Shockwave Therapy for Achilles Pain: Time to Call Bullsh*t?

If you’ve battled insertional Achilles pain, chances are someone has mentioned shockwave.

Maybe you’ve already tried it.

The machine comes out. It’s loud. It hurts. You’re told it will “stimulate healing” or “regenerate the tendon.”

And after months of dealing with stubborn Achilles pain, it sounds pretty appealing.

But a recent high-quality trial has thrown a serious spanner in the works.

For insertional Achilles tendinopathy, adding shockwave therapy to a proper exercise and education program didn’t improve pain or function any more than sham treatment.

Yep.

The expensive machine performed no better than the pretend version.

The Study That Burst the Bubble

Researchers from Monash University studied 76 adults with insertional Achilles tendinopathy lasting longer than three months.

Everyone completed the same structured exercise and education program.

The difference?

One group received real radial shockwave therapy.

The other received sham shockwave — same sort of treatment experience, but without the therapeutic shockwave dose.

And the result?

At 6 and 12 weeks, there was no meaningful difference between the groups in pain or function.

The real shockwave group also reported more treatment-related discomfort and minor adverse effects.

That matters.

Because people are often paying significant money for shockwave believing it’s the thing that’s going to finally “fix” their tendon.

This study suggests that, at least for insertional Achilles tendinopathy, that confidence may be misplaced.

So… Is Shockwave Therapy Bullsh*t?

For insertional Achilles tendinopathy?

The evidence just became a lot harder to defend.

That doesn’t mean shockwave has absolutely no role in every tendon problem.

There has been research suggesting potential benefits in other presentations, including some cases of midportion Achilles tendinopathy.

But we need to be specific.

This study looked at insertional Achilles tendinopathy, where the tendon becomes painful where it attaches onto the heel bone.

And when shockwave was added to a solid rehabilitation program, it didn’t provide additional benefit.

That’s the important bit.

Why Does Shockwave Seem to Work for Some People?

Because treatment is rarely happening in isolation.

If someone receives shockwave while also:

Reducing aggravating loads
Starting a strengthening program
Changing their running
Improving recovery
Getting reassurance from their physio

…and then they improve, it’s easy to credit the machine.

But was it actually the shockwave?

That’s exactly why sham-controlled studies are so useful.

They help separate the effect of the treatment itself from everything else happening around it.

What Actually Matters for Achilles Rehab?

This bit isn’t nearly as exciting.

There’s no fancy machine.

No dramatic treatment.

No shortcut.

The foundation is still:

Progressive Loading

Your Achilles needs to gradually rebuild its capacity to tolerate load.

That usually means strengthening the calf and Achilles progressively rather than simply resting until the pain disappears.

Load Management

We work out what your tendon can currently tolerate and adjust:

Running volume
Hills
Speed work
Jumping
Gym loading
Work and daily activity

The goal isn’t to avoid load.

It’s to give the tendon the right amount of load at the right time.

Consistency

Achilles tendons can be stubborn.

They often don’t change overnight.

A good rehab program requires consistency, progression and patience.

Not three painful sessions with an expensive machine and fingers crossed.

What About Insertional Achilles Pain Specifically?

Insertional Achilles tendinopathy behaves a little differently from pain in the middle of the tendon.

Certain positions — particularly deep ankle dorsiflexion — can increase compression where the tendon attaches to the heel.

That means your rehab needs to match the type of Achilles problem you actually have.

This might involve temporarily modifying:

Deep calf stretching
Heel-drop exercises below step level
Hills
Running volume
Certain jumping or lifting exercises

Then gradually rebuilding those movements as your tendon becomes more tolerant.

This is why copying an Achilles program off Instagram isn’t always the smartest move.

The Real Problem With "Quick Fix" Treatment

Shockwave isn’t the only treatment guilty of this.

The bigger issue is when passive treatment gets sold as the solution.

If something helps reduce your pain temporarily, great.

But if you haven’t rebuilt the tendon’s ability to handle running, training, work or sport, the underlying capacity problem is still there.

At Fighting Fit, that’s what we care about.

Not just:

“Does it hurt less today?”

But:

“Can this tendon handle what you actually need it to do?”

The Bottom Line

If you’ve got insertional Achilles tendinopathy, the latest evidence gives us another reason not to rely on shockwave as the magic answer.

A high-quality 2025 trial found that adding radial shockwave therapy to exercise and education provided no additional improvement in pain or function compared with sham shockwave.

What still matters?

Accurate diagnosis
Smart load management
Progressive strengthening
A rehab program matched to your goals
Consistency

It’s not sexy.

But it works.

Sick of Your Achilles Dictating What You Can Do?

If you’ve rested it, stretched it, treated it, shocked it — and it’s still hanging around — it might be time for a proper rehab plan.

At Fighting Fit Physiotherapy, we don’t build treatment around gimmicks.

We assess what your tendon can tolerate, identify what’s keeping it irritated, and progressively rebuild the capacity you need for running, training, sport or everyday life.

👉 Book in with the Fighting Fit team and let’s rebuild your Achilles properly.

Reference:

Alsulaimani B, Perraton L, Vallance P, Powers T, Malliaras P. (2025). Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial. Clinical Rehabilitation, 39(2), 174–186.

Dean Phelps

Dean is a registered Gold Coast Physiotherapist with undergraduate and postgraduate studies in Human Movement and Exercise Science. His background has developed his vision for Fighting Fit Physiotherapy to focus on optimal health and peak physical performance for every single patient. Utilising his many qualifications, in depth knowledge of the body and passion for exercise he can provide a holistic approach to your treatment and exercise prescription to get the best outcome.

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If you’ve battled insertional Achilles pain, chances are someone has mentioned shockwave.

The Study That Burst the Bubble

So… Is Shockwave Therapy Bullsh*t?

Why Does Shockwave Seem to Work for Some People?

What Actually Matters for Achilles Rehab?

Progressive Loading

Load Management

Consistency

What About Insertional Achilles Pain Specifically?

The Real Problem With "Quick Fix" Treatment

The Bottom Line

Sick of Your Achilles Dictating What You Can Do?

Reference:

Alsulaimani B, Perraton L, Vallance P, Powers T, Malliaras P. (2025). Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial. Clinical Rehabilitation, 39(2), 174–186.

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