When it comes to pediatric use of shockwave therapy, clinicians have traditionally been taught to avoid growth plates entirely. Now, instead of a blanket approach to treatment, the conversation around shockwave use in youth athletes is changing. It’s no longer a black-and-white discussion. The current guidance emphasizes nuanced risk stratification, tissue-specific thinking, and careful dosing decisions in younger populations.

In 2020, musculoskeletal disorders were the number one non-fatal disability with over 1.63 billion impacted globally, including pediatric patients, and that number is predicted to rise within the coming decades. This further emphasizes the need to approach these injuries with precision treatment and decision-making when developing a care plan. As more youth athletes injure themselves, it becomes clear a one-size-fits-all isn’t possible or even effective. A more sophisticated approach is required from clinicians to ensure the long-term health and healing of patients.

Clinicians are moving away from the assumption that shockwave isn’t appropriate for youth athletes and towards informed decision-making. It’s reflective of the pattern and approach clinicians are noticing and adopting with regards to their adult patients. Clinicians are being called to consider the risks and benefits when it comes to youth patients’ long-term health and athletic abilities. This approach requires a structured framework to decide if, and when, shockwave treatment will benefit a youth athlete.

What the Delphi Study Means for Pediatric Use

A recent modified Delphi study in the British Journal of Sports Medicine sought expert consensus on shockwave therapy clinical indications, dosing, and safety across common sports medicine conditions. The majority of the work focuses on adults, but several themes translate directly to youth patients:

  • Shockwave is a valuable option after appropriate conservative care has been tried. It is not the first line of defense or a quick fix.
  • Dose matters: As with adults, the energy level, number of shocks, and treatment frequency should be tailored to tissue type and location.
  • Safety is context-dependent: proximity to bone, neurovascular structures, and sensitive regions requires caution and sometimes avoidance.

For clinicians working with youth athletes, the key takeaway is that shockwave decisions must integrate skeletal maturity, tissue target, and overall load on the developing musculoskeletal system. It’s not simply about the presence or absence of a growth plate.

Reframing the Core Clinical Questions

Instead of asking “Is shockwave allowed in this age group?”, clinicians should structure their reasoning around a series of more specific questions:

  • Is the athlete skeletally mature, or are there open physes that change the risk profile?
  • Is the target region clearly near an open growth plate, or is it primarily tendinous, muscular, or apophyseal tissue?
  • Is the condition one where mechanical load and repetitive traction at apophyses are driving symptoms e.g.traction apophysitis, or is it a more classic tendinopathy?
  • Is shockwave being considered as an escalation after a well-executed conservative rehab has failed to progress the patient along the care-path, or is it being proposed prematurely because of time pressure or competitive demands?

Each of these questions shifts the discussion away from age alone and toward tissue-specific and context-specific reasoning. Shockwave isn’t indicated for all youth athletes, but appropriate usage may improve long-term health and mobility for the right candidates.

Tissue, Energy, and Location: The Real Risk Stratification

The Delphi panel highlights that shockwave dosing should be matched to the structure being treated. In youth athletes, this becomes even more important. Clinicians treating youth athletes should consider the tissue being treated, the energy levels used, and the location of the injury. This might look like one of the following examples:

  • Apophyseal and bony regions: These often require the greatest caution because of their proximity to physes and their role in growth and development. Conservative management and load modification should be exhausted before device-based escalation.
  • Tendinous structures: In some older adolescents with near or complete skeletal maturity, carefully dosed shockwave may be appropriate when chronic tendinopathy is limiting participation and other interventions have plateaued.
  • Muscular targets: Lower energy levels and more superficial treatments may be considered in select cases, but it should still be integrated within a broader load-management and strengthening program.

Decisions about energy level, device type (focused vs radial), and target anatomy must be grounded in an understanding of what structure is absorbing the energy and what is the plausible therapeutic mechanism in all tissues.

A Considered Care Approach: Collaboration, Communication, and Consent in Pediatric Care

Youth cases demand a higher standard of communication and collaboration. Before proceeding with shockwave treatment in a younger athlete, clinicians should be able to answer the following:

  • Has appropriate imaging or physician involvement clarified the diagnosis and skeletal status where needed?
  • Are the athlete, parents, and the care team aligned on the rationale, potential benefits, uncertainties, and possible risks?
  • Is everyone clear that shockwave is not a shortcut around load management, rehabilitation, and long-term development goals?

When clinicians take this approach, shockwave becomes one tool within a shared decision-making process and not a stand-alone solution. Shared accountability and discussion in youth cases enable the highest standards of care by ensuring that all aspects of the care plan are considered. Open discussions with a pediatric patients’ care team, including primary caregivers, create a more holistic approach that aligns home care and in-office care on the treatment path and progression plan.

It’s one aspect of a shockwave treatment plan in youth athletes that helps to guarantee their long-term athletic health. As clinicians begin to see an influx of youth athletes, it becomes even more important that shockwave is used concisely as part of a larger rehabilitation plan. The better the treatment in youth, the less likely patients will be to experience ongoing issues or comorbidities as their athletic careers progress and they move into adulthood.

Smarter, Not Broader Use

Shockwave is not a universal solution for youth sports injuries. However, it does have a place in healing pediatric patients so that long-term athletic health is prioritized. The key is understanding how to implement shockwave responsibly into an overall care plan. Rather than clinicians simply wondering, “Is this allowed?”, the more clinically astute question is, “What specific information do I need before deciding whether shockwave is appropriate for this youth athlete?” That includes skeletal maturity, imaging findings, tissue target, treatment history, device parameters, and stakeholder alignment.  Shifting away from “if” and into “when” to use shockwave with youth athletes allows clinicians to move away from fear-based absolutes regarding treatment and toward a more structured, transparent risk-benefit analysis that prioritizes patient health.

As musculoskeletal injuries rise globally and shockwave treatment becomes more common in sports medicine, clinicians need a better framework for when to treat, when to modify, when to refer, and, especially with pediatric patients, when to wait. Kinas is here to help guide clinical decision-making and support clinicians as they implement shockwave use into care plans.

Contact us at info@kinasmedical.com or (770) 612-8245 if you’d like more information on building a sound decision-making framework for implementing shockwave care with youth athletes.

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This blog is based off the 2024 Modified Delphi Study published in the British Journal of Sports Medicine: https://bjsm.bmj.com/content/59/18/1287