OSTEOPATHY AUCKLAND
Supraspinatus tendinopathy
Shockwave therapy
MOVEMENT MECHANICS OSTEOPATHY AUCKLAND
Supraspinatus injuries, such as tendinopathy & tendon tears, can be effectively treated with Shockwave Therapy.
At Movement Mechanics Osteopathy, we champion effective, evidence-based interventions. Expect considered care that combines osteopathic assessment with EMS DolorClast® shockwave therapy, used where the science says it adds value. Combining EMS Dolorclast® shockwave therapy with traditional osteopathic treatment for supraspinatus injuries has been shown to be superior to conventional physiotherapy alone. Shockwave therapy for the treatment of calcific and non-calcific supraspinatus tendinopathy is fast becoming the gold standard for conservative treatment.
What is Supraspinatus tendinopathy?
The supraspinatus is one of the four rotator-cuff tendons that help lift and stabilise your shoulder. Tendinopathy refers to a tendon that is irritated or degenerative, typically causing pain with overhead use, night pain when lying on the shoulder, and stiffness. Two common patterns are:
Calcific tendinopathy - calcium hydroxyapatite deposits within the tendon that may cause acute or chronic pain and stiffness. Many cases eventually resorb, but persistent, symptomatic deposits can need targeted treatment.
Non-calcific tendinopathy - a degenerative/overuse process without calcification, driven by failed tendon repair and load intolerance.
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Conservative care (education, load management, exercise therapy, analgesia) is the first-line, but often we find this is not effective for many patients.
Tears are commonly described by thickness (partial-thickness grade I–III vs full-thickness), location (articular-sided, bursal-sided, or intratendinous), and size/pattern (small, medium, large, massive; patterns on MRI guide care).
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For muscle injuries in sport, clinicians also use the Munich classification (Müller-Wohlfahrt), which separates functional problems (no macroscopic tear) from structural tears:
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Type 1A: fatigue-induced muscle disorder (often normal MRI)
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Type 2B: muscle-related neuromuscular disorder (often normal MRI)
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Type 3A/3B: partial muscle tears
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Type 4: complete tear/tendon avulsion (Müller-Wohlfahrt et al., 2013).
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Why does this matter? Many “rotator-cuff” pains are functional (1A/2B) aching, tight, weak, but show little on imaging. These often respond to load management, scapular/neck care and, when appropriate, shockwave therapy as part of a plan.
We take a modern and considered approach to osteopathy. We assess the whole chain (neck, thoracic spine, ribcage, scapular control), because cervical or scapular issues can mimic or drive shoulder pain; imaging alone may mislead. Build a bespoke plan: activity modification, progressive strengthening, tendon-specific loading, sleep/position strategies, and, where indicated, shockwave therapy. Keep you moving for the long term - proactive wellness over quick fixes.
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive option we use alongside osteopathic rehab:
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Calcific supraspinatus tendinopathy: High-energy focused ESWT has shown pain and function benefits (Gerdesmeyer et al., 2003), and performs similarly to ultrasound-guided needling at 1-year (Louwerens et al., 2020).
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Non-calcific rotator-cuff tendinopathy: Both focused (fESWT) and radial (rESWT) improve pain and function (Li et al., 2021).
We integrate shockwave therapy with hands-on osteopathic care and a clear loading and movement plan.
Shockwave therapy delivers short acoustic pressure waves to the sore area. In plain language, it helps by:
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Turning pain down: Shockwaves reduce pain-neuropeptides (e.g., substance P) and modulate nerve sensitivity like turning down a volume knob (Ryskalin et al., 2022; Wuerfel et al., 2022).
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Kick-starting repair: They trigger mechanotransduction in tendon cells, encouraging angiogenesis (new blood vessels), controlled inflammation, and collagen remodelling, which supports tendon healing (Chen et al., 2022; Waugh et al., 2015).
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Micro-mechanical effects: They create cavitations and shear that stimulate local biology; focused waves deliver energy precisely at depth (Császár et al., 2015; Simplicio et al., 2020).
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Stimulating the tendon “building plan” (scleraxis): Focused/radial shockwaves can nudge tendon cells toward a tendon-making programme by influencing scleraxis, the transcription factor that drives tenocyte identity, and it can promote tenogenic differentiation of stem cells.
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Smoother tendon glide (lubricin/PRG4): Shockwaves can increase lubricin (PRG4), a natural “teflon-like” coating that reduces tendon friction, helping tight, painful shoulders move more freely.
For functional shoulder pain that resembles Munich Type 1A/2B (tight, painful, often MRI-normal), adding shockwave therapy to a multimodal programme can accelerate return to sport/function; in elite sports teams, where keeping players on the pitch is the goal, adopting a shockwave therapy protocol that consist of near-daily sessions has been shown to be both effective and safe (Morgan et al., 2021).
If assessment suggests spine-related (Type 2A) pain, we’ll treat the neck/thoracic drivers first, shockwave to the supraspinatus won’t fix a cervical source (Müller-Wohlfahrt et al., 2013; Katsuura et al., 2019).
​For partial-thickness tendon tears, the main consideration for the use of shockwave therapy is the dangers of modulating pain, ultimately removing the patient's protective mechanism, pain.
Why EMS DolorClast® Shockwave?
Because precision and evidence matter.
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Piezoelectric direct focusing (focused): EMS’s focused shockwave therapy uses piezoelectric direct focusing to concentrate energy at depth with minimal proximal dispersion, useful for deeper supraspinatus targets.
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Radial technology you can feel: EMS radial shockwave therapy handpieces deliver consistent energy for superficial tendon and myofascial presentations.
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We combine focused shockwave therapy for deeper, well-localised pain (e.g., calcific foci) and radial shockwave therapy for broader myotendinous and subacromial pain. This is always done alongside hands-on osteopathic care, strengthening and load management.
Supraspinatus tendiniopathy and supraspinatus tears are painful injuries of the shoulder joint. You’ll likely feel the pain when you lift your arm or flex your arm. Don't suffer in silence. Get treatment that works.