Does Shockwave Therapy Work for Achilles Tendinopathy?

The short answer

Yes — for chronic Achilles tendinopathy, shockwave therapy is one of the better-evidenced treatments available, and it is where we see some of the most reliable results. In clinic, about 80 % of patients report a marked reduction in pain and a return to normal function after only three to four sessions.

But the honest, important caveat is this: shockwave works when it is paired with a proper loading programme. On its own it rarely resolves a stubborn Achilles. Used to open the door for progressive rehab, it can be the thing that finally gets a long-standing tendon moving in the right direction.

What Achilles tendinopathy actually is

Tendinopathy is a tendon injury caused by overload rather than a single dramatic event. The term has replaced the older “tendinitis” label, because chronic tendon problems show surprisingly little inflammation — the tissue itself has become disorganised and less able to tolerate load.

For the Achilles, that usually shows up as pain and stiffness at the back of the heel or a few centimetres up the tendon, worst first thing in the morning or at the start of exercise. It is common in runners and anyone who has ramped up training quickly, but desk-bound weekend athletes get it too. Because it is a loading problem, the long-term answer is always about restoring the tendon’s capacity — not just quietening the pain.

How shockwave therapy works

Extracorporeal shock wave therapy (ESWT) is a non-electrical, non-harmful sound wave delivered through the skin via a hand-held probe. We use the Lika Vario Pro, a clinical-grade radial shockwave device, under HCPC-registered physiotherapy oversight.

The wave does three useful things at the tendon: it increases local blood flow to the target site, it helps break down stubborn fibrous tissue that has built up over time, and it has a pain-relieving effect. In other words, the treatment session itself acts as a catalyst for healing rather than a passive comfort measure — it nudges a stalled tendon back into a state where it can respond to rehab.

What a treatment course looks like

Most Achilles cases take three to four treatments, usually weekly, with each session lasting about ten minutes. Here is the shape of it:

1. Assessment and suitability screen. We assess the tendon, confirm the diagnosis, and screen for the contraindications below. Shockwave is not right for every case, and we will say so when a loading plan alone will do the job.
2. The treatment session. You feel a rapid percussive sensation through the probe — uncomfortable but tolerable for most people, easing within seconds of the probe lifting. We may pair it with relevant hands-on therapy the same day.
3. Loading rehab between sessions. This is the part that does the rebuilding (more below).
4. Reassessment. After session three or four we compare against your baseline pain and function. Most people have improved markedly by this point; a small number benefit from one or two top-up sessions where the data supports it.

Why shockwave alone isn’t enough

If there is one thing to take away, it is this: shockwave creates the biological window for tendon remodelling; progressive loading does the actual rebuilding.

Between sessions you follow a loading programme tailored to the Achilles — most often eccentric heel drops based on the well-established Alfredson protocol. Eccentric loading emphasises the lengthening phase of the movement, which remodels tendon tissue without flaring it up. This is why the exercise homework is not optional: skip it, and even a good response to shockwave tends to fade. We deliver the programme through Track Rehab so you have video-led guidance between visits.

Who shouldn’t have shockwave

Shockwave is a safe treatment with no known major side effects, but it is not suitable for everyone. We screen for these contraindications at every visit:

• Pregnancy, or when actively trying to conceive
• Under-18s without specialist consultation
• Metal pins, plates, or implants in the treatment area, or active infection over the site
• An active or untreated tumour in the treatment area
• Certain circulatory, clotting, or nerve-related conditions affecting the area
• Anticoagulant therapy without prescriber clearance

Tell us about any of these before booking. If shockwave is not appropriate for you, it does not mean your Achilles cannot be treated — it simply means the plan is built around loading rehab and hands-on therapy instead.

What results to expect

For a genuinely chronic Achilles tendinopathy, a realistic expectation is a meaningful reduction in pain and a return towards normal function across a three-to-four-session course, provided you keep up the loading programme. Mild ache or skin redness for up to 24 hours after a session is normal; you can resume light activity the same day and simply avoid heavy training of the tendon for a day or two.

What we will not do is sell you sessions you do not need. The plan is measured against your own progress, and if reassessment shows the tendon is responding, we move you into a maintenance loading programme rather than open-ended treatment. If Achilles pain has been holding back your running or training, a suitability assessment is the right place to start.