The Achilles tendon is the largest tendon in the body and is most likely to be injured, a condition known as Achilles tendonitis. Exercise therapy is the most effective treatment for Achilles tendonitis. In complex cases, we may use additional treatments to complement exercise therapy. One of these treatments is shockwave therapy. What is shockwave therapy, and how effective is it for Achilles tendonitis?  

What is Achilles tendonitis?

We refer to Achilles tendonitis as swelling of the Achilles tendon due to tendon overload. Excessive activity leads to impaired healing and tendon breakdown. Pain occurs when the body fails to control tendon swelling. These changes occur at the insertion (insertional) or in the middle (mid-portion) of the Achilles tendon. 

What is shockwave therapy?

Shockwave therapy directs pressure waves to human tissue. These pressure waves can be low-energy (radial) or high-energy (focused). Most clinics use radial shockwaves because they are easier to use and cheaper. However, focused shockwave is becoming more popular, as it can be used for multiple superficial and deep tendon and bone conditions. Moreover, focused shockwave administers more energy with less pain. 

For Achilles tendonitis, both forms of shockwave are acceptable. However, focused shockwave is generally less painful. 

Radial (soft) shockwave 

Radial shockwaves produce radial pressure waves. These waves are produced by compressed air that accelerates a metal ball, which hits a metal tip. This collision creates a radial wave, strongest at the source and weakening as it moves away from the source. 

Generally, we use radial shockwave therapy for superficial tendon structures, such as the Achilles tendon, plantar fascia, or tennis elbow. 

Focused (hard) shockwave 

Focused shockwave produces a pressure wave using electricity and magnets. The beauty of a focused shockwave is that it can be directed to a deep structure without losing energy. We can focus the wave on one point in the body. As such, we can target deeper tendon structures such as greater trochanteric pain syndrome, hamstring origin tendonitis, and calcific tendonitis at higher energies. 

How does shockwave therapy work? 

We know that shockwave produces positive changes in tendon tissue. The diseased tissue is subjected to a pressure wave that stimulates the release of healing substances such as nitric oxide and increases blood vessels and growth factors. We also believe that shockwave therapy stuns the pain fibres by increasing a pain-reducing hormone called Substance P. 

Evidence for the use of Shockwave Therapy for Achilles tendonitis 

A recent review of shockwave therapy for Achilles tendonitis found positive results. These studies compared shockwave therapy to other treatments, such as exercise and stretching, with generally good results for shockwave therapy. Moreover, this review found the most effective treatment was a combination of shockwave therapy and calf-strengthening exercises. Therefore, based on this data, we know that shockwave therapy complements or enhances calf-strengthening exercises. Also, shockwave therapy is safe, cheap and easy to administer. It is much more appealing than other treatments, such as tendon injections, which can cause harm. 

Another review found that shockwave therapy is most effective for Achilles tendonitis when combined with calf strengthening exercises. 

Other frequently asked questions about shockwave therapy for Achilles tendonitis:

shockwave therpay for a patient's insertional Achilles tendonitis and bone spurs

How many sessions do you need for shockwave therapy for Achilles tendonitis?

Generally, we recommend a minimum of three sessions per week, spaced apart. Sometimes, we recommend more sessions, up to six, if you find the shockwave therapy effective. 

What should you do during shockwave therapy for Achilles tendonitis? 

During shockwave treatment, we recommend avoiding icing the tendon and taking anti-inflammatory medications, such as ibuprofen. However, you can continue exercising within the limits of your rehab programme. 

What are the contraindications of shockwave therapy? 

A few contraindications include infection, osteoporosis and an overlying wound. Women who are pregnant are safe to proceed with shockwaves as long as the waves are not focused on the pelvic region. 

Is shockwave therapy painful? 

Yes, administering shockwave therapy can be painful. However, focused shockwave is generally less painful and better tolerated. 

Can you use other treatments with shockwave therapy? 

Yes. We know that shockwave therapy combined with calf strengthening produces the best results. Other treatments for Achilles tendonitis, such as GTN patches and collagen supplements, can be used with shockwave therapy. 

Final word from sportdoctorlondon about shockwave therapy for Achilles tendonitis  

Shockwave therapy is a safe, easy-to-administer, and effective treatment for Achilles tendonitis. It works best when combined with a comprehensive rehabilitation program that includes calf strengthening. Generally, we favour focused shockwaves over the more common radial shockwaves, which administer more energy with less pain. 

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