The Achilles tendon is the largest tendon in the body and the most commonly injured. Exercise therapy is the most effective treatment for Achilles tendonitis, but in complex cases, we add treatments to support it — and one of the best-evidenced is shockwave therapy. So what is it, and how well does shockwave therapy for Achilles tendonitis actually work?
What is Achilles tendonitis?
Achilles tendonitis is swelling of the tendon from overload. Excess activity impairs healing and breaks down collagen, and pain follows when the body can’t control the swelling. It occurs at the insertion (insertional) or the middle (mid-portion) of the tendon.
What is shockwave therapy?
Shockwave therapy directs pressure waves into tissue. These are either low-energy (radial) or high-energy (focused).
Radial (soft) shockwave
Compressed air accelerates a metal ball against a tip, producing a radial wave that is strongest at the surface and weakens with depth. It suits superficial structures — the Achilles, plantar fascia, and tennis elbow. Most clinics use radial because it’s cheaper and easier.
Focused (hard) shockwave
Electricity and magnets produce a wave that can be focused on a single deep point without energy loss, so it reaches deeper targets such as greater trochanteric pain syndrome, hamstring origin tendonitis, and calcific tendonitis at higher energies. For the Achilles, both work — but focused shockwave delivers more energy with less pain.
How does shockwave therapy work?
The pressure wave stimulates the diseased tissue to release healing substances such as nitric oxide, increases blood vessels and growth factors, and is thought to stun the pain fibres by raising the pain-reducing hormone Substance P.
What’s the evidence for shockwave therapy in Achilles tendonitis?
It’s strong — with one key condition. A review of shockwave therapy for Achilles tendonitis found positive results compared with exercise and stretching, and, crucially, that the most effective treatment was shockwave combined with calf strengthening. Shockwave complements exercise rather than replacing it. It’s also safe, cheap, and easy to administer — more appealing than injections, which can harm the tendon.
Frequently asked questions about shockwave therapy for Achilles tendonitis
How many sessions of shockwave therapy do I need?
A minimum of three sessions, spaced about a week apart, sometimes up to six if you’re responding well.
What should I do during a course of shockwave therapy?
Avoid icing the tendon and avoid anti-inflammatories such as ibuprofen — both blunt the healing response shockwave is trying to trigger. You can keep exercising within your rehab limits.
Is shockwave therapy painful?
It can be. Focused shockwave is generally less painful and better tolerated than radial.
What are the contraindications?
Infection, osteoporosis, and an overlying wound. Pregnant women can have shockwaves as long as they are not focused on the pelvic region.
Can I combine Shockwave with other treatments?
Yes — and you should combine it with calf strengthening for the best results. GTN patches and collagen supplements also work alongside it.
Does shockwave work for insertional Achilles tendonitis and bone spurs?
Yes — focused shockwave reaches the insertion, and the associated bone spur effectively, which is one reason we favour it over radial for these cases.
Final word from Sport Doctor London about shockwave therapy for Achilles tendonitis
Shockwave therapy is safe, easy to administer, and effective for Achilles tendonitis — best combined with a calf-strengthening programme. We favour focused shockwave over the more common radial machines, as it delivers more energy with less pain.
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