Shockwave treatment for Achilles tendinopathy

Shockwave is often prescribed as part to the treatment for Achilles tendinopathy. In this article Maryke discusses how it works, what the research is currently showing with regards to its usefulness as well as when, in her experience, it may be worth using.



In this article:

  • What is shockwave therapy?

  • Does the research support its use for Achilles tendinopathy?

  • When, in my experience, you may find benefit from using shockwave for treating your Achilles pain


What is shockwave therapy?


Shockwave therapy uses soundwaves to treat the injured area. The machine consists of a “gun” that has a small piece of metal that moves extremely quickly backwards and forwards inside the gun. As this piece of metal repeatedly crashes into the metal point of the gun, it creates a (very) loud sound wave.


The clinician will usually move the point of the gun over the painful area in your tendon. Shockwave has been shown to cause a long-lasting reduction in pain in a wide variety of soft tissue injuries. Interestingly, we don’t actually yet understand the exact mechanism of how the shockwaves manages to numb pain.


Does the research support its use for Achilles tendinopathy?


Yes, there are plenty of studies that show that shockwave therapy can provide long term pain relief for both insertional as well as mid-portion Achilles tendinopathy. The only problem is that most of these studies did not include a control group so we can’t really tell if these patients would have gotten better in any case, regardless of any treatments applied.


There are very few randomized controlled trials (where they test the effect of shockwave compared to other treatments or just not doing anything) and the ones that are available are of rather poor quality or compare shockwave treatment to treatments that we know aren’t ideal – eccentric exercise for insertional Achilles tendinopathy for instance.


In summary: There’s not enough research yet to 100% support the use of shockwave for Achilles tendinopathy, but the available research do suggest that it may be useful.



When, in my experience, you may find benefit from using shockwave for treating your Achilles pain


I’ve often used shockwave in combination with a progressive strength training programme for my patients with Achilles tendinopathy – especially the ones with insertional Achilles tendinopathy. In my experience it has a very good long-lasting pain dulling effect which makes it especially useful for patients where pain is preventing them from getting on with their rehab.


One of the disadvantages of it is the costs involved. It is not cheap and you usually require between 3 and 6 sessions. It’s a relatively safe procedure, but can cause some pain and irritation for a few days after treatment.


I find that shockwave isn’t tolerated by all my patients. For some it is just too painful. The machine also makes a hell of a noise which I think adds to the scare factor for some patients.


Let me know if you have any questions. Need more help with your Achilles injury? You’re welcome to consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.





References:


  1. Fan, Y., et al. (2020). "Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis." Orthopaedic journal of sports medicine 8(2): 2325967120903430.

  2. Korakakis, V., et al. (2018). "The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction." British Journal of Sports Medicine 52(6): 387-407.

  3. Maffulli, Gayle, et al. "Extracorporeal shock wave therapy in the management of insertional achilles tendinopathy: the ASSERT database." Muscle Ligaments and Tendons Journal 8.3 (2018): 416-422.

  4. Maffulli, Gayle, et al. "Extracorporeal shock wave therapy in the management of midsubstance Achilles tendinopathy: the ASSERT database." Muscles, Ligaments and Tendons Journal 8.3 (2018): 409-415.

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