Why TMPHYSIO
Not all shockwave is created equal
The difference is in the protocol. We treat according to current recommendations from sportärztezeitung and the international Delphi consensus – with medical diagnostics first, cleanly dosed impulses and an active rehab plan behind it. That turns "pain therapy" into real healing.
Diagnostics first
We analyse the cause via palpation, ultrasound or MRI – instead of blindly pressing on the painful spot.
Evidence-based dosing
Every indication has its own protocol (pulse count, frequency, energy flux density) – per current research.
Active accompanying therapy
Heavy Slow Resistance, eccentric training, manual therapy and EMG biofeedback make healing sustainable.
Complaints & indications
Recognise yourself here?
These are the conditions we treat successfully every day with focused and radial shockwave therapy:
Evidence · sportärztezeitung
Indication focus backed by research
We follow the international Delphi consensus on ESWT in sports medicine and publications by leading sportärztezeitung authors. Every indication follows a defined, reproducible protocol.
Muscle injuries
Fibre tear · Bundle tear · Scar management
ESWT stimulates satellite cells (myogenic stem cells), increases IGF-1 and HGF and accelerates muscle regeneration. In the subacute phase (from day 3–5) it reduces excessive scar formation (myofibrosis). Morgan et al. (2021) showed significantly shorter return-to-play time after acute hamstring injuries under rESWT.
Protocol
rESWT · 2,000–3,000 pulses · 1.5–3 bar · 8–15 Hz · 3–5 sessions one week apart. For grade II–III, add focused ESWT to the scar zone.
Source: Schmitz (LMU Munich), Morgan et al. 2021, Crupnik et al. 2019
Osteitis pubis & bone marrow oedema
Osteitis pubis · BMOS · Adductor insertion
A systematic review (Häußer, Wieber & Catalá-Lehnen, JOSR 2021) shows significant MRI reduction of bone marrow oedema and clear pain and function improvement. ESWT activates osteoblasts, BMP-2 and VEGF.
Protocol
fESWT · 1,500–6,000 pulses · energy flux density 0.08–0.40 mJ/mm² · 3–6 sessions. Multimodal with adductor and pelvic floor training.
Source: Catalá-Lehnen, Häußer, Wieber, Niedhart, Maier
Tendinopathies
Achilles · Patella · Insertions
For mid-portion Achilles tendinopathy and patellar tendinopathy, level-I-evidence RCTs exist. ESWT boosts tenocyte proliferation and collagen-I synthesis and delivers better long-term outcomes than cortisone injections – without the rupture risk.
Protocol
Patella: rESWT 2,000–3,000 pulses · 2.5–4 bar · 10–15 Hz · 4–6 sessions. Achilles insertion: fESWT 1,500–2,000 pulses. Combined with Heavy Slow Resistance or Alfredson protocol.
Source: Ott, Hirschmüller, Weisskopf, Weinert
Stress fractures & early reactions
Tibia · Metatarsal · Pubic ramus
Focused ESWT activates callus formation and periosteal stem cells, shortens healing time and supports an orderly return-to-sport. Indicated for reactive bone oedema with intact cortex.
Protocol
fESWT directly on the fracture zone · 3–5 sessions · combined with partial offloading. MRI monitoring after 6–8 weeks.
Source: Niedhart, Catalá-Lehnen
Mechanisms of action
What shockwave triggers in tissue
Cellular
↑ tenocyte & myoblast proliferation, ↑ type-I collagen, activation of mesenchymal stem cells.
Analgesic
Inhibition of substance P, modulation of neurogenic inflammation, ↓ COX-2 and NF-κB.
Vascular
↑ VEGF release, neovascularisation and improved micro-perfusion in target tissue.
Osseous
↑ osteoblast activity, ↑ BMP-2, reduction of intraosseous pressure in bone marrow oedema.
Radial ESWT
Broad area · near-surface
Divergent pressure waves over a large field. The treatment of choice for muscles, trigger points, fascia and superficial tendon insertions like epicondylitis or plantar fasciitis.
Focused ESWT
Point-precise · deep
Energy is bundled at a defined deep point. Indicated for bone marrow oedema, symphysis pathology, stress reactions and deep insertional tendinopathies.
Process
From assessment to Return-to-Sport
01
Diagnostics
Clinical exam, ultrasound or MRI review, definition of the target structure.
02
Therapy
3–6 ESWT sessions of 10–15 min weekly, individually dosed.
03
Active accompanying therapy
Heavy Slow Resistance, eccentric training, manual therapy and EMG biofeedback.
04
Re-assessment
Functional tests and imaging if needed for objective progress control.
Expertise & sources
Treatment at research level
Thomas Maier is a guest author and speaker at sportärztezeitung and part of an international expert circle on shockwave therapy in sports medicine.
Our protocols draw on the Delphi consensus on ESWT in sports medicine and publications by Schmitz (LMU), Catalá-Lehnen, Häußer and Wieber (LANS Medicum), Weisskopf, Hirschmüller, Ott, Niedhart and Maier.
FAQ