Shockwave Therapy for Achilles Tendinopathy

What Achilles tendinopathy is.

The Achilles tendon connects your calf muscles to your heel bone. Achilles tendinopathy is a painful, irritated tendon that has been asked to handle more load than it can currently tolerate, usually through repetition rather than a single injury. It is common in runners and other active people, but it also shows up in people who are not especially athletic.

Typical signs include:

• Pain and stiffness in the back of the ankle or heel, often worst with the first steps in the morning
• Pain that eases as you warm up, then returns or worsens after activity
• Tenderness or thickening along the tendon, or right where it attaches to the heel

Tendinopathy can affect the middle of the tendon or the point where it attaches to the heel, and the two areas can respond a little differently to exercise. Our pages on tendinitis and foot and ankle pain cover the broader picture.

Loading comes first.

Rest alone rarely fixes a tendon. Tendons adapt to load slowly, over weeks and months, and they need progressive loading to rebuild their capacity. For Achilles tendinopathy, that usually means a structured calf-strengthening program that gradually builds from what you can tolerate today toward the demands of your activity, along with adjustments to training volume, footwear, and the activities that flare it.

Early on, that may mean calf raises at a load and range that keep pain manageable while the tendon is irritable. Over the following weeks the program typically progresses toward heavier, slower calf work, and then toward the springy, faster loading that running and jumping require. Mild discomfort during exercise is often acceptable as long as it settles and your morning stiffness is not getting worse over time. Your therapist will help you find that line.

For many people, a well-guided loading program is enough. Some tendons, though, plateau. Months go by with the same morning stiffness and the same pain after activity, even with consistent exercise. That is where shockwave therapy may come in.

How shockwave therapy helps a stalled tendon.

Shockwave therapy, more formally extracorporeal shockwave therapy, uses focused acoustic pressure waves delivered through a handheld applicator. Despite the name, these are not electrical shocks. They are pulses of mechanical energy that pass through the skin into the target tissue.

That controlled stimulus is thought to prompt a renewed healing response in tissue that has stopped progressing on its own, including increased blood flow and new collagen activity. Achilles tendinopathy is one of the chronic tendon conditions where shockwave tends to be used, alongside plantar fasciitis, tennis and golfer's elbow, and calcific shoulder tendinitis.

Research on shockwave for Achilles tendinopathy has been encouraging, particularly when it is combined with an exercise program, but responses vary from person to person. No single treatment can guarantee a result, and your therapist will tell you honestly whether it makes sense for your situation.

What shockwave sessions are like.

• Assessment first. Your therapist locates the exact area of tendon involvement through palpation and movement testing, since precise placement matters.
• Short treatments. The shockwave portion of a session typically lasts only a few minutes. You will feel a distinct thumping or aching sensation that can be uncomfortable but should never be unbearable, and the intensity is adjusted to your feedback.
• A series, not a single visit. Most plans involve several sessions spaced about a week apart, so the response can build.
• Mild soreness afterward. Some soreness for a day or two is normal. You will get specific guidance on activity and exercise between sessions.

Shockwave therapy is not appropriate during pregnancy, over an implanted pacemaker, over an active growth plate in a child or teenager, or in an area with a known blood clot or tumor. Tell your therapist about these and any other medical conditions or medications before your first session. When you are ready to find out whether shockwave fits your plan, you can request an appointment.

When to see a doctor first.

Seek prompt medical care if you have:

• A sudden pop or snap at the back of the ankle, with sharp pain and difficulty pushing off or rising onto your toes, which can signal a tendon rupture
• Calf swelling, warmth, redness, or tenderness, which can signal a blood clot
• Heel or tendon pain with fever, or a hot, red, swollen joint

Also let your doctor know if Achilles pain began after starting a new medication, since certain antibiotics have been linked to tendon problems.