A Comprehensive Guide to Shockwave Therapy for Achilles Tendonitis

Achilles tendonitis or more appropriately termed tendinosis is a common medical condition affecting athletes and active individuals, causing pain, inflammation, and discomfort in the Achilles tendon. This article provides an in-depth exploration of a cutting-edge treatment for this condition: shockwave therapy.

Understanding Achilles Tendonosis

Achilles tendinosis is a condition characterized by chronic inflammation and pain in the Achilles tendon, the largest tendon in the human body. Oftentimes the tendon is thickened, swollen, and scarred, with limited blood flow. This tendon connects your calf muscles to your heel bone and plays a crucial role in walking, running, and jumping activities. When this tendon is overused or subjected to high stress, it can become irritated and inflamed, leading to Achilles tendinosis.

Symptoms and Causes of Achilles Tendonitis

The primary symptom of Achilles tendonitis is pain along the back of the foot and above the heel, especially when stretching the ankle or standing on tiptoes. Other symptoms may include limited range of motion when flexing the foot, skin over the heel feeling hot to the touch, and swelling in the heel.

Achilles tendonitis typically results from overuse, specifically, repetitive or intense strain on the Achilles tendon. This could be due to increasing the intensity or frequency of sports activities, or starting a new form of exercise without proper conditioning. Other factors contributing to this condition include having flat feet, aging, wearing inappropriate footwear during physical activities, or having high blood pressure and diabetes. When tendinitis symptoms persist for over 4-6 wks it transitions to tendinosis as it gets stuck in the healing process. 

The Role of Shockwave Therapy in Treating Achilles Tendinosis

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that has gained popularity in treating various musculoskeletal conditions, including Achilles tendinosis. It involves the use of pressure waves to stimulate the healing process in injured areas.

How Does Shockwave Therapy Work?

Shockwaves are pressure disturbances that travel rapidly through a medium. In the context of ESWT, these shockwaves are delivered through the skin to the affected tendon. The therapy stimulates blood flow, promotes cellular regeneration, and accelerates the body’s self-healing processes. It also has an analgesic effect, relieving pain in the treated area.

While the exact mechanisms behind ESWT’s effectiveness are still being studied, current research suggests it works by inducing an inflammatory response, which leads to the release of growth factors and the formation of new blood vessels. These processes contribute to tissue regeneration and healing.

Application of Shockwave Therapy for Achilles Tendonitis

The application of ESWT for Achilles tendonitis typically involves several sessions, each lasting around 15-30 minutes. During treatment, a gel is applied to the skin, and a device that delivers the shockwaves is moved in a circular motion over the inflamed tendon.

Some protocols recommend using low-energy shockwaves over multiple sessions, while others advocate for a single, high-energy shockwave treatment. The best approach may vary depending on the specifics of the patient’s condition and response to treatment.

Efficacy of Shockwave Therapy for Achilles Tendonitis

Several clinical studies have demonstrated the potential benefits of ESWT for Achilles tendonitis. These include reduced pain, improved functionality, and increased quality of life.

In one randomized controlled trial, patients with Achilles tendinopathy who underwent ESWT reported significant improvements in their symptoms compared to those who received traditional treatments like physical therapy and medication. Another study found that ESWT, combined with traditional treatments, was more effective than traditional treatments alone.

Despite these promising results, more research is needed to determine the optimal treatment parameters, such as the number of shockwaves to apply and the intensity of the shockwaves.

Precautions and Side Effects of Shockwave Therapy

ESWT is generally considered safe, but like any treatment, it can cause side effects. These may include minor pain or discomfort during and after the procedure, redness and swelling at the treatment site, and, in rare cases, small bruises. However, these side effects are typically temporary and should resolve within a few days.

Before undergoing ESWT, patients should inform their healthcare provider about their complete medical history, as certain conditions may preclude the use of this treatment. For instance, individuals with blood clotting disorders, infections, or tumors at the treatment site are usually advised against undergoing ESWT.


Achilles tendonitis is a debilitating condition that can significantly impact an individual’s mobility and quality of life. However, innovative treatments like extracorporeal shockwave therapy offer new hope for individuals battling this condition. By stimulating the body’s natural healing processes, ESWT can effectively alleviate the symptoms of Achilles tendonitis and help patients return to their regular activities.

While more research is needed to refine treatment parameters and better understand the mechanisms behind ESWT, current findings support its potential as an effective treatment for Achilles tendonitis. As with any medical treatment, it’s essential to consult with a healthcare provider to discuss the potential benefits and risks and determine the best treatment plan for your specific condition.

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