Skip to main content



  • Jumper’s Knee or Patellar Tendinopathy

  • Knee Arthritis

  • Iliotibial Band Syndrome

When you come to our San Jose or Los Gatos office your individual knee pain will be addressed with a comprehensive exam covering joint mechanics, neurology, soft tissue palpation and functional analysis.  Whether it be Jumper’s Knee, Knee arthritis or IT Band syndrome, you will be treated with rehab exercises, joint mobilization, neuromuscular re-education and, if needed, extracorporeal shockwave therapy, ESWT. Here are some knee conditions and how they can be helped with ESWT.

Piezowave extracorporeal shockwave demonstrated by Dr Adam Fields

Dr. Fields of San Jose, CA demonstrating the Piezowave 2 and it’s use for patellar tendon dysfunction.


The quad muscles of your thigh are connected to your lower leg (tibia) by a tendon called the patellar tendon.  In the middle of your patellar tendon is your kneecap or patella.  When the knees take a lot of stress from jumping, pivoting or changing direction, knee pain is felt above and below the kneecap. The patellar tendon develops tiny tears in it.  This is the beginning of Jumper’s knee.Patellar Tendiopathies can be helped with ESWT

The tears heal by laying down scar tissue and the elastic collagen fibers degenerate. This is where extracorporeal shockwave therapy (ESWT) comes in.  Our Piezowave 2 ESWT (located in our Los Gatos office) sends sound waves into the tissue.  These sound waves are set at very specific depth and intesity and cause the tissue to ripple on a microscopic level.  Normal tissue gets a deep tissue massage from this but the brittle scar tissue breaks up.  


Studies on Jumper’s Knee or Patellar tendinopathy and achilles tendinopathy and ESWT have shown success rates from 73.5% to 87.5% [1, 2, 3, 4, 5, 6].  When evaluated with ultrasound, the patellar tendons show increased vascularity and decreased thickness with ESWT [3].  When functional outcomes of those who had failures with conservative care, ESWT showed excellent results comparing the treatment to surgery [6].

Vertical jump score was increased by 1.5 inches in a 2003 study [7].

When it comes to your patellar tendon, ESWT and our rehab system have you covered.


Knee arthritis is when the cartilage begins to degenerate and the bone begins to remodel.  In its extreme forms, the meniscus (cartilage) is gone and the knee is “bone on bone”.  Like when sitting for too long or waking up in the morning, arthritis hurts with inactivity.  Hydration greatly diminished in the arthritic knee but non-weight bearing  movement can help temporarily lubricate an arthritic joint and decrease knee pain.The pain of knee arthritic can be helped with ESWT

Extracorporeal shockwave therapy helps break up old adhesions in your knee and causes angiogenesis (blood vessel proliferation).  This takes place in the knee joint and in the surrounding muscles, tendons and ligaments. This helps increase mobility, encourage lubrication and decrease pain.

You will also be instructed on a course of rehabilitation exercises that are suited to address the needs of your unique situation.  To start with a general home care, you may want to view our video on foam rolling for the knees.  Take a look at some of the research on knee arthritis and ESWT:

“ESWT is effective in reducing pain and improving knee function, with better results than placebo during the 12-wk treatment”  [8].

“ESWT showed effectiveness in the reduction of osteoporotic osteoarthritis of the knee in rats” [9].

Also realize that the machine that we will use on your knee is the Piezowave 2.  This is the newest and best available shockwave therapy.  These waves are very specific and do not just randomly go throughout your knee.  You will feel sensations and know when we have targeted the right location for your knee.


Los Gatos is perfect for mountain and road biking but many bikers have poor body mechanics and get IT Band Syndrome.  Your tensor fasciae latae muscle (TFL) is on the side of your hip and makes a connection to the iliotibial band (IT Band). The IT Band connects to your lower leg and is helps your knees more stable when you lift your opposite leg.  The ITB acts like a knee brace. When the muscles attached to the IT Band get tight due to trigger points or the IT Band gets adhesions, it rubs against your outer knee.  

Symptoms of iliotibial band syndrome:

  • Pain on your outer knee
  • Tight or painful outer hip muscles
  • Temporary relief with stretching
  • Pain with knee-centric activities like running and cycling

ESWT when used for IT Band Syndrome results in:

  • Increased flexibility of the IT Band
  • Relief from myofascial trigger points [10]
  • Better knee mechanics
  • A great decrease in pain

We are so thrilled to be joining our years of experience with this new technology for your knees.  

You can reach Dr Fields for in-person (Los Gatos and San Jose, California) or telehealth appointments here.


  1. van Leeuwen MT, Zwerver J, van den Akker-Scheek I: Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature. Br J Sports Med. 2009, 43 (3): 163-8.PubMedView ArticleGoogle Scholar
  2. Vulpiani MC, Vetrano M, Savoia V, Di Pangrazio E, Trischitta D, Ferretti A: Jumper’s knee treatment with extracorporeal shock wave therapy: a long-term follow-up observational study. J Sports Med Physical Fitness. 2007, 47 (3): 323-8.Google Scholar
  3. Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL: Extracorporeal shockwave for chronic patellar tendinopathy aka Jumper’s Knee. Am J Sports Med. 2007, 35 (6): 972-8. 10.1177/0363546506298109.PubMedView ArticleGoogle Scholar
  4. Zwerver J, Dekker F, Pepping GJ: Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy: a pilot study. J Back Musculoskeletal Rehab. 2010, 23 (3): 111-5.Google Scholar
  5. Hsu RW, Hsu WH, Tai CL, Lee KF: Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res. 2004, 22 (1): 221-7. 10.1016/S0736-0266(03)00138-4.PubMedView ArticleGoogle Scholar
  6. Peers KH, Lysens RJ, Brys P, Bellemans J: Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med. 2003, 13 (2): 79-83. 10.1097/00042752-200303000-00003.PubMedView ArticleGoogle Scholar
  7. Jack Taunton, MD, K.M. Taunton, BSc, K.M. Khan, MD, PhD. Treatment of patellar tendinopathy with extracorporeal shock wave therapy. Issue: BCMJ, Vol. 45, No. 10, December 2003, page(s) Articles
  8. Zhe Zhao, MD, Rufang Jing, MD, Zhan Shi, PhD, Bin Zhao, MD, Quan Ai, MM,Gengyan Xing, MD. Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. Journal of Surgical Research.December 2013 Volume 185, Issue 2, Pages 661–666
  9. Ching-Jen Wang, Chien-Yiu Huang, Shan-Ling Hsu, Jen-Hung Chen and Jai-Hong Cheng.Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: an experiment in animals. Arthritis Research & Therapy201416:R139 DOI: 10.1186/ar4601
  10. Müller Ehrenberg. A presentation of High Definition 3 tesla MRI Imaging Pictures of a Myofascial Triggerpoint before and after piezoelectric focused sound MyACT – Poster MyoPain 2013 Seattle