New to shockwave or in pain for more than 3 months? Book a Telehealth to see if we can help you!
Living with a stress fracture can be incredibly frustrating. Every step reminds you of the injury, and the usual advice – rest, ice, wait – can leave you sidelined for months. If you’re struggling with a stress fracture that just won’t heal, you’re not alone. Many people (from older adults with fragile bones to high-level athletes in their prime) experience the disappointment of a slow-healing stress fracture. Shockwave therapy may offer a ray of hope. This non-surgical treatment is drawing attention for its ability to stimulate bone healing and reduce chronic pain. In fact, shockwave therapy is already well-known for treating stubborn tendon injuries and even kidney stones – and now research suggests it can help bones heal too. Could this be a game-changer for your stress fracture? Let’s explore how shockwave therapy works, what the evidence says (with an honest look at its limits), and how we at Unpain Clinic use it to get patients back on their feet. (Spoiler: “chronic” doesn’t have to mean “forever” – even if you’ve been in pain for 3+ months.)
(Always remember: results may vary; it’s important to consult a healthcare provider about your specific situation.)
A stress fracture is a tiny crack in a bone, typically caused by repetitive stress or overuse. Unlike an acute fracture from a single trauma, stress fractures develop gradually. Imagine a paperclip bent back and forth – eventually it weakens and snaps. Similarly, when a bone is subjected to too much load without enough recovery, microdamage accumulates. Early on, this might just cause a bone bruise or “stress reaction,” but if the activity continues, a small crack (hairline fracture) can form. Common sites include weight-bearing bones: the tibia (shin), metatarsals in the foot, calcaneus (heel), or hip. Athletes (runners, dancers, military recruits) are frequent victims – in fact, roughly 20% of sports injuries are stress fractures. However, older adults with osteoporosis or low bone density can also get stress fractures from relatively minor stresses. For example, the bones of the foot or hip can develop stress fractures in someone with weakened bones, even during normal daily activities. In these cases, an underlying condition (like osteoporosis or poor circulation) means the bone isn’t as quick to repair microdamage.
What do stress fractures feel like? Typically, the pain starts as a mild ache during or after the offending activity and diminishes with rest – at first. You might notice a very localized tenderness if you press on the exact spot of the crack. Swelling or a bit of bruising can occur in some cases. Unlike muscle or tendon pain which can be diffuse, a stress fracture’s pain is often pinpoint and may even hurt during rest if it’s severe. For instance, if you have a stress fracture in your foot, your whole forefoot might ache, but pressing on the injured metatarsal bone triggers sharp pain. As the injury progresses, pain can become constant – even at night or during routine walking, not just high-impact exercise. This is a red flag that the bone has not been able to heal and the injury may be worsening.
Why does the pain sometimes persist for months? In many cases, stress fractures do heal with conservative care: typically 6–8 weeks of rest and protection (like a walking boot) gives the bone a chance to mend. During that time, the pain gradually subsides as new bone bridges the crack. But frustratingly, up to one-third of stress fractures may fail to heal with rest alone. In these non-healing cases, the tiny crack doesn’t fully mend and can become a chronic source of pain or even progress to a complete fracture. Certain locations – like the navicular bone in the mid-foot or the femoral neck in the hip – are considered high-risk stress fractures because they have poor blood supply and a higher tendency to go into non-union. If a stress fracture hasn’t healed after 3+ months, doctors consider it a delayed union or non-union (in other words, the bone’s healing process has stalled). At this point, continued rest might not be enough. Traditionally, the next steps could include casting for an extended period, electronic bone stimulators (with mixed results), or even surgery to pin the bone. Surgery is typically a last resort for stress fractures, since it’s invasive and carries risks like infection. Unfortunately, for high-risk fractures or ones that have completely failed to heal, surgery (inserting screws or bone grafts) has sometimes been the only option to finally heal the bone.
The vicious cycle of chronic stress fractures: Patients with a lingering stress fracture often feel stuck. You’ve tried rest – multiple times – yet each time you return to activity, the pain flares up again. You might have spent months in a boot or on crutches, taken calcium and vitamin D, diligently avoided impact exercise… and still, every MRI comes back showing the crack or bone edema is still there. This can be demoralizing, and it’s not uncommon to feel anxiety about whether you’ll ever get back to your normal activities. Older individuals may fear that the bone will never heal because of age or bone loss; athletes fear the end of their season (or career). It’s in these tough scenarios that shockwave therapy has emerged as a potential difference-maker. Before we get ahead of ourselves, let’s dive into what shockwave therapy actually is and what research says about using it for stress fractures.
Shockwave therapy, formally known as Extracorporeal Shockwave Therapy (ESWT), involves sending high-energy sound waves into injured tissue (in this case, bone). The word “extracorporeal” just means the treatment is applied from outside the body – nothing invasive. Shockwave has been used medically for decades, starting with blasting kidney stones (lithotripsy). Doctors then noticed an interesting side effect: bones near the treated kidney stones showed increased bone density and healing on X-rays. This spurred research into using shockwaves to stimulate bone repair.
How could sound waves heal a bone? It sounds a bit sci-fi, but the mechanism is mechanotransduction – the conversion of mechanical stimuli into a biological response. The acoustic waves create tiny mechanical stress in the bone tissue, which kick-starts your body’s healing pathways. Studies show shockwaves can provoke a cascade of healing responses: increased expression of growth factors, recruitment of stem cells, formation of new blood vessels, and stimulation of osteoblasts (bone-building cells). In simpler terms, shockwave therapy wakes up a stalled healing process. It’s like jump-starting a car’s dead battery. The treatment causes controlled micro-trauma that signals the body to send repair mechanisms to the area. Importantly, this doesn’t damage the bone or surrounding tissues – when applied at therapeutic settings, shockwave’s effect is to trigger regeneration, not break things apart. (Fun fact: shockwaves can even induce neovascularization, meaning the growth of new blood vessels, which improves blood supply to the fracture site.) Better blood flow and activated healing cells create an environment where a stubborn fracture can finally start knitting together.
What does the evidence say? Because stress fractures can heal on their own, the gold standard to test any new treatment is rigorous studies – ideally randomized controlled trials (RCTs). For shockwave therapy and stress fractures, large RCTs are still limited. However, we have a growing number of smaller studies, case series, and related research on bone healing:
Case series on chronic stress fractures: Some of the first reports came from treating athletes who had stress fractures that refused to heal. In one such series, five young athletes with chronic stress fractures (in places like the tibia, ankle, and pelvis) underwent a single high-energy focused shockwave treatment under anesthesia. All five had radiographic healing of their fractures within ~2–3 months and were able to return to sport by about 3–6 months post-treatment. Another report in 10 soccer players (ages 20–29) with stress fractures (including a stubborn fifth metatarsal “Jones fracture” that hadn’t healed even after surgery) used 3–4 weekly shockwave sessions. Result: all athletes’ fractures healed on imaging within 6–14 weeks of shockwave, and they returned to play in ~2–10 months. These early successes, though in small numbers, were very encouraging – they suggested shockwave could rescue a bone healing process that had stalled out.
Head-to-head vs. surgery in non-unions: While specific RCTs on stress fractures are rare, there have been trials on fracture non-unions (fractures that hadn’t healed for many months, often long bones like the tibia). In these studies, shockwave therapy has been compared to surgical fixation. Amazingly, shockwave achieved bone healing rates equivalent to surgery, with far fewer complications. A 2010 review of difficult-to-heal fractures concluded that shockwave therapy produced union (bone healing) in about 70–80% of cases – similar to surgical outcomes – but without the risks of anesthesia or infection. In other words, patients could potentially avoid surgery yet still heal their fracture using shockwaves. That review emphasized that shockwave is safe, well-tolerated, and can be done as an outpatient with minimal downtime. (It’s worth noting the studies in that review included non-unions of various bones, not just stress fractures, but it demonstrates the bone-healing power of shockwaves in tough cases.)
Recent study in runners: One of the largest reports to date on shockwave for stress-related bone injuries came in 2023. Researchers followed 40 runners (average age ~30, majority female) who had bone stress injuries that weren’t improving with rest alone. These included both true stress fractures and severe stress reactions. Each runner began focused shockwave therapy about ~5 weeks after diagnosis on average, receiving roughly 5 sessions (once or twice per week). The results were impressive: all but one runner (who had a very severe navicular stress fracture and decided on surgery) returned to pain-free running after completing shockwave therapy. Even the runners with delayed or non-healing injuries (some had been trying to heal for >6 months) recovered, though their return to running took a bit longer than those who got shockwave early. Equally important, zero complications were reported – no stress fracture worsened or broke fully, and no one had to stop treatment because of pain. This suggests that focused shockwave is a safe treatment for bone stress injuries in active individuals.
Systematic reviews and expert opinions: Orthopedic researchers have taken notice of these outcomes. A 2015 review in the International Journal of Surgery highlighted that medium- and high-energy focused ESWT showed excellent results in treating stress fractures, with faster return to sports for athletes. The authors reported high healing and return-to-play rates in both professional athletes and military recruits treated with shockwave, and notably no significant complications. They went so far as to suggest shockwave therapy could be considered a first-line treatment for low-risk stress fractures that aren’t responding to traditional care. Another review article noted shockwave has been successfully used not only for fractures but even for conditions like avascular necrosis (bone death due to poor blood flow), thanks to its ability to stimulate bone turnover and blood vessel formation.
Of course, it’s important to temper expectations: while the research is promising, shockwave therapy for stress fractures is still a relatively new application. The existing studies have moderate sample sizes, and some lack a control group (meaning we’re comparing results to historical healing rates or other treatments rather than placebo). More large-scale trials are needed to pin down exactly how much faster or more completely fractures heal with shockwave versus without. That said, the trend in the literature is consistently positive. The consensus in recent literature is that shockwave is a safe, effective option for aiding stress fracture recovery – especially when used in combination with the standard approach of rest and gradual rehab. It’s essentially an added tool to “kick-start” healing when nature needs a boost. And unlike medications that just mask pain, or surgeries that carry significant risk, shockwave aims to actually fix the underlying issue by healing the bone.
What about other treatments? You might be wondering how shockwave compares to things like ultrasound bone stimulators or electrical stimulation devices (often marketed for fracture healing). The truth is, those modalities have mixed evidence. For example, low-intensity pulsed ultrasound (LIPUS) was once popular for fracture healing, but recent studies have questioned its effectiveness (leading even to FDA re-evaluation). Electrical bone stimulators exist, but again, robust evidence is limited. Shockwave, on the other hand, has a growing track record in scientific studies for various bone conditions – including non-healing fractures. It stands out as a regenerative therapy that helps the bone heal itself rather than just providing temporary relief. Also, shockwave therapy has no systemic side effects – it’s localized to the injury site, unlike, say, taking high-dose anti-inflammatories which can affect your whole body. To be clear, no treatment is 100% guaranteed, and we always tailor to the individual – but if a stress fracture isn’t healing, shockwave is one of the most compelling options to tip the scales in favor of recovery.
Finally, it’s worth noting that shockwave is non-invasive. Treatment doesn’t require needles, incisions, or anesthesia (in most cases). You come in for a session, which might last only a few minutes per bone area, then you walk out and continue with your day. That convenience, combined with the evidence of high success rates, is why many sports medicine doctors and physiotherapists are excited about shockwave. In the next section, we’ll discuss how we use shockwave therapy at Unpain Clinic for patients with stress fractures – including what to expect during treatment, how many sessions it might take, and a real example of a patient who got back to activity with this approach.
(If scientific references interest you, see the References section at the end for studies and reviews that informed these insights.)
At Unpain Clinic, shockwave therapy isn’t a last-ditch add-on – it’s often a core part of our treatment plans for stubborn injuries. Our clinic specializes in regenerative, non-surgical therapies, and we’ve found shockwave to be a game-changer for many patients living with chronic pain. In fact, our founder Uran Berisha (BSc PT, RMT) and his team have delivered over 40,000 shockwave treatments over the years, fine-tuning protocols for everything from chronic tendon issues to post-surgical bone healing. When it comes to stress fractures, our approach is twofold: accelerate the bone’s healing and address the root causes that led to the fracture in the first place.
Assessment and personalized plan: We start with a thorough assessment – not just of the injured area, but of your entire biomechanical chain. For example, if you come in with a stress fracture in the shin, we’ll examine things like foot arch biomechanics, calf flexibility, hip strength, and your gait (walking/running form). We want to answer the question, “Why did this fracture happen?” Often, we find contributory factors such as muscle imbalances or training errors. Perhaps your calves are extremely tight, transferring excessive load to your tibia. Or maybe weak foot muscles and worn-out shoes meant your metatarsal was taking a beating with each run. Identifying these factors is crucial – because while shockwave therapy will help heal the bone, we also need to fix the underlying issues to prevent a recurrence. This holistic view is part of what makes our clinic’s approach unique. As Uran often says, we don’t just ask “Where does it hurt?” — we dig into “Why does it hurt?”
Shockwave therapy sessions: For a stress fracture, we primarily use focused shockwave therapy (what we call “True Shockwave™” at Unpain) because of its ability to penetrate deep to the bone. This is delivered with a specialized handheld device that concentrates acoustic energy at the precise location of the fracture. Don’t worry – it’s not an electric shock, and nothing invasive touches your body aside from the applicator on the skin. We typically apply a gel on the skin (to help transmit the waves) and then move the applicator over the fracture site and the surrounding area. Patients often describe the feeling as a rapid, rhythmic tapping sensation. There can be moments of discomfort (especially if the area is very tender), but it’s generally quite tolerable. We adjust the intensity based on your feedback to keep you comfortable. No anesthesia is needed; most people handle it just fine with a little gritting through the more sensitive spots. The treatment itself is quick – often only 5–10 minutes of shockwave application per session focusing on the bone. Afterward, the area might feel a bit achy or warm – that’s a normal response as circulation increases. There’s no downtime – you can walk out and continue your day, just avoiding high-impact activities.
We usually recommend a series of sessions for stress fractures. A common regimen is 3–6 sessions, typically spaced about one week apart. The exact number depends on the severity of your fracture and how chronic it is. Many patients report noticeable improvement after the first 1–2 sessions – for example, less pain with walking. However, the bone needs to actually heal, so we continue through the full course. By session 4 or 5, we often have evidence (via imaging or improved function) that the healing is well underway. Each case is different: an acute stress fracture caught early might only need a few sessions, whereas a year-old non-union might require more. We closely monitor progress, sometimes coordinating with your physician to get a follow-up X-ray or ultrasound to confirm the bone’s healing progress. The good news is that shockwave builds on itself – the healing responses it triggers (like new blood vessel growth) unfold over weeks, so improvements continue even between sessions and after the last treatment.
Beyond shockwave – complementary therapies: While shockwave therapy is the star of the show, we do incorporate other modalities when appropriate. One tool we often add is EMTT (Electromagnetic Transduction Therapy) – a non-invasive therapy using high-frequency electromagnetic waves. Think of it like a magnetic field therapy that further stimulates cell repair. EMTT is painless (you typically just lie there while a loop or pad delivers pulses) and can help reduce inflammation and pain in bone and soft tissue. For challenging cases (for instance, a high-risk hip stress fracture in an older adult), we might even liaise with other providers to incorporate treatments like hyperbaric oxygen therapy (to super-oxygenate the healing bone) in conjunction with our shockwave+EMTT protocol. Our ethos is to throw the kitchen sink at the problem when needed – using any safe tool at our disposal to stimulate healing. We stay at the forefront of technology, so if there’s an evidence-backed modality that could help your recovery, we either have it or can help you access it. That said, we always tailor the plan to what’s necessary – we won’t upsell you on gadgets without a purpose. Some straightforward stress fractures heal great with shockwave alone and good rehab, and we won’t complicate that.
Rehabilitation and whole-body care: One thing that sets Unpain Clinic apart is that we combine these advanced therapies with traditional physiotherapy and rehab. Healing a bone is priority one – but we also have to ensure your body is ready to return to activity. During your sessions, especially as pain decreases, our team (which includes experienced physiotherapists and chiropractors) will guide you in exercises and stretches that address contributing factors. For example, if your hip weakness and poor running form contributed to a tibial stress fracture, we’ll incorporate hip strengthening and gait re-training. If an osteoporotic bone led to a fracture in an older adult, we’ll emphasize balance exercises, vitamin/mineral guidance, and maybe refer you for medical management of bone density. We might work on calf flexibility, foot muscle strength, core stability – whatever is needed around the fracture area so that as the bone heals, the rest of your body is prepared to support it. This holistic approach means that when the bone is finally declared healed, you aren’t just back at square one – you’re actually in better shape than before. Many of our patients not only heal their fracture but end up correcting long-standing biomechanical issues, coming back stronger and less injury-prone.
To illustrate how this all comes together, let’s share a real-world style example of a patient journey (name changed for privacy):
Meet Mark, a 52-year-old avid hiker and weekend warrior. Mark came to Unpain Clinic with a stress fracture in his shin (tibia) that had been bothering him for over four months. He’s an active person – not an elite athlete, but he loves hiking and jogging. This stress fracture cropped up after he pushed himself hiking a steep 20km trail while wearing an overloaded backpack. He felt a nagging ache in his lower leg that worsened over a few weeks. An MRI confirmed a tibial stress fracture. Mark did the right thing initially – saw an orthopedic specialist, rested for 8 weeks, took calcium and vitamin D, and wore a fracture boot. But each time he tried to wean off the boot and walk normally, the deep bone pain came roaring back. By month four, he was frustrated and worried. “I’m in my fifties; maybe I just don’t heal like I used to,” he thought. He also feared that the next step might be surgery, which he was keen to avoid.
First visit: When Mark visited Unpain Clinic, he was limping and still using a walking boot most of the day. We performed a head-to-toe assessment. We found that Mark had very tight calf muscles and slightly limited ankle mobility. He also had weakness in his hip stabilizer muscles. These factors likely meant his shin bone was taking more force than it should with each step. His bone density was on the lower end of normal for his age (osteopenia), which can slow healing. We discussed a plan: we’d use focused shockwave therapy on the tibial stress fracture to jump-start healing, combined with a tailored exercise program (to gently stretch his calves and begin activating his hips and core without stressing the fracture). We also liaised with his family doctor to ensure his vitamin D levels were adequate, given his age and bone health. Mark was on board – anything to avoid surgery and get back on the trails.
Shockwave treatment and rehab: We started shockwave therapy that week. In the first session, Mark was a bit nervous, but as the shockwave pulses began tapping on his shin, he was surprised that it wasn’t painful – “it feels like a tiny jackhammer, but I can handle this,” he joked. After two shockwave sessions, spaced a week apart, Mark reported a noticeable reduction in his everyday pain. He could walk around the house without the boot for short periods, pain-free, which he hadn’t done in months. Encouraged, we continued weekly sessions. By his fifth shockwave session, about five weeks in, he had another assessment with his doctor: an ultrasound scan showed clear signs of new bone healing bridging the fracture site. Mark was ecstatic – this was the first imaging evidence that his bone was finally mending. Clinically, he felt it too: he was able to do short walks in regular shoes and even light stationary cycling with no pain. Over the next few weeks, we gradually increased his activity. Eight weeks into our program, Mark was completely pain-free in the shin. We guided him through a return-to-running plan: starting with brisk walking, then a walk-jog, and slowly upping the running intervals. Three months after starting shockwave, Mark jogged a 5km route without any pain at all. It was a huge personal victory for him.
Addressing the causes: Alongside the bone healing, recall that we worked on Mark’s biomechanics. We coached him on calf stretches and ankle mobility drills to relieve stress on the tibia. We introduced hip strengthening exercises (hello, clamshells and side planks!) to improve his gait stability. We also discussed hiking techniques – for example, using trekking poles on long hikes to offload the legs, and gradually increasing hike intensity instead of sudden jumps. Mark took all this to heart. Today, about six months since he first came in, he’s back to hiking intermediate trails and is building up distance slowly. He’s also incorporated weight training and balance exercises into his weekly routine to keep his bones and muscles strong. In his words, the combination of shockwave therapy and guided rehab “gave me my active life back.” Perhaps just as crucial, he feels confident now that he understands how to avoid future injuries by listening to his body and not ignoring the early warning aches.
(Note: Individual results can vary. Mark’s story is illustrative of a best-case outcome with comprehensive care. Not every chronic stress fracture will heal this quickly, and not every patient is back to full activity in 3 months – but with the right approach, even long-standing injuries have a much better shot at healing. We share this story with permission, to offer hope that there are solutions beyond “just rest” when rest isn’t enough.)
Professional treatment is key to overcoming a stubborn stress fracture, but there’s a lot you can do at home to support healing and prevent future problems. Here are some at-home guidance tips in plain language:
Rest – but don’t lose all activity: Giving the injured bone time to heal is crucial. Follow your provider’s advice on weight-bearing. This often means avoiding impact activities (running, jumping, heavy lifting) for the recommended period. It can be frustrating to halt your favorite workouts, but think of it as an investment in getting back to 100%. Importantly, rest doesn’t mean you must become a couch potato. You can usually do some pain-free cross-training to maintain fitness. Low-impact options like swimming, pool running, cycling, or using an arm ergometer can keep you active without pounding the injured bone (always confirm with your physio or doctor what’s safe). Listen to your body – if any activity causes pain at the fracture site, stop it. Pain is your guide right now.
Protect and support the area: Use any support device prescribed – this might be a walking boot, brace, crutches, or splint. These aids reduce stress on the bone as it heals. It’s tempting to ditch the boot early when you start feeling a bit better, but stick with it for as long as your healthcare provider advises. Prematurely returning to full weight-bearing can set you back. Also, wear supportive shoes, even indoors. For example, if you have a foot stress fracture, a stiff-soled shoe or sandal can reduce bending stress through the foot during daily activities. Think of these supports as a gentle crutch – they’re temporary, but essential to offload the bone while it’s repairing.
Optimize nutrition for bone healing: Your body needs the right building blocks to heal a crack in the bone. Make sure you’re getting plenty of calcium and Vitamin D, as well as protein. Calcium and Vitamin D are crucial for bone strength – your doctor might even recommend supplements if you’re not hitting the daily targets (around 1000–1200 mg calcium and 800–1000 IU of D for many adults, though needs can vary). Good sources of calcium include dairy products, leafy green veggies, and fortified foods; Vitamin D can come from sunlight, fatty fish, or supplements. Protein is important too – bones are about 30% protein by structure. Lean meats, beans, eggs, and protein-rich snacks can help. Also, avoid smoking and keep alcohol moderate – smoking in particular is known to delay fracture healing by impairing blood flow. Bottom line: a well-nourished body heals faster, so feed your bones!
Pain management (smartly): It’s okay to use measures like ice packs to manage pain and swelling, especially in the early stages. Applying ice for 15–20 minutes at a time (with a cloth barrier to protect your skin) can numb the ache and reduce inflammation. Over-the-counter pain relievers like acetaminophen (Tylenol) are generally safe to use as needed for pain. Be cautious with NSAIDs (like ibuprofen) – while they’re great for pain and inflammation, some research suggests that excessive NSAID use might slow bone healing (because inflammation is actually part of the healing process for bones). One or two ibuprofen here and there won’t ruin your recovery, but it’s best not to rely on them daily for weeks on end without medical guidance. Often, as the bone heals (especially if you’re doing treatments like shockwave), you’ll find the pain diminishes naturally and you can phase out pain meds.
Gentle movement and exercise (as appropriate): Just because you’re resting the bone doesn’t mean everything has to rest. In fact, keeping the rest of your body limber can help you bounce back faster once the fracture is healed. Typically, as long as you avoid stressing the fracture site, gentle range-of-motion exercises are encouraged. For example, with a foot stress fracture, you might do toe curls, ankle circles, or easy calf stretches to keep those areas mobile (if they’re pain-free). If you have a pelvic or hip stress fracture, you might do core and glute exercises that don’t load the leg (like gentle bridges or abdominal bracing exercises). Always follow guidance from your physiotherapist or doctor on what’s allowed – they can give you a specific list of safe exercises. The goal is to maintain circulation and muscle tone without disturbing the bone’s healing. Movement also helps prevent stiffness in nearby joints from wearing a boot or using crutches.
Gradual return to activity: Patience is your best friend during recovery. When your healthcare provider clears you to resume activities, take it slow. A common mistake (especially among eager athletes) is jumping back in full throttle and ending up re-injured. Instead, follow a structured, step-by-step progression. For runners, we often use a walk-jog program: for example, start with intervals like 1 minute of jogging alternated with 4 minutes of walking, repeat 5–10 times, and see how it feels. Over subsequent weeks, gradually increase the jogging time and decrease the walking time. The general rule of thumb is to increase your activity no more than ~10% per week. And build in rest days – at least 1–2 rest days per week from impact activity. Your bone adapts and strengthens in response to stress and recovery, so you must allow those recovery periods. Also, don’t be discouraged by mild soreness – that can be normal – but sharp pain is a sign to back off. Keep communicating with your provider about your progress.
Address root causes during downtime: Use this “down period” as an opportunity to fix anything that contributed to the fracture. This might involve investing in better footwear or orthotics (if flat feet or poor shoes played a role), working on muscle imbalances, or tweaking your training routine. For instance, if you have very high arches that concentrate pressure on your metatarsals, you might benefit from arch supports or more cushioned shoes once you go back to running. If weak hips led to poor running form, continue the strengthening exercises prescribed by your physio. Sometimes even a session with a coach or trainer to check your running or walking form can pay dividends – small changes in technique (like increasing your cadence or shortening stride) can reduce the load on certain bones. Think of it this way: your stress fracture was your body’s way of saying “something wasn’t ideal.” By correcting those factors, you reduce the risk of an encore injury.
Lastly, be patient and stay positive. Bone healing is a process – typically a matter of weeks to a few months for most stress fractures to mend to the point of normal activity. It’s normal to feel impatient, but remind yourself that the bone is working hard behind the scenes to repair itself. Celebrate small milestones: “Hey, last week I could barely hop on that leg and now I can!” Each week should get a little better. If you’re doing shockwave therapy or other treatments, trust the process – the improvements often compound over time. And keep your eyes on the prize: returning to the activities you love, stronger and smarter than before. With diligence both in the clinic and at home, you’ll get there. (Disclaimer: always follow the specific recommendations of your healthcare provider, since every individual and injury is unique. The above tips are general and not a substitute for medical advice.)
Yes – in the hands of trained professionals, shockwave therapy is considered very safe for treating stress fractures. Clinical studies have reported no significant complications when using focused shockwave on bone injuries like stress fractures. Unlike surgery, there’s no risk of infection or anesthesia complications. The most common side effects are temporary and local – you might have some soreness, redness, or mild bruising on the skin over the treatment area, which usually resolves within a day or two. Shockwave has been used in orthopedics for decades (initially for fracture non-unions and tendon issues), and it has an excellent safety profile. It’s non-invasive and does not expose you to radiation or any chemicals. That said, it’s crucial that a proper evaluation is done first – for example, if a stress fracture is extremely advanced or nearly a full fracture, a doctor should determine if shockwave is appropriate or if stabilization (casting/surgery) is needed first. At Unpain Clinic, we work in conjunction with physicians to ensure that shockwave is only used when safe. We also adjust the energy levels to what’s appropriate for the bone and your comfort. Rest assured, when guidelines are followed, shockwave therapy is a low-risk, high-reward treatment for stubborn stress fractures.
The exact number of sessions can vary, but most patients need a series of treatments rather than just one. A typical protocol for a stress fracture might be around 3 to 6 sessions, scheduled about 1 week apart. In published case series, some athletes healed after just 1–3 high-energy sessions, while other studies (like the 40-runner study) delivered around 5 sessions on average. At Unpain Clinic, we tailor the plan to the individual: if your stress fracture is recent and mild, as few as 3 sessions might do the job. For a more chronic or severe case, we might schedule 6–8 sessions. We will monitor your progress – if the bone is healing quickly, we can always stop earlier. Conversely, if it’s improving but not fully healed, we might add an extra session or two. Many people notice improvement after the first couple of sessions (like reduced pain), but it’s important to complete the full course to ensure the bone consolidates strongly. Sessions themselves are quick (a few minutes of actual shockwave application, plus time for prep). Think of it like this: each session is one step in layering on the biological stimulus for healing. By the end of the series, you’ve given your body multiple “boosts” to solidify the repair. Your therapist will discuss the recommended number for your specific case during your initial assessment, and we’ll re-evaluate as we go.
Shockwave therapy can cause some discomfort, but it’s usually quite tolerable. Patients often describe the sensation as a rapid tapping or thumping feeling on the skin. When we treat a tender area like a stress fracture, there may be moments where it’s a bit painful (sharp or achy) – but we have full control over the intensity and will adjust it to keep you comfortable. We start at a low energy and increase gradually; you can tell us “that’s a bit much” and we’ll dial it down. The good news is the uncomfortable part only lasts a few minutes and stops as soon as the treatment ends – there’s no lingering intense pain after the session. In fact, many patients walk out feeling better than when they walked in, because shockwave also has an immediate analgesic effect for many. You might feel a little sore or bruised-feeling in the treated area later in the day, but this is generally mild and temporary. No anesthesia or numbing is required; most people handle it with just normal breathing and maybe some wincing at first. We often hear comments like, “Oh, that wasn’t as bad as I imagined!” Keep in mind, pain is very subjective – if you’re very pain-sensitive or anxious, let us know and we’ll take extra care with settings and perhaps do a shorter test round first. In summary: it’s not a spa-like feeling, but it’s a far cry from the pain of something like surgery. And each pulse of discomfort is aimed at relieving the much bigger, chronic pain you’ve been enduring from the fracture. Patients overwhelmingly consider that trade-off worth it.
It very well might. Shockwave therapy has shown success even in long-standing non-healed fractures. For example, there are documented cases of fractures that hadn’t healed for 1–2 years finally achieving union after shockwave treatment. The therapy is specifically useful for “awakening” chronic injuries. If your stress fracture from years ago still gives you pain or never showed proper healing on imaging, it could essentially be behaving like a non-union. Shockwave can stimulate fresh healing activity in that area. We’ve seen patients who say, “I’ve had this bone injury for ages and just learned to live with it,” and we were able to significantly reduce their pain and improve function by treating it with shockwave. That said, every situation is unique. Factors like your age, overall health, bone quality, and what treatments have been tried before all play a role. In an older stress fracture, there might be a lot of scar tissue or poor blood supply around the site. Shockwave helps by breaking down scar tissue and increasing blood flow in addition to stimulating bone cells. One thing to note: if a stress fracture from years ago did heal but you’re having pain again in the same area, we need to determine if it’s a new injury or some other issue (like arthritis or tendonitis) – shockwave might still help those, but the approach could differ. In summary, if you have a “stress fracture that never fully healed,” shockwave therapy is certainly worth discussing with us or your doctor. We’ll assess whether there’s a treatable chronic issue there. Often, the answer is yes, and shockwave can be the catalyst that finally closes the chapter on that old injury.
While shockwave therapy is safe for most people, there are some contraindications and cases where we avoid or postpone it. You should not have shockwave therapy directly over an area if you have active cancer or a tumor there – we avoid treating over malignancies. It’s also not used over open fractures or infections (those need emergency care). If you have a blood clotting disorder or are on strong blood thinners, we use caution because shockwave can cause a bit of local bleeding/bruising – it’s not an absolute no, but we’d work closely with your physician. Shockwave isn’t applied over growth plates in children (so we typically reserve it for skeletally mature patients, roughly 18+ years old, unless a specialist advises otherwise). We avoid the abdomen or low back of pregnant women just out of precaution (no one’s going to experiment on a fetus with shockwaves!). Also, areas near gas-filled organs (like lung tissue) are generally avoided with high-energy focused shockwave, because theoretically it could cause lung injury – so we wouldn’t, for instance, treat a rib fracture with full-power shockwave over the chest wall. Fortunately, for most musculoskeletal targets (feet, shins, hips, etc.), these issues don’t apply. During your assessment, we’ll go through your medical history to ensure you’re a good candidate. If for some reason shockwave isn’t suitable, we’ll discuss alternative treatments. The vast majority of people with stress fractures are candidates for shockwave. Finally, immediate post-surgery areas (where metal pins/plates were just put in) might be approached carefully or delayed until initial healing passes – but that’s case-by-case. Always disclose your full medical history so we can make the best and safest plan for you.
Insurance coverage for shockwave therapy varies. In Canada (where Unpain Clinic is based), shockwave therapy is often provided by physiotherapists or chiropractors, so the treatment can be billed under your physiotherapy or chiropractic benefits. Many extended health benefits plans will cover a portion of the treatment cost just like a regular physio visit, since it’s considered part of that service. However, it’s important to check the specifics of your plan: some insurers have caps on physiotherapy or classify shockwave under certain codes. In general, provincial healthcare (like Alberta Health Services) does not directly cover shockwave therapy in a private clinic setting, so it’s typically out-of-pocket or through private insurance. In the United States and other countries, some insurance plans may cover shockwave for specific conditions (for example, plantar fasciitis or tennis elbow) if certain criteria are met, but coverage for off-label uses like stress fractures might be hit or miss. The good news is that in recent years, insurance companies are becoming more familiar with shockwave as it gains evidence. At Unpain Clinic, our team can provide you with the appropriate receipts and treatment codes, and we’ll help however we can in documentation if you plan to submit claims. It’s always a good idea to call your insurance provider and ask: “Do my benefits cover physiotherapy that includes shockwave therapy?” If not, you can also use Health Spending Accounts or similar if you have them, since shockwave would be an eligible medical expense. Bottom line: some patients do get a significant chunk reimbursed, others pay out-of-pocket. We strive to make it worth your while by delivering results that potentially save you bigger costs (and downtime) associated with surgeries or prolonged issues.
Shockwave therapy is non-invasive, so side effects are generally mild and localized. The most common side effects include: temporary soreness, redness, or swelling at the treatment site. It’s a bit like how you might feel after a deep tissue massage – a sense that the area was worked on. You might notice a small bruise on the skin, especially if you bruise easily (because the shockwaves can cause tiny blood vessels to leak a bit – that’s part of the healing response). These effects usually last only a day or two. Some patients report a tingling or numbness in the area for a short time after – this is due to stimulation of nerves and typically resolves quickly. During the treatment, if we’re near a superficial bone, you might feel a sharp ping – but again, that ceases when the treatment stops. Importantly, shockwave does not damage the bone or tissue when applied at therapeutic levels. It might feel odd, but it’s not breaking your bone or anything like that (a common misconception!). In fact, studies have shown that shockwave can be applied without harming healthy tissues – it specifically targets pathologic tissues by inducing repair mechanisms. Rarely, if someone has an overactive pain response, they might feel a pain flare for a day after treatment (like a transient inflammatory flare), but this is uncommon and manageable with rest and ice. There’s also a very slight risk of tendon or tissue damage if shockwave is done improperly (e.g., too high energy over a tendon insertion), but in a clinical setting with trained therapists, this is not a concern. We follow evidence-based protocols. Finally, one side effect to mention is improved healing – yes, that’s the goal! Many “side effects” of shockwave are actually positive: increased blood flow, tissue regeneration, etc., which aren’t felt as side effects per se but are happening behind the scenes. To sum up: expect maybe a bit of soreness/bruising, but otherwise shockwave therapy is usually uneventful in terms of side effects – certainly far fewer side effects than medications or surgical interventions for a similar issue.
Stress fractures, though small in size, can cause a big disruption in your life. The good news is that with proper care, these tiny cracks do heal – and most people can safely get back to their sport or daily activities. In this article, we explored what stress fractures are (tiny bone cracks from overuse or weakened bone), why they happen (too much stress, too little recovery, sometimes compounded by issues like poor biomechanics or low bone density), and how to treat them effectively. The traditional prescription of rest remains fundamental – you have to give the bone a chance to mend – but now we have cutting-edge treatments like shockwave therapy that can significantly speed up and enhance the healing process. Shockwave therapy offers a non-surgical, drug-free approach to kick-start bone repair when nature needs assistance. It’s not magic or a “quick fix” in the sense that you still need time and rehab, but it can make the difference between an injury that heals in a few months versus one that might have lingered for half a year or more.
At Unpain Clinic, we pride ourselves on combining these advanced technologies with holistic rehabilitation, truly tailoring treatment to each patient’s unique needs. Whether you’re a young athlete eager to return to competition, or an older adult wanting to stay active without pain, the goal is the same: heal the fracture and address the cause so you come out on the other side stronger. Many of our patients not only mend their stress fractures but also gain knowledge and improvements in their overall musculoskeletal health – they leave feeling empowered in their long-term health journey.
If you’re dealing with a stress fracture (or suspect you have one), don’t lose hope. Even if you’ve been told to “just rest and wait,” remember that there are additional options like shockwave therapy that research has shown to be effective in aiding bone healing. Results may vary for each individual, but the evidence and our clinical experience indicate that shockwave can be a game-changer for suitable candidates. Particularly if you’ve been struggling for months with no improvement, or if you’re trying to avoid a potential surgery, it’s worth considering a shockwave therapy assessment.
Healing a stress fracture requires patience – there’s no denying that. But you won’t be doing it alone. With a supportive healthcare team and the right approach, you’ll be amazed at how your body can repair itself when given the proper help. This injury might even be an opportunity in disguise: a chance to correct imbalances, learn better training habits, and come back stronger than before. We’ve seen athletes return to their sport better conditioned and more mindful of recovery, and older patients becoming more confident in their strength and balance. Your body has an incredible capacity to heal, especially when we give it the boost it needs.
If you’re tired of pain dictating your life, or if you’ve been stuck in the cycle of “rest, attempt activity, pain returns,” it may be time for a fresh approach. Shockwave therapy could be the key to finally closing that crack – literally and figuratively – and getting you back to the life you love.
Now, as you consider your next steps, imagine a future a few weeks or months from now: You’re lacing up your shoes again for that run. You’re heading back to the hiking trail or dance studio, or simply walking through the park without that nagging pain. That future is within reach. The body wants to heal – we sometimes just have to nudge it in the right direction. At Unpain Clinic, we’re here to be your partner in that healing journey, every step of the way.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Cleveland Clinic – Stress Fractures: Symptoms, Causes & Treatment. (Accessed 2025).
2. Leal C, et al. (2015). Current concepts of shockwave therapy in stress fractures. Int J Surg, 24(Pt B), 195-200.
3. Furia JP, et al. (2010). Shock wave therapy as a treatment of nonunions, avascular necrosis, and delayed healing of stress fractures. Foot Ankle Clin, 15(4): 651-662.
4. Beling AL, et al. (2023). Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners. Bioengineering (Basel), 10(8): 885.
5. Moretti B, et al. (2009). Shock waves in the treatment of stress fractures. Ultrasound Med Biol, 35(6): 1042-1049.
6. Shockwave Canada Blog (2024). Current Concepts of Shockwave Therapy in Treating Low-Risk and High-Risk Stress Fractures. (Summary of research evidence and expert opinion).
7.“Why Shockwave Is a Game Changer” – I Love Shockwave Podcast, Uran Berisha (host) & Nick
Wigger (guest), Mar 28, 2025. (Discussion on Unpain Clinic’s shockwave experience and success in fracture healing).
