The Achilles tendon is the largest in the body and most likely to be injured, a process called Achilles tendonitis. Exercise therapy is the most effective treatment for Achilles tendonitis. In difficult cases, we use other treatments that help 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 machine

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 produces a radial wave, strongest at the source and weakens as it moves away from the source. 

Generally, we use radial shockwave 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 to other treatments, such as exercise and stretching, with good results for shockwave. Moreover, this review found the most effective treatment was a combination of shockwave therapy and calf-strengthening exercises. So, from this data, we know that shockwave therapy complements or adds to 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 the most effective for Achilles tendonitis when combined with calf strengthening. 

Other frequently asked questions about shockwave therapy for Achilles tendonitis:

shockwave therpay for a patient's insertional Achilles tendonitis

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

Generally, we suggest a minimum of three sessions a week apart. Sometimes, we advocate for more sessions, up to six, if you find shockwave effective. 

What should you do during shockwave therapy for Achilles tendonitis? 

During shockwave treatment, we suggest you avoid icing the tendon and taking anti-inflammatories such as ibuprofen. However, you can continue exercising within your rehab programme’s limits. 

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 safe, easy to administer, and effective for Achilles tendonitis. It works best when combined with a comprehensive rehab program of calf strengthening. Generally, we favour focused shockwave over the more common radial shockwave, which administers more energy with less pain. 

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