TABLE 1.

Proposed cellular mechanisms of action for extracorporeal shockwave therapy

Increased collagen synthesis	Enhanced fibroblast proliferation (increased transforming growth factor beta [TGF‐β]) and upregulation of collagen I and III 5 , 13
	Regulation of scleraxis, tenomodulin 13
Cellular proliferation and wound healing	Upregulation of tendon‐derived tenocytes 13
	Increased ATP release and downstream extracellular signal‐regulated kinase activation 14
	Enhancement of osteogenesis 5
	IL‐6 and IL‐8 mediated tendon remodeling 5
Pain reduction	Gate‐control theory 5
	Modifies substance P release 14
	Decreased calcitonin‐gene‐related peptide 14
Neovascularization	Induction of TGF‐βI and insulin‐like growth factor I 5
Decrease in soft tissue calcifications 5
Decrease in inflammation 5