Shockwave for Achilles Tendinopathy

Achilles tendinopathy is often caused by over use of the affected limb and or abnormal forces placed on it regularly. If left untreated it can escalate into an Achilles tendon rupture which would be treated either by using a cast to immobilise it or by surgery to repair it.

One of the treatments that can be used for Achilles Tendinopathy is Extra Corporeal Shock Wave Therapy (ESWT).  Check out how a large rugby club in the UK uses ESWT.

This treatment approach is supported by the following studies:

Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles tendinopathy: a prospective study. Saxena A, Ramdath S Jr, O’Halloran P, Gerdesmeyer L, Gollwitzer H. J Foot Ankle Surg. 2011;50(3):315-9.

This study showed statistically and clinically significant improvements in 78.38% of tendons treated with the low-energy radial shockwave device at least 1 year after treatment. Improvement in activity level, which is beneficial not only for athletic individuals but also for anyone required to work on their feet. The authors conclude shockwave therapy serves as a safe, viable, and effective option for the treatment of Achilles tendinopathy.
Key message: Radial shockwave therapy produces significant improvement of symptoms and activity level and is therefore considered as a viable non-surgical treatment option for Achilles tendinopathy.

Eccentric Loading Versus Eccentric Loading Plus Shock-Wave Treatment for Midportion Achilles Tendinopathy. A Randomized Controlled Trial. Rompe, Furia, Maffulli. American Journal of Sports Medicine, Volume 37, No. 3, pp. 463-471

The likelihood of recovery after 4 months was higher after a combined approach of both eccentric loading and SWT compared to eccentric loading alone. Eccentric training plus SWT should be offered to patients with chronic recalcitrant midportion tendinopathy of the Achilles tendon.
Key message: The combined approach of eccentric loading plus repetitive low-energy SWT produced significantly better results (82% success rate) than eccentric calf muscle training alone.

Eccentric Loading, Shock-Wave Treatment, or a Wait-and-See Policy for Tendinopathy of the Main Body of Tendo Achillis A Randomized Controlled Trial. Rompe JD, Nafe B, Furia JP, Maffulli N. Am J Sports Med. 2007 Mar;35(3):374-83

At 4-month follow-up, eccentric loading and low-energy SWT showed comparable results. The wait-and-see strategy was ineffective for the management of chronic recalcitrant tendinopathy of the main body of the Achilles tendon.
Key message: Both eccentric loading and repetitive low-energy SWT led to a successful outcome in 50% to 60% of patients and should be offered to patients with chronic recalcitrant midportion tendinopathy as an alternatieve to surgery.

For more support for ESWT and alternative treatment approaches be sure to check out the Achilles Tendinopathy Toolkit in Physiopedia.