What Is Shockwave Therapy and How Can It Help You? Inside the Conversation With Dr. Manish

Ask most people what "shockwave therapy" means and you'll get guesses ranging from physical-therapy jargon to something out of a video game. On this episode, Mark Anthony sat down with Dr. Manish, a chiropractor practicing in Princeton, New Jersey, to walk through what the treatment actually is — and why he built a meaningful part of his practice around it after using it to help hundreds of patients.

Dr. Manish's path into chiropractic wasn't a straight line. Raised partly in India in a family that expected him to become a doctor or an engineer, he set his sights on dentistry first, missing the cutoff for dental school admission by a single point despite a strong GPA. A former college tennis player who went on to coach the sport for 12 years, he was steered toward chiropractic school instead, becoming a chiropractor in 2008. It took a serious injury of his own, six years later, to change how he understood the job.

From Patient to Practitioner: A Career-Changing Back Injury

In 2014, Dr. Manish woke up one Saturday morning, reached over a bathroom sink, and felt his entire left leg go numb — sharp, shooting, burning pain radiating from his lower back. It was, he said, the worst pain of his life, and it came on with no clear trigger. The pain was so severe that no chiropractor, including his own colleagues, could put a hand on his lower back to attempt an adjustment.

Looking back, he traced a possible root cause to a 2002 car accident — a T-bone collision that left him with a hairline fracture in his pelvic area and some back issues that had gone quiet for over a decade. He treated himself with spinal decompression in his own office five days a week, and it took nine months to become pain-free and two years before he could return to running. The experience reshaped how he thought about his own field. Until then, he said, he understood chiropractic largely as neck-and-back pain management.

Real Shockwave vs. Mechanical Pressure-Wave Devices

As he recovered, Dr. Manish started researching other tools to speed healing for his most severe, chronic cases — patients with disc issues, failed back surgeries, spinal stenosis, and years of injections, cortisone shots, and physical therapy that hadn't resolved their pain. He began incorporating cold laser (red light) therapy around 2012, well before it became widely known. Then, while relocating his practice from Illinois back to New Jersey around the start of the COVID-19 pandemic and waiting on his state license, his research led him to shockwave.

He's careful to distinguish between two different technologies that both get marketed as "shockwave." The version most people encounter is a mechanical pressure-wave device — Dr. Manish compares it to "a deep-tissue massager on steroids." It can be effective for tendon issues, but it works at the surface, can bruise the skin, isn't recommended for patients on blood thinners, and shouldn't be used directly on bone. The version he uses — a true electrohydraulic shockwave, sold under the "softwave" name — works differently: an electrical coil discharges inside water, producing a sound Dr. Manish says travels at roughly 3,355 miles per hour, a supersonic burst delivered in a tight, pinpoint area rather than spread broadly across the tissue. He began using it in his Princeton practice in 2020, when he says he was one of three providers in New Jersey, and fewer than 100 nationwide, offering it.

How Shockwave Triggers the Body's Own Healing Response

Dr. Manish explained the mechanism in plain terms: the sound wave causes a vibration at the cellular level — a process called mechanotransduction — that effectively "tricks" the body into treating the area as freshly injured. That matters, he said, because inflammation itself isn't the problem; it's the body's normal signal to begin healing. Trouble starts when that inflammation doesn't resolve and becomes chronic — at that point, he said, the brain essentially decides it's done what it can and shuts off the active healing response, leaving pain-driving chemicals to linger and cause more tissue damage.

Shockwave, he said, reduces those lingering inflammatory chemicals while boosting the chemical signals associated with active healing, and helps activate the body's own dormant stem cells at the site. It also triggers angiogenesis — the formation of new blood vessels — which brings more blood flow, oxygen, and nutrients to damaged tissue. That's part of why he's applied it beyond typical musculoskeletal injuries to neuropathy patients, where improved circulation to a damaged nerve can help reduce both numbness and pain. Patients do feel some discomfort when the sound hits the site of an injury, he noted, though it stays localized to that area.

Real Outcomes Discussed in the Episode

Dr. Manish described categories of patients who've found relief after other options fell short: people with decades of chronic low back pain who'd already had spinal stimulators, cages, and fusion surgery; patients told they needed a joint replacement who are now managing stairs without pain; and neuropathy patients who've regained function they didn't expect to get back. He was also specific about one case: a young patient with a serious knee injury who, for more than a year, hadn't been able to sit in a low chair without difficulty getting back up. Referred in from a colleague in Philadelphia, she drove an hour each way a couple of times a week; within about six visits — not even three full months in — she could sit down and stand back up again without trouble. In the months after, he said, she returned to exercise and lost a significant amount of weight, changes he attributes to simply being able to move again.

He also placed the technology in a wider medical context: true shockwave was originally developed to break up kidney stones, was later adopted in urology for sexual dysfunction, then moved into musculoskeletal medicine, and today is even used in cardiology — applied during open-heart surgery to help reduce scar-tissue formation before a patient is stitched up. In his own practice, he's used it on conditions ranging from disc and joint issues to TMJ and pelvic-floor concerns, always framed, he said, around finding and treating the root cause rather than managing symptoms alone.