Extracorporeal shockwave therapy for Achilles tendonitis – Does it work?
- Maryke Louw
- 12 minutes ago
- 5 min read
Shockwave is often prescribed as part of the treatment for Achilles tendonitis. Learn how this works, what the research says about its usefulness, and when it might be worth giving it a go.
Remember, if you need help with an Achilles injury, you're welcome to consult one of our physio team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
In this article:
Types of extracorporeal shockwave
Shockwave therapy uses sound waves to treat the injured area. The people in the white lab coats aren't exactly sure how this helps injury healing, but it is thought to:
help kickstart the healing process by creating micro-injuries in the tissue
help reduce pain by calming the nervous system
help break down calcifications, if any are present.
The sound waves are created in slightly different ways depending on the type of shockwave therapy being used.
Extracorporeal shockwave therapy (ESWT) is an umbrella term for various sound wave treatments delivered through the skin to influence tissue healing and pain. Clinics typically use one of three types:
Radial (spreads outward from the applicator, best for shallow targets up to 3-3.5 cm)
Focused (concentrated on a small zone at a chosen depth, can reach up to 12 cm)
Soft-focused or defocused (sits between the two – wider zone than focused, deeper than radial).
Does shockwave therapy work for Achilles tendonitis?
Sometimes. And the current research suggests it's not a treatment that should be given to everyone.
💡 Before we get into the nitty-gritty, it's worth noting that all the recent research reviews on this subject have reported the level of evidence as low to moderate, which means the available research studies are likely to have significant flaws, and we shouldn't take the results as 100% evidence yet – this might change either which way if higher-quality research is done.
When shockwave therapy was compared to the standard treatment for Achilles tendonitis (both insertional and mid-portion tendonitis), it usually didn't outperform the standard treatment, which consists of a combination of relative rest and rehab exercises. Combining the standard treatment with shockwave also didn't appear to add extra benefit.
However, we know that the standard treatment doesn't resolve every case of Achilles tendinopathy, and the current research has not looked at what happens if you add shockwave to the treatment of "stubborn" cases – ones where the symptoms aren't improving as expected despite the physio and the patient doing all the right things.
👉 Our recommendation based on the available research plus our clinical experience:
Treatment aimed at temporarily reducing the load on the Achilles tendon through relative rest while gradually strengthening it appears to be more beneficial than shockwave for most patients.
However, if someone's Achilles pain isn't reacting to the standard treatment, shockwave might be something to try.
You need to try the standard treatment for at least three months before considering shockwave, since that's usually the least amount of time needed to experience a significant improvement in symptoms and using it on a newly flared up tendon might actually make your symptoms worse.
Here's our overview of the best research-backed treatments for Achilles tendonitis and tendinopathy if you'd like to explore options other than shockwave.
What about shockwave for calcific Achilles tendonitis?
I couldn't find any research study that specifically looked at the use of shockwave as treatment for calcific Achilles tendonitis. There is, however, lots of research into its use for calcific tendonitis at the shoulder, and a few studies that looked at the gluteal tendons.
The evidence from the shoulder and hip research suggests that:
shockwave might help break up calcifications in tendons, leading to its absorption
it likely works better for smaller calcium deposits than bigger ones
but in many cases the calcium deposits are absorbed without adding extra treatments like shockwave, so shockwave shouldn't be the go-to treatment.
Can shockwave damage your Achilles tendon?
In the vast majority of cases, shockwave is safe, but there are exceptions.
It's normal to experience pain and discomfort after a shockwave session. One study showed that this might be linked to swelling in the paratenon (the thin sheath of fascia around the Achilles tendon), and this swelling resolved within 48 hours with the help of ice.
💡 The current advice for using shockwave is to leave at least four days between treatment sessions – most research studies administered only one session per week.
⚠️ Why not use it daily? Shockwave is thought to help stimulate healing by causing micro-injuries in the tissue. Your body needs time to repair these before the next session. If you use shockwave too often, the micro-injuries might stack up and, instead of stimulating the healing response, cause serious injuries like Achilles ruptures.
It's also not a good idea to use it close to the bone if the patients has osteoporosis (low bone density), as this might cause stress fractures.
Shockwave will likely also make your symptoms worse if you have acute bursitis or other signs of active inflammation in the injured area.
How we can help
Need help with your Achilles or related injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
