Shockwave therapy for Achilles tendonitis

I've never thought of myself as someone particularly immobile, but when it comes to my ankles, I'm so far out of the ideal range, it's ridiculous. This, unfortunately, has led to a series of injuries throughout my running life, from chronic Achilles tendonitis to mechanically induced stress fractures. Back in 2020, the Achilles tendon in my left hand flared up significantly and got to the point where… My physicistJoe, who I've been going to for years, recommended shockwave therapy.

What is Achilles tendonitis?

Whatever the cause (acute injury or accumulated over time), Achilles tendinitis is inflammation/swelling of the Achilles tendon – the stiff band of tissue that connects the leg to the ankle. This causes pain and stiffness, and is sometimes characterized by a mass of damage.

For me, daily symptoms included extreme stiffness when sitting or lying down for long periods of time and a painful lump over the insertion point in my heel. At worst, I was in pain daily and struggled to run. The rigidity meant I couldn't put my heels on when I first got out of bed!

What is shock wave therapy?

Extracorporeal shock wave therapy (ESWT) is a non-surgical musculoskeletal soft tissue treatment, using shock waves to deliver a mechanical force to the target tissue. This force stimulates tendon cell metabolism, initiating the repair process.

Tendons do not have a good blood supply, so they only get stimulated to repair when they are loaded. This is one of the things that often makes tendonitis a chronic condition. It's a delicate balance between enough load and too much load. Shockwave therapy creates stimulation for repair without load.

How did my treatment work?

Joe recommended a course of four treatments, spaced one or two weeks apart. It was best to rest my Achilles tendon for 2-3 days after each course of treatment, so as not to aggravate it in an already weak condition. This means that with running 3 days a week (all easy and no speeding), I will go for a treatment in the afternoon after my run.

Treatment began with conservative intensity and number of shocks, and increased each time I visited her. I can't say it was “painful,” per se, but it was uncomfortable. Since the tendon itself hurts, what I can only describe as repeatedly tapping it was never a walk in the park! But it also ended very quickly.

Results of shockwave therapy.

Joe always said it would take about 12 weeks to see result as that is the normal healing time frame for any tendon. Funny enough, about 12 weeks after finishing treatment, I felt like I could finally increase my running rate. I worked my way up to longer distances and added some faster sessions. I even got out of bed naturally in the morning!

In fact, this will be my guide forever! Having a standard like how you feel in your Achilles tendon in those first few steps makes it easier to deal with discomforts and injuries.

About a year ago…

It's now been just over a year since I started shockwave therapy with Joe. I think I made a full recovery after receiving treatment, but I was always at risk of recurrence because the underlying cause was still there. I didn't devote as much time as I should have to increasing my range of motion, and unfortunately, running in shoes that were too low for me meant a flare-up about halfway through the year.

I've kept things under control during the racing season, but with the result I achieved last time, I'm confident I can get back to where I was with additional treatment. The earthquake is not a miracle cure, so we still need to find what works and what does not work for us in terms of prevention and management.

Have you ever had or had shockwave therapy recommended? I'm a big believer in this and would love to hear what others think too!

About Forge Physio

Forge Physio is an independent physiotherapy practice providing shockwave therapy and other physiotherapy treatments, outside of London and locally in Essex. They also work with recognized insurance companies to provide remediation through policy claims.