Does Shockwave Therapy Work for Achilles Tendinopathy? What the Latest Research Says

If you’ve been struggling with Achilles tendon pain, you may have come across a treatment called shockwave therapy.

Many clinics offer shockwave therapy for Achilles tendinopathy, but before spending your money and time on treatment, it’s worth understanding what the research actually says as recently a very high-quality research paper has shed more light on this.

At Thriving Lives Co., we believe patients deserve clear, honest information so they can make informed decisions about their healthcare.

Shockwave therapy achilles tendinopathy

Full Disclosure

We do not currently offer shockwave therapy for Achilles tendinopathy as after continuing to monitor the research, we believe exercise-based rehabilitation remains the treatment with the strongest evidence of benefit. However, we support informed, person-centred decision-making and can discuss the evidence and provide referrals if someone wishes to explore shockwave therapy as part of their overall rehabilitation plan.

What Is Achilles Tendinopathy?

Your Achilles tendon is the strong band of tissue that connects your calf muscles to your heel bone.

It helps you walk, run, jump, climb stairs, and push off the ground when moving.

When the tendon becomes irritated and struggles to cope with load, it can become painful and common symptoms include:

  • Pain at the back of the heel or ankle
  • Morning stiffness
  • Pain during or after activity
  • Tenderness when touching the tendon
  • Difficulty running, jumping, or walking long distances

What Is Shockwave Therapy?

Shockwave therapy uses sound waves delivered into painful tissue through a handheld device.

Researchers have proposed several ways shockwave therapy might help, including stimulating tissue repair, increasing blood flow, or changing how pain is processed by the nervous system. However, many of these theories come from animal or laboratory studies, and researchers still do not fully understand whether these mechanisms explain improvements seen in people with Achilles tendinopathy.

Does Shockwave Therapy Work for Achilles Tendinopathy?

  • A large 2026 review examined nine clinical trials involving 557 people with Achilles tendinopathy
  • Researchers compared shockwave therapy to sham (fake) treatments or other comparison groups.

Insertional Achilles Tendinopathy

Insertional Achilles tendinopathy occurs where the tendon attaches to the heel bone.

The review found no convincing evidence that shockwave therapy worked better than a sham treatment for improving pain or function.

Mid-portion Achilles Tendinopathy

Mid-portion Achilles tendinopathy occurs in the middle section of the tendon.

The results were mixed. Some studies suggested possible benefits, while others found no difference. Overall, the researchers concluded that the evidence remains uncertain and that more high-quality studies are needed.

What Is a Sham Treatment?

A sham treatment is a fake version of a treatment that looks and feels similar to the real thing but leaves out the part that is supposed to provide the benefit.

Researchers use sham treatments to answer an important question:

“Is the treatment itself helping, or would people have improved anyway?”

For example, when someone receives treatment they also receive:

  • Attention from a clinician
  • Advice and reassurance
  • Encouragement
  • Hope that treatment may help

All of these things can help people feel and function better.

A sham treatment helps researchers work out whether the treatment itself provides benefit beyond these other factors.

Importantly, the review found that the study with the lowest risk of bias and the only study that confirmed successful participant blinding found no meaningful benefit of shockwave therapy over sham treatment for insertional Achilles Tendinopathy.

This does not mean people who improve after shockwave therapy are imagining their improvement as their improvement is real. It simply means we cannot confidently say that the shockwave itself caused that improvement.

Why Doesn’t Thriving Lives Co. Offer Shockwave Therapy for Achilles Tendinopathy?

After reviewing the current evidence, we do not believe there is enough evidence to justify routinely recommending or providing shockwave therapy for Achilles tendinopathy.

It’s no coincidence the title of this research paper is called “Shockwave Therapy for Midportion and Insertional Achilles Tendionpathy: A Nail in the Coffin?

This recent high-quality paper found:

  • No convincing evidence of benefit for insertional Achilles tendinopathy.
  • Uncertain evidence for mid-portion Achilles tendinopathy.
  • Stronger evidence supporting progressive exercise rehabilitation as the foundation of treatment.

Because of this, we focus on treatments with stronger evidence, including:

  • Strength and conditioning programs
  • Progressive tendon loading
  • Education and self-management
  • Return-to-running rehabilitation
  • Activity modification where needed
  • Individualised exercise programs

Your Preference Still Matters

Not offering shockwave therapy doesn’t mean we dismiss it completely.

If a patient asks about shockwave therapy, we’ll discuss:

  • The available evidence
  • What is known and what remains uncertain
  • The likely costs and benefits
  • Alternative treatment options

If, after understanding the evidence, a patient wishes to pursue shockwave therapy, we are happy to support their decision and refer them to an appropriate provider.

Our role is not to tell people what they must do. Our role is to help people make informed decisions that align with their goals and preferences.

What Treatment Has the Strongest Evidence?

The treatment with the strongest evidence for Achilles tendinopathy is Progressive Exercise Rehabilitation.

Research continues to show that structured strengthening and loading programs help people improve pain, function, strength, and confidence over time.

For most people with Achilles tendon pain, a well-designed rehabilitation program remains the most important part of recovery.

Is it a “nail in the coffin” for shockwave therapy for achilles tendinopathy?

Shockwave therapy appears relatively safe, but the current evidence does not clearly show that it provides meaningful benefits beyond placebo or sham treatment for Achilles tendinopathy. The evidence is particularly unconvincing for insertional Achilles tendinopathy, while evidence for mid-portion Achilles tendinopathy remains uncertain.

At Thriving Lives Co., we focus on providing evidence-based rehabilitation and helping people make informed choices. While we do not currently offer shockwave therapy for Achilles tendinopathy, we are happy to discuss the evidence and support patients who wish to explore all available treatment options.

Need Help With Achilles Tendinopathy?

If you’re looking for help with Achilles tendinopathy treatment in Cairns, our team of exercise physiologists and allied health professionals can help you understand your options and build an evidence-based rehabilitation plan tailored to your goals

Reference

Korakakis V, Kotsifaki R, Sotiralis Y, Malliaras P. Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy. 2026;56(5):282-299. doi:10.2519/jospt.2026.13985

Read the journal article:
https://www.jospt.org/doi/10.2519/jospt.2026.13985

Disclaimer: This article is intended for general education and should not replace individual medical advice from a qualified healthcare professional.

Article written by:

David Dall’Alba
Exercise Physiologist
Masters in Science of Medicine (Pain Management)

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