Shockwave treatment for Achilles tendonitis

Shockwave is often prescribed as part of the treatment for Achilles tendonitis. In this article, Maryke discusses how it works, what the research says about its usefulness, and when it may be worth giving it a go. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our 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 our articles.

In this article:

1. What is shockwave therapy?

2. Does the research support its use for Achilles tendinopathy?

3. When shockwave may help for your Achilles pain

4. How we can help

I've also discussed it in this video:

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 strong soundwave.

The clinician will usually move 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 tendonitis?

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 whether these patients would have gotten better in any case, regardless of any treatments applied.

There are very few randomized controlled trials (where they compare the effect of shockwave compared with other treatments or no treatment), and the ones that are available are of rather poor quality, or they compare shockwave treatment with treatments that we know aren’t ideal; eccentric exercises 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 does suggest that it may be useful.

When shockwave may help for 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 is the cost. It is not cheap, and you usually need between three and six sessions. It’s a relatively safe procedure, but can cause some pain and irritation for a few days afterwards.

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.

How we can help

Need more help with your Achilles 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. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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." Muscle Ligaments and Tendons Journal 8.3 (2018): 409-415.