Quick answer
Extracorporeal shockwave therapy is sometimes used as an adjunct for persistent Achilles tendinopathy. Evidence is mixed and depends on the population and tendon location; it should not displace a progressive exercise program.
Article
What shockwave is trying to do
Shockwave delivers acoustic energy to symptomatic tissue. Proposed mechanisms include effects on pain and local biological signalling, but the clinically important question is whether it improves patient outcomes.
Evidence is not uniform
Older studies suggested benefit in some chronic Achilles populations. More recent evidence has been less consistent. In a 2025 randomised trial of insertional Achilles tendinopathy, adding radial shockwave to identical education and exercise did not improve pain or function over sham at 6 or 12 weeks.
How shockwave may be positioned
Shockwave can be discussed for selected persistent cases, particularly after diagnosis and loading strategy have been reviewed. It should be presented as an adjunct with uncertain incremental benefit, not as a guaranteed tendon-healing treatment.
Key points
- Different shockwave devices and protocols limit simple comparisons between studies.
- Do not promise “regeneration” from shockwave.
- Reassess diagnosis and loading before adding another passive treatment.
Frequently Asked Questions
Does shockwave replace exercises?
No. When used, it is generally better viewed as an adjunct to education and progressive loading.
Is shockwave proven for insertional Achilles tendinopathy?
Evidence is mixed; a recent sham-controlled trial did not show added benefit over exercise and education at 12 weeks.