Knee Osteoarthritis: What the Evidence Supports Before Injections or Joint Replacement

Short answer: Knee osteoarthritis does not automatically mean you need injections or a joint replacement. Major international guidelines consistently recommend education, exercise and appropriate load or weight management as first-line care. Randomised trials and meta-analyses also suggest extracorporeal shockwave therapy can improve pain and function in selected people with knee OA, while high-power laser therapy may help reduce pain and irritability enough to make rehabilitation more achievable.

Neither shockwave nor laser regrows lost cartilage, and neither replaces strengthening.

Their potential value is more practical: reducing pain, improving function and helping you move well enough to progressively strengthen the knee.

Joint replacement remains an excellent operation for the right knee at the right time. But for many people, it should follow a properly delivered conservative programme rather than replace one.

t Movement Mechanics in Browns Bay, we frequently meet people who have been shown an X-ray and told some version of:

“It’s bone on bone eventually you’ll need a replacement.”

That sentence can profoundly change the way someone moves, often for the worse.

The better questions are:

• What does the X-ray actually tell us?

• What is generating the pain?

• What can still be changed?

• Has rehabilitation genuinely been tested?

• Is pain preventing adequate strengthening?

• Could shockwave or high-power laser help?

• And when is surgery actually the best option?

Does “bone on bone” mean I need a knee replacement?

No “Bone on bone” is a description of an X-ray, not a prognosis

Radiographic osteoarthritis and symptoms do not always match neatly. Some people have substantial structural changes with surprisingly little pain, while others have relatively modest X-ray findings and significant disability.

That does not mean imaging is irrelevant.

It means the X-ray tells us one part of the story.

Osteoarthritis affects the entire joint rather than cartilage alone, including:

• subchondral bone

• synovium

• menisci

• ligaments

• periarticular tendons

• muscles surrounding the knee

Pain, function and the need for surgery therefore cannot be predicted from joint-space narrowing alone.

What actually causes pain in knee osteoarthritis?

Knee osteoarthritis pain is usually caused by several interacting factors rather than simply “worn cartilage”.

Synovitis and inflammatory activity

The synovial lining can become irritated and contribute to:

• swelling

• stiffness

• warmth

• painful flares

• reduced tolerance to exercise

In some patients this inflammatory component is one of the dominant reasons the knee suddenly becomes much more painful.

Subchondral bone

The bone underneath the cartilage is biologically active and richly innervated.

Changes within subchondral bone, including bone-marrow lesions and altered remodelling, appear to be relevant contributors to osteoarthritis pain.

This is particularly interesting in shockwave research because subchondral bone is one of the proposed therapeutic targets for focused ESWT.

Muscle capacity

Quadriceps weakness is common in knee OA and is one of the most important modifiable contributors to function.

Reduced quadriceps, gluteal and calf capacity means the knee has less muscular support during:

• walking

• stairs

• getting out of a chair

• hills

• sport

• everyday load

Other painful structures around the knee

Not every sharp pain around an arthritic knee comes from the joint itself.

Coexisting problems can include:

• patellar tendinopathy

• quadriceps tendon pain

• pes anserine irritation

• myofascial pain

• referred pain from the hip or lumbar spine

These may require a different treatment approach from the osteoarthritis itself.

Pain-system sensitisation

After months or years of symptoms, the nervous system can become more responsive to sensory input from the knee.

That means the amount of pain experienced may no longer correspond directly with the amount of structural change seen on an X-ray.

Sleep, stress and general health

Sleep, metabolic health, stress, physical activity and general conditioning all influence pain sensitivity and recovery.

Almost every factor above can be modified to some degree.

Cartilage thickness is the thing patients understandably focus on, yet it is often the least modifiable part of the clinical picture.

Does movement wear out an arthritic knee?

Appropriate movement generally helps knee osteoarthritis rather than wearing the joint out.

One of the most damaging consequences of being told a knee is “bone on bone” can be fear of movement.

The predictable cycle is:

less activity → quadriceps and gluteal weakness → reduced shock absorption and control → everyday tasks become relatively harder → more pain → even less activity

Add cardiovascular deconditioning and possible weight gain, and the knee is now being asked to tolerate similar everyday loads with substantially less muscular support.

This is why our philosophy at Movement Mechanics is:

Movement Matters™.

An osteoarthritic knee is not simply a mechanical bearing slowly grinding itself into failure.

It is living tissue influenced by:

• movement

• muscle capacity

• loading

• circulation

• inflammation

• nervous-system behaviour

What is the first-line treatment for knee osteoarthritis?

The foundation of knee osteoarthritis treatment is education, structured exercise and load or weight management where appropriate.

Major international guidelines such as OARSI, NICE and ACR consistently place these measures at the centre of non-surgical management.

But there is an important distinction between:

“Go and exercise.”

and:

“Complete a structured, progressively loaded programme matched to your current capacity and goals.”

Proper rehabilitation may involve:

• quadriceps strengthening

• gluteal strengthening

• calf strengthening

• sit-to-stand training

• balance

• walking progression

• cycling

• stair training

• sport-specific exercise where relevant

The programme should become progressively more demanding as capacity improves.

Why does exercise sometimes fail for knee arthritis?

Exercise often appears to fail because pain prevents meaningful loading, the programme is too generic, or it is never progressed sufficiently.

Someone may reasonably say:

“I’ve already tried exercises.”

But that can mean anything from three exercises printed on a sheet to a properly progressed three-month rehabilitation programme.

Successful strengthening usually requires:

• an appropriate starting load

• progressive resistance

• symptom-response rules

• sufficient duration

• consistency

• management of flares

• objective reassessment

Sometimes the problem is that the knee is simply too irritable to tolerate the load required to make meaningful gains.

This is one of the situations where adjunctive treatment becomes useful.

The goal is not to replace exercise.

It is to make exercise possible.

Does shockwave therapy work for knee osteoarthritis?

Research suggests extracorporeal shockwave therapy can improve pain and physical function in selected people with knee osteoarthritis. However, knee OA should still be viewed as an evolving rather than universally established ESWT indication.

A 2020 systematic review and meta-analysis of 14 randomised clinical trials involving 782 participants reported significant improvements in pain and WOMAC outcomes after ESWT, with relatively few and generally minor adverse effects.

Subsequent research has investigated:

• treatment dose

• focused versus radial sources

• anatomical targeting

• combination with exercise

• combination with other non-injective treatments

A network meta-analysis also suggested that ESWT combined with other non-injective care may perform better than ESWT alone.

That fits how we use it clinically.

Shockwave is an adjunct to rehabilitation, not a substitute for strengthening.

Is shockwave therapy an indication for knee OA?

The evidence is very promising, and at Movement Mechanics we have had very good clinical results in managing knee OA in those not wanting surgry or not yet considered candidates for surgical intervention.

Knee osteoarthritis sits within the group of conditions with growing clinical use and evidence rather than among the most firmly established standard ESWT indications.

“There is meaningful clinical evidence that shockwave can improve pain and function in selected knee OA patients.”

How does shockwave therapy work for knee osteoarthritis?

Shockwave therapy delivers mechanical acoustic energy that can influence cellular signalling, a process known as mechanotransduction.

Research into knee OA suggests several potential mechanisms.

Subchondral bone remodelling

Preclinical research suggests focused ESWT can influence biological activity within the subchondral bone beneath the articular surface.

This is potentially relevant because subchondral pathology contributes to pain in osteoarthritis.

Vascular signalling

Experimental work has demonstrated effects on pathways including:

• VEGF

• eNOS

• nitric oxide

These pathways influence angiogenesis and tissue perfusion.

Inflammatory signalling

Preclinical studies suggest ESWT may influence inflammatory mediators including:

• TNF-α

• IL-1β

• MMP-13

• ADAMTS-5

Pain modulation

Shockwave may influence nociceptive signalling and neuropeptides including:

• Substance P

• CGRP

Cartilage-related biological effects

Animal studies have reported changes involving type II collagen, aggrecan and other pathways relevant to cartilage metabolism.

Shockwave has also been shown to stimulate lubricin expression. Lubricin (PRG4) is an important boundary-lubricating glycoprotein within synovial joints that helps reduce friction at the cartilage surface. Research has shown that ESWT can upregulate lubricin expression in mechanically loaded connective tissues, with a dose-related increase demonstrated in animal tendon models.

Because altered lubricin expression and impaired boundary lubrication are associated with osteoarthritis, this provides a plausible mechanism by which shockwave may support joint-surface homeostasis.

Can shockwave therapy regrow knee cartilage?

No good clinical evidence currently shows that ESWT regrows normal human articular cartilage in an osteoarthritic knee.

Experimental research suggests potentially favourable biological effects on cartilage and subchondral bone.

That is scientifically interesting, but it is not the same as demonstrating structural reversal of knee OA in humans.

What clinical research supports much more clearly is:

• reduced pain

• improved function

• improved walking ability

• greater tolerance to rehabilitation

Those are meaningful outcomes without needing to promise cartilage regeneration.

Who is most likely to benefit from shockwave therapy for knee OA?

The strongest rationale appears to be for people with mild-to-moderate knee osteoarthritis whose symptoms continue despite appropriate first-line care.

Clinical research has particularly examined patients with Kellgren-Lawrence Grade II–III OA.

Potential candidates include people who:

• have persistent pain despite rehabilitation

• struggle to strengthen because the knee remains painful

• want a non-invasive adjunct before considering injection

• are not yet ready for replacement

• are unsuitable for surgery

• have an associated tendinopathy contributing to symptoms

Grade IV or end-stage osteoarthritis is different.

ESWT may still provide symptom relief in selected patients, but expectations should be much more conservative.

It should not be presented as a treatment capable of reversing end-stage joint disease.

What does Kellgren-Lawrence Grade II, III or IV knee arthritis mean?

The Kellgren-Lawrence system grades knee osteoarthritis on X-ray from Grade I to Grade IV.

Grade I

Doubtful or very early radiographic change.

Grade II

Definite osteophytes with possible joint-space narrowing.

Grade III

Definite joint-space narrowing with moderate osteophytes and possible subchondral sclerosis.

Grade IV

Severe joint-space narrowing with substantial osteophytes, sclerosis and possible deformity.

The most encouraging ESWT research currently relates to early-to-moderate rather than end-stage OA.

Focused or radial shockwave: which is better for knee osteoarthritis?

Focused and radial shockwave are different acoustic technologies, and the best choice depends on what tissue is being targeted.

A randomised clinical study comparing focused and radial shockwave in knee OA reported improvement with both approaches, with focused ESWT producing greater improvement in some pain, WOMAC and walking outcomes.

That does not mean focused is automatically the right treatment for every arthritic knee.

When focused shockwave may make sense

Focused ESWT concentrates acoustic energy at a defined depth.

This makes it particularly useful when the intended target is deeper, including:

• medial tibial subchondral bone

• femoral condyle

• focal deeper pathology

Preclinical work has specifically investigated the medial tibial subchondral region as a therapeutic target.

When radial pressure wave therapy may make sense

Radial pressure waves deliver their greatest energy superficially and spread across a broader treatment field.

They may be useful for:

• superficial periarticular tissues

• muscular involvement

• broader areas of pain

• associated tendinopathies

The appropriate question is therefore not:

“Is focused better than radial?”

It is:

“Which tissue are we trying to influence, and which acoustic source can reach it appropriately?”

Movement Mechanics has both technologies available, so treatment does not have to be forced through a single shockwave device.

Where does high-power laser therapy fit for knee osteoarthritis?

High-power laser therapy can be useful when pain, inflammatory irritability or tissue sensitivity is preventing effective rehabilitation.

The EMS DolorClast® 905 nm high-power laser used at Movement Mechanics works through photobiomodulation.

Light energy interacts with cellular chromophores and influences biological processes including:

• mitochondrial activity

• ATP production

• nitric oxide signalling

• inflammatory signalling

• nociceptor sensitivity

• microcirculation

Clinical research supports high-intensity laser therapy as an adjunct for improving pain and function in knee OA.

As with shockwave, it does not replace strengthening.

Its clinical value is often in making the knee less irritable and more trainable.

Shockwave or high-power laser: which is better for an arthritic knee?

Neither is automatically better. They use different mechanisms and may suit different clinical presentations. At Movement Mechanics we combine the two modalites for better treatment outcomes.

We may favour high-power laser when:

• there is an inflammatory flare

• the knee has an effusion

• pain sensitivity is high

• mechanical treatment is poorly tolerated

• pain is significantly restricting exercise

We may consider shockwave when:

• symptoms are persistent rather than acutely reactive

• subchondral bone is an intended target

• periarticular tendinopathy is contributing

• rehabilitation has plateaued

Some patients may have a clinical rationale for using both modalities.

What shockwave and laser do NOT do

Neither shockwave nor high-power laser regrows lost cartilage or “cures” osteoarthritis.

That is important to say clearly.

Most of the clinical research evaluates:

• pain

• function

• WOMAC scores

• walking capacity

• quality of life

rather than complete structural reversal of disease.

The practical objective is:

reduce pain → restore movement → progressively load the leg → improve capacity

That matters because strengthening and physical activity remain the interventions with the most important long-term role.

What happens at a Movement Mechanics knee osteoarthritis assessment?

Our first job is to establish why the knee hurts not simply confirm that osteoarthritis exists.

Assessment may include:

• detailed symptom history

• orthopaedic examination

• knee range of motion

• quadriceps capacity

• calf capacity

• hip contribution

• ankle contribution

• gait

• stair function

• review of existing imaging

• assessment for coexisting tendinopathy

• screening for referred pain

Do I need an X-ray or MRI before treatment?

Not necessarily. Imaging is useful when it improves diagnostic confidence or changes treatment selection.

X-ray

X-ray is generally the most useful first-line imaging investigation for structural knee OA.

It can show:

• joint-space narrowing

• osteophytes

• sclerosis

• alignment

• radiographic severity

MRI

MRI is usually reserved for circumstances where another pathology is suspected or more detailed imaging would change management, such as:

• significant meniscal pathology

• osteochondral lesions

• ligament injury

• unexplained persistent swelling

• surgical planning

If you already have imaging, bring it with you.

If further imaging is clinically useful, we can recommend it.

Our 12-week structure for a painful osteoarthritic knee

There is no universal programme, but a structured framework helps distinguish genuine rehabilitation from simply “trying some exercises”.

Weeks 1–4: reduce irritability and establish a baseline

The first phase is about identifying what is stopping the knee from loading properly.

This may include:

• orthopaedic assessment

• imaging review

• identification of synovitis or effusion

• assessment for coexisting tendinopathy

• screening of hip or lumbar referral

• baseline strength and movement measures

• initial progressive exercise

• high-power laser where irritability dominates

• shockwave where an appropriate target exists

• osteopathic treatment where hip, ankle or lumbopelvic restrictions are clinically relevant

The objective is not simply to make the knee temporarily less painful.

It is to increase the amount of useful movement it can tolerate.

Weeks 4–8: build capacity

Progressive resistance training becomes the centrepiece.

Common targets include:

• quadriceps

• gluteals

• calf

• functional sit-to-stand strength

• balance and control

Exercise progression is determined by how the knee responds rather than by arbitrary dates.

Adjunctive treatment should progressively become less important as capacity improves.

Weeks 8–12: consolidate and test

The programme becomes increasingly specific to the activities you want back.

That might mean:

• walking further

• stairs

• gardening

• golf

• cycling

• hiking

• gym training

• running

We reassess against baseline and establish a flare-management plan so that one painful week does not derail months of progress.

What happens if my knee is not better after 12 weeks?

Failure to improve after properly delivered conservative care is useful clinical information.

At that point, the answer should not be indefinite treatment.

We reassess.

Depending on the situation, the next step may include:

• further imaging

• GP review

• medication discussion

• injection

• orthopaedic referral

• joint replacement consultation

If surgery becomes appropriate, completing meaningful rehabilitation beforehand also means entering surgery with better strength and conditioning.

Can I avoid a knee replacement?

Some people can delay or avoid knee replacement with structured conservative care, but not everyone can.

Whether surgery becomes necessary depends on:

• pain

• functional limitation

• disease severity

• response to rehabilitation

• goals

• overall health

• quality of life

Conservative care is not a promise that you will never need surgery.

It is an opportunity to determine how much function the knee can regain before more invasive treatment is considered.

When is knee replacement the right option?

Joint replacement becomes a reasonable conversation when substantial pain and disability persist despite properly delivered non-operative treatment.

Signs the conversation may be appropriate include:

• persistent night pain

• severe restriction of everyday activity

• progressive deformity

• instability

• significant walking limitation

• sustained deterioration in quality of life

• failure of appropriate conservative treatment

Total knee replacement is one of the most successful procedures in modern orthopaedic surgery.

We are not interested in talking someone out of an operation they genuinely need.

The goal is to make sure the decision happens at the right time.

Is there any point exercising if I am already waiting for a knee replacement?

Yes. Waiting for surgery can be one of your most valuable prehabilitation windows.

Strength and physical capacity going into surgery influence what you have available to work with afterwards.

Prehabilitation may include:

• quadriceps strengthening

• gluteal strengthening

• calf strength

• walking tolerance

• aerobic conditioning

• practising rehabilitation exercises

If the knee is painful enough to prevent meaningful exercise, symptom-modulating treatment may sometimes help maintain that programme while you wait.

What about cortisone injections for knee osteoarthritis?

Corticosteroid injections can provide useful short-term relief during selected inflammatory flares, but they do not reverse osteoarthritis.

Their role is primarily symptom control.

Benefits may diminish over weeks to months, and repeated injection needs to be considered carefully.

If you have recently had a steroid injection, tell us before booking shockwave treatment.

Many ESWT protocols use a waiting period after corticosteroid injection because corticosteroids and shockwave are intended to influence tissue biology in very different ways.

What about hyaluronic acid injections?

Evidence for hyaluronic acid is mixed, and recommendations differ between guidelines.

Some patients report worthwhile symptom improvement.

Others experience little change.

It remains one of several options that can be discussed when rehabilitation alone has not produced sufficient improvement.

Is running bad for knee osteoarthritis?

Running is not automatically harmful for someone with knee osteoarthritis.

Recreational running has not been consistently associated with an increased risk of knee OA.

What matters clinically is:

• your current capacity

• previous running history

• strength

• symptom behaviour

• load progression

• recovery

If the knee is highly irritable, running may need to be reduced temporarily.

The long-term aim may still be to return to it.

Can I exercise during a knee arthritis flare?

Usually yes, but the amount and type of load may need to change temporarily.

During an irritable period, you may modify:

• resistance

• range

• walking volume

• impact

• exercise frequency

Complete inactivity is rarely the long-term answer.

The objective is to maintain as much tolerable movement as possible while allowing the flare to settle.

How many shockwave treatments are needed for knee OA?

There is no fixed number that suits every arthritic knee.

Published studies use varying protocols depending on:

• focused or radial source

• target tissue

• energy level

• patient population

In clinical practice, shockwave is generally delivered as a short course with defined reassessment points rather than indefinite treatment.

The rehabilitation programme continues well beyond the shockwave course.

How many laser treatments will I need?

Laser therapy is usually delivered more frequently than shockwave over a short treatment period, but the number of sessions depends on irritability and clinical response.

We reassess progress rather than selling open-ended treatment packages.

Is knee osteoarthritis treatment covered by ACC?

Osteoarthritis itself is usually not an ACC injury, although ACC may apply where symptoms relate to an accepted injury claim.

This depends on the individual circumstances of the claim.

Movement Mechanics is also a Southern Cross Easy-Claim provider.

Current appointment pricing is available on our Fees page.

Frequently Asked Questions About Knee Osteoarthritis

Does shockwave therapy work for knee osteoarthritis?

Randomised trials and meta-analyses suggest ESWT can improve pain and function in selected knee OA patients. The evidence is promising, although knee OA is not currently one of the most firmly established standard ISMST ESWT indications.

Does shockwave therapy regrow cartilage?

No. Preclinical studies have identified potentially beneficial cartilage and subchondral-bone effects, but there is no convincing clinical evidence that shockwave regrows normal human articular cartilage.

Is focused shockwave better than radial for knee OA?

Not universally. Focused ESWT is better able to target deeper structures such as subchondral bone, while radial pressure waves are suited to broader superficial and periarticular tissues. The treatment target should determine the technology.

Does high-power laser help knee arthritis?

Clinical evidence suggests high-intensity laser therapy can improve pain and function, particularly when combined with exercise. Its role is symptom modulation and supporting rehabilitation rather than reversing structural arthritis.

Can I avoid knee replacement?

Many people can delay or avoid surgery through structured conservative care, while others eventually need replacement. The reasonable goal is to properly test non-surgical treatment before deciding.

Is “bone on bone” knee arthritis reversible?

The structural joint-space loss seen on X-ray is not currently reversible through exercise, shockwave or laser. However, pain, strength, walking ability and overall function can still improve substantially.

Should I exercise if my knee is bone on bone?

Usually yes. Exercise is a core treatment for knee OA, including advanced disease, although the programme should be matched to your pain and current physical capacity.

Do I need imaging before coming in?

No. If you already have imaging, bring it with you. If further imaging would improve diagnosis or treatment selection, we can recommend it.

Do I need a GP referral?

No referral is required to book an assessment at Movement Mechanics.

What if I am already on a surgical waiting list?

Rehabilitation can still be extremely valuable. Improving strength and general conditioning before surgery gives you a better physical starting point for postoperative recovery.

Knee osteoarthritis treatment at Movement Mechanics, Browns Bay

Movement Mechanics offers a particularly broad non-invasive MSK treatment toolkit on Auckland’s North Shore.

Jonathan Hall can integrate:

• osteopathic assessment

• progressive rehabilitation

• EMS DolorClast® Radial Shockwave Therapy

• EMS DolorClast® Focused Shockwave Therapy

• EMS DolorClast® 905 nm High-Power Laser Therapy

• imaging referral where indicated

Having multiple modalities matters because not every painful arthritic knee needs the same intervention.

An irritable knee with effusion is different from a relatively settled Grade II–III knee with a suspected subchondral pain component.

A knee with pes anserine or patellar tendon pain is different again.

Treatment should follow the diagnosis rather than the device.

Been told you will eventually need a knee replacement?

You do not need to choose between ignoring the arthritis and immediately accepting surgery.

There is an important middle ground:

understand the pain → reduce irritability → restore movement → build strength → reassess honestly

If the knee improves, keep building.

If it does not, that is genuinely useful information and we can support the next step whether that means an injection, updated imaging or orthopaedic opinion.

Get a real plan for your knee

Book an assessment with Jonathan Hall, M.Ost, ACC-registered osteopath and EMS DolorClast® Key Opinion Leader for Aotearoa.

Movement Mechanics Browns Bay, North Shore Auckland

No referral required. Imaging can be recommended where indicated. Same-week appointments subject to availability.

Book with Jonathan →

Movement Matters™

The bottom line

An osteoarthritic knee is not automatically a countdown to surgery.

Knee OA is a whole-joint condition, and pain is influenced by cartilage, subchondral bone, inflammation, muscle capacity, biomechanics and the nervous system.

Many of those factors remain modifiable.

Exercise is still the foundation.

Shockwave therapy and high-power laser therapy are evidence-supported, non-invasive adjuncts that may help selected patients reduce pain and tolerate rehabilitation more effectively.

They do not regrow cartilage.

They do not cure osteoarthritis.

And they should not replace strengthening.

Their value is potentially much more useful than that:

making movement possible again.

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Jonathan Hall M.Ost, BAppSci (Human Biology), PGCertHSc (Acupuncture), GradDipHeal, FIFA Diploma in Football Medicine.

Jonathan is an EMS DolorClast® clinical expert and an ISMST certified practitioner.

References

1. Ma H, Zhang W, Shi J, et al. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Surg. 2020;82:64–75.

2. Relative effect of extracorporeal shockwave therapy alone or in combination with non-injective treatments on pain and physical function in knee osteoarthritis: a network meta-analysis of randomized controlled trials. Biomedicines. 2022;10(2):306.

3. Mostafa MSEM, Hamada HA, Kadry AM, Zahran SS, Helmy NA. Effect of high-power laser therapy versus shock wave therapy on pain and function in knee osteoarthritis patients: a randomized controlled trial. Photobiomodul Photomed Laser Surg. 2022.

4. Ezzati K, Laakso EL, Salari A, et al. Effectiveness of high intensity laser therapy for reduction of pain in knee osteoarthritis. Pain Res Manag. 2016.

5. Comparative effectiveness of focused extracorporeal versus radial extracorporeal shockwave therapy for knee osteoarthritis randomized controlled study. Int J Environ Res Public Health. 2022.

6. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589.

7. Zhang, D., Kearney, C. J., Cheriyan, T., Schmid, T. M., & Spector, M. (2011). Extracorporeal shockwave-induced expression of lubricin in tendons and septa. Cell and Tissue Research, 346(2), 255–262. https://doi.org/10.1007/s00441-011-1258-7 PubMed

8. Poenaru, D., Sandulescu, M. I., & Cinteza, D. (2023). Biological effects of extracorporeal shockwave therapy in tendons: A systematic review. Biomedical Reports, 18(2), Article 15. https://doi.org/10.3892/br.2022.1597

This article is general information, not individual clinical advice. Treatment recommendations require assessment.

Get a real plan for your knee

Book with Jonathan Hall → Browns Bay, Auckland. Monday to Saturday. Or call 09 884 0935.