to endurably painful depending on how sensitized the tissue is. It's mercifully brief and ends the moment the probe comes off. Some soreness in the treated area for 24–48 hours afterward is normal and expected.

Step 03 —

Tissue Response Window

Sessions are typically spaced one week apart. This interval is intentional — shockwave initiates a tissue repair cascade that needs time to run. We're also watching how the body responds between sessions and adjusting the protocol accordingly.

Step 04 —

Course Completion & Ongoing

Most patients complete 6–9 sessions. The clinical evidence supports more sessions than most providers quote — meaningful results start showing up around session 6, and the most significant outcomes tend to land around session 9. We're honest about that upfront: it's an investment in time and some real discomfort. Our patients consistently say it's more than worth it. Many also continue with periodic ProActive Systems-Based Bodywork™ to maintain the structural corrections that prevent reloading the tendon. We'll be direct about what we think you need — and what you don't.

"He doesn't do a cookie-cutter treatment plan. Recently I had severe tendonitis for 6+ months with no help from Kaiser. Dr. Cohen introduced me to shockwave therapy he'd been working with at the Olympic Training Center. After a couple months of treatments, I'm feeling fantastic. Life changing."

D. · El Cerrito · 7-year patient

Common Questions

Shockwave FAQ

What conditions does shockwave therapy treat?

ESWT is most effective for chronic tendon conditions that have stopped responding to conventional treatment: plantar fasciitis, Achilles tendinopathy, calcific shoulder, patellar tendinopathy, greater trochanteric pain, and lateral/medial epicondylalgia. It's particularly well-suited for conditions that have been present for 3+ months and haven't responded fully to PT, rest, or injections.

How many sessions will I need?

The clinical evidence supports more sessions than most providers quote. Meaningful results start showing up around session 6 — and the most significant outcomes tend to land around session 9. We'll be honest about that upfront rather than undersell it and leave you wondering why you're not where you expected to be. It's an investment in time and some real discomfort. Our patients consistently say it's more than worth it. The exact number depends on the condition, its duration, and how your tissue responds. Every shockwave course at ProActive is preceded by a full diagnostic assessment so we know what we're treating before the first pulse.

Is shockwave therapy painful?

Honestly? Yes. We're not going to tell you it feels fine. Think of it like tattoo pain — worse in some places than others, ranging from uncomfortable to endurably painful depending on the site and how sensitive the tissue is. It's mercifully brief, and the discomfort ends when the probe comes off. Mild soreness in the treated area for 24–48 hours is normal and generally a sign the tissue is responding. Our patients say the ouch is more than worth it.

What makes ProActive's shockwave therapy different?

The technology is widely available. What isn't: a doctor with 20+ years of sports medicine experience and Olympic Training Center credentialing deciding where to apply it, at what parameters, and whether it's the right tool for your specific injury. At ProActive, shockwave is integrated into a full diagnostic assessment — never applied in isolation. A tight calf that's never been addressed will keep loading the Achilles no matter how many sessions you do.

Does insurance cover shockwave therapy?

ESWT is not typically covered by insurance. ProActive is out-of-network by design — insurance reimbursement structures reward volume and speed, not the kind of thorough diagnostic work that makes shockwave actually hold. Many patients use FSA/HSA accounts, and we provide superbills for out-of-network reimbursement if your plan supports it.

Do I need to be an existing ProActive patient to get shockwave therapy?

No — book a Shockwave Intake (New Patients). It's a focused evaluation to confirm shockwave is appropriate for your presentation and rule out contraindications, plus your first treatment. It's shorter than our full Body Intelligence Assessment™, but it's not skipped — we won't apply shockwave without understanding what we're treating. Existing ProActive patients receive shockwave at their regular visit rate.

Do I need to stop running / training during treatment?

Usually not — and we make that decision based on the specific condition and your training load. In some cases we'll recommend modifying intensity during the tissue repair window. The goal is to keep you training wherever possible, and to correct the mechanical pattern that was loading the tendon abnormally in the first place.

Where is ProActive Chiropractic located?

22 Battery St., Suite 600, in downtown San Francisco (Financial District). One block from MUNI, near the Embarcadero BART station, and a short walk from the Ferry Building. We're on the 6th floor; the building has a lobby attendant. If you take Waymo, get it to drop you off on Bush or Front Street — the bots can't handle Battery after 1pm.

Book Treatment

Stop managing it.
Start fixing it.

Ready to start? Book a Shockwave Intake if you're coming specifically for shockwave, or a Body Intelligence Assessment™ if you want the full diagnostic picture. Either way, we'll tell you exactly what's driving the condition and whether shockwave is the right tool.

Book Treatment
Same-week appointments usually available
(415) 762-8141 · Call or text
Fax: (415) 683-7868
22 Battery St., Suite 600
San Francisco, CA 94111
Downtown San Francisco · Near BART & Ferry Building

Monday–Friday · 9am–6pm