An experienced physical therapist explains why he frequently follows shockwave therapy with Class IV laser to support tissue recovery.
After years of treating musculoskeletal injuries and integrating rehabilitation technologies into clinical practice, Art Van Leuven, PT, DPT, ATC, founder of SB Physio, has developed a preference for using Class IV laser therapy following shockwave treatment.
While both technologies have independent applications, Van Leuven frequently uses laser immediately after shockwave because of their potentially complementary physiological effects.
The reasoning centers on two goals: reducing post-treatment soreness and supporting the biological response initiated by shockwave.
Shockwave Creates the Mechanical Stimulus
Shockwave therapy delivers mechanical pressure waves into tissue, stimulating cellular responses through a process called mechanotransduction.
This mechanical stimulus can influence signaling pathways involved in tissue adaptation and remodeling, making shockwave a useful option for certain chronic tendon and soft tissue conditions.
However, the treatment can also create temporary soreness as tissues respond to mechanical stimulation.
Why Follow Shockwave With Class IV Laser?
Class IV laser therapy works through a different mechanism called photobiomodulation, where light energy influences cellular signaling and metabolic processes.
Van Leuven frequently follows shockwave with laser for two primary reasons.
1. To help manage post-treatment soreness.
Laser therapy may help regulate pain signaling and inflammatory activity. Following the mechanical stimulation of shockwave, this may help patients recover more comfortably.
2. To support the biological response.
Photobiomodulation may influence mitochondrial activity, nitric oxide signaling, and local microcirculation.
The clinical reasoning is that after shockwave stimulates the tissue mechanically, laser may provide an additional biological stimulus that supports the recovery environment.
The goal isn't to create more inflammation or simply deliver more treatment. It's to combine different forms of stimulation that may complement one another.
Does Every Laser Treatment Need Shockwave?
Absolutely not.
Class IV laser therapy has applications independent of shockwave treatment, including certain painful musculoskeletal conditions where shockwave may not be indicated or appropriate.
In Van Leuven's practice, laser is frequently used as a standalone treatment or alongside other rehabilitation techniques.
The distinction is that when shockwave is appropriate, he often considers adding laser afterward—not that every patient receiving laser should also receive shockwave.
Does Combining Them Improve Results?
There is a physiological rationale for combining mechanical stimulation with photobiomodulation, but the specific benefit of applying Class IV laser immediately after shockwave has not been conclusively established.
Clinical decisions depend on the tissue being treated, patient response, treatment goals, and the overall rehabilitation plan.
Neither technology replaces progressive loading, exercise, or addressing the underlying cause of a patient's symptoms.
The Clinical Perspective
Shockwave provides a mechanical stimulus. Class IV laser offers an additional way to influence cellular signaling and potentially manage post-treatment soreness.
For Van Leuven, using laser after shockwave is a practical approach to combining two technologies with different mechanisms.
The goal is not simply to use more equipment. It's to provide an appropriate stimulus and support the tissue's recovery afterward.
Learn More About Shockwave and Class IV Laser Therapy
SB Physio integrates advanced rehabilitation technologies with individualized physical therapy.
To learn more or schedule an appointment, visit sbphysio.com or text 805-682-2536.
Disclaimer: This article is educational and reflects an individual clinician's treatment rationale. The proposed benefits of combining shockwave and Class IV laser therapy are based on physiological mechanisms and clinical reasoning; improved outcomes from their combined use are not guaranteed. Treatment should be individualized following appropriate clinical evaluation.
