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Living with Achilles tendinopathy can be frustrating. Every morning brings that sharp pain in the back of your heel, and even simple activities like walking or climbing stairs become painful challenges. Many people “try everything” – rest, ice, painkillers, new shoes, even cortisone shots – only for the pain to come back. If this sounds familiar, you’re not alone. Chronic Achilles tendon pain (often called Achilles tendinitis, though it’s usually a degenerative issue rather than pure inflammation) can persist for months despite traditional treatments. In fact, as many as one in four patients with Achilles tendinopathy eventually end up needing surgery when conservative care fails.
The good news? There’s a promising non-surgical option that research suggests may help when other treatments haven’t: shockwave therapy. Shockwave therapy (technically known as Extracorporeal Shockwave Therapy, or ESWT) uses targeted acoustic waves to stimulate healing in injured tissues. This therapy has been used successfully for stubborn tendon problems like plantar fasciitis, tennis elbow, and calcific shoulder tendinitis – and it’s now being applied to Achilles tendinopathy. In this article, we’ll explore what Achilles tendinopathy is, why it can be so hard to heal, and how shockwave therapy for Achilles tendinopathy works according to the latest evidence. We’ll also explain how we use shockwave at Unpain Clinic in a whole-body approach, share an example of a patient’s recovery, and answer your FAQs. (Disclaimer: This article is for educational purposes only. Results may vary; always consult a qualified healthcare provider for assessment and treatment.)
What is it? Achilles tendinopathy is a condition where the Achilles tendon (the thick tendon connecting your calf muscles to your heel) becomes painful and weakened due to tiny micro-tears and failed healing. Unlike an acute Achilles tendonitis (which implies short-term inflammation), chronic tendinopathy is more about degeneration of the tendon’s collagen fibers with minimal inflammation. Under a microscope, a chronically painful Achilles tendon often shows disorganized, frayed tissue and abnormal blood vessel growth rather than a classic inflammatory response. This is why simply taking anti-inflammatory pills or resting often isn’t a lasting fix – the tendon needs stimulus to remodel and get stronger, not just suppression of inflammation.
Mid-portion vs. insertional: There are two main types of Achilles tendinopathy. Mid-portion Achilles tendinopathy causes pain and tendon thickening about 2–6 cm above the heel. This is the more common type, often seen in runners and middle-aged adults. Insertional Achilles tendinopathy affects the lower part of the tendon where it attaches to the heel bone, sometimes accompanied by a bone spur at the heel. Both types cause pain with walking, running, or climbing stairs, though treatment approaches may differ slightly. (For instance, certain stretching exercises need modification for insertional cases to avoid compressing the tendon against the heel bone.)
Why does it happen and persist? Achilles tendinopathy is usually an overuse injury with contributing factors. Common triggers include a sudden increase in training intensity or running uphill, tight calf muscles or limited ankle mobility, and poor footwear or hard surfaces. Often, there are biomechanical issues at play: weakness or poor activation in the glutes or core can shift extra strain down to the Achilles. Over time, repetitive overload outpaces the tendon’s ability to repair, and the collagen fibers begin to degrade. The result is a painful, thickened tendon that just won’t seem to heal. In many people, the pain becomes chronic (lasting >3 months) and cycles through flare-ups. The nervous system may start to “guard” the area, causing you to limp or feel stiff to protect the tendon. Unfortunately, this protective response can further weaken the tendon and surrounding muscles.
Why traditional treatments may fall short: Typical advice like rest, ice, and stretching can provide temporary relief, but they might not address the underlying problem. Complete rest often leads to tendon weakness, so when you resume activity the pain comes right back. Anti-inflammatory medications or cortisone injections may dull the pain in the short term, but they don’t rebuild the damaged tendon tissue (and cortisone can even weaken tendons with repeated use). Standard physiotherapy exercises are crucial (more on that below), but if you only strengthen the calf and ignore issues higher up the chain (like inactive glutes or tight hamstrings), the tendon may continue to be overstressed. As the team at Unpain Clinic often reminds patients: where it hurts isn’t always why it hurts. For example, weak gluteal muscles or an old lower back issue can alter your gait and put excessive load on the Achilles. That’s why a holistic approach is key – and where shockwave therapy can fit in as a catalyst to jump-start healing in the stubborn tendon itself.
Shockwave therapy has gained attention as a treatment for chronic Achilles tendinopathy, but what does the evidence actually say? In short, the research is promising but nuanced. Here’s a summary of the findings:
Reduction in pain and improved function: Several clinical trials and reviews indicate that shockwave therapy can reduce pain and improve performance in chronic mid-portion Achilles tendinopathy. A 2022 systematic review of randomized controlled trials concluded that extracorporeal shockwave therapy is a safe and effective modality for mid-portion Achilles tendinopathy, leading to significant pain reduction and functional improvement. In these studies, patients who received shockwave often reported better outcomes than those who got placebo or standard care. For example, an earlier landmark study by Rompe et al. found that patients who added shockwave therapy to an eccentric exercise program had faster pain relief and higher activity levels at 12 weeks compared to exercise alone.
Best results when combined with exercise: Notably, research suggests shockwave is most effective when used alongside a loading exercise program rather than as a standalone treatment. The 2022 review mentioned above found the best outcomes came from combining ESWT with eccentric calf exercises and stretching, versus ESWT alone. Similarly, a 2022 Sports Medicine Open analysis showed that adding shockwave to a tendon-loading program led to a clinically important improvement in tendon function scores (VISA-A questionnaire) for mid-portion Achilles issues. In plain language: doing shockwave on your Achilles while also following a structured exercise therapy routine yields more improvement than either treatment by itself. This combined approach likely addresses both the tendon’s physical healing (via shockwave) and its strength and resilience (via exercise).
Mid-portion vs. insertional Achilles: If your Achilles pain is at the insertion (heel bone area), the evidence for shockwave is more mixed. Research to date shows strong evidence for shockwave helping mid-portion Achilles tendinopathy, but much weaker evidence for insertional cases. In fact, one systematic review found that shockwave therapy was no better than placebo for insertional Achilles tendinopathy on average. In some insertional cases, shockwave plus exercise still helps, but results are less consistent. The likely reason is that insertional tendinopathy has some different biology (often involving bone spurs or calcification) and may not respond as readily to the same protocol. It doesn’t mean shockwave never helps insertional issues – but expectations should be tempered, and a combined approach (including eccentric-loading modified to avoid tendon compression) is critical.
Evidence quality and consensus: You might come across studies with conflicting conclusions on shockwave for Achilles pain. For instance, a 2023 meta-analysis noted that due to variability in study designs and small sample sizes, the overall quality of evidence is low and it’s hard to make a firm conclusion that shockwave is superior to other conservative treatments. In other words, while many patients benefit, some studies did not find a statistically significant difference between ESWT and sham or other therapies. This doesn’t mean shockwave “doesn’t work” – rather, it reflects that Achilles tendinopathy outcomes can vary and more high-quality research is needed. Most experts consider shockwave an optional add-on therapy: helpful in many cases, but not a guaranteed cure-all. The encouraging part is that no study has found serious harm from shockwave in Achilles treatment, and several have found meaningful benefits, especially for chronic cases that failed to improve with exercise alone.
How it works (mechanism): Shockwave therapy for tendinopathy involves directing high-energy sound waves into the affected tendon and the surrounding tissues. This causes a mild mechanical stress that stimulates the body’s natural healing processes. Research shows a few key effects: (1) Shockwave can induce neovascularization – in other words, it promotes the formation of new blood vessels in and around the tendon. Tendons normally have poor blood supply, so increasing circulation is a game-changer for delivering the nutrients needed for repair. (2) It triggers cellular regeneration by activating growth factors and even recruiting stem cells to the area. The waves cause microscopic tissue disruption (like a pro-inflammatory micro-trauma) that “resets” a stalled healing process without causing actual damage to the tendon. In response, the body lays down new collagen fibers. (3) Shockwave helps break down scar tissue and calcifications that often build up in chronic tendons. By disrupting these disorganized fibers, it clears the way for healthier tissue to form. (4) Patients often experience pain relief due to shockwave’s effect on nerves – it can diminish substance P (a pain signaling chemical) and over-stimulate nerve endings to essentially recalibrate pain perception in the area. Many people feel a reduction in pain after a few sessions even before the tendon has fully healed, indicating a neuromodulation effect.
Treatment timeline and expectations: Achilles tendinopathy doesn’t heal overnight, and neither does any regenerative treatment. Shockwave therapy is typically delivered as a series of sessions rather than a one-time procedure. Clinical studies often use 3 to 6 sessions, spaced about 1 week apart. An often-cited protocol is 3 sessions (one per week) with about 2000 shockwave pulses each, at the highest energy level tolerable, which has been suggested as an optimal regimen. In practice, clinics may adjust the number of sessions based on severity – some patients might need a few extra rounds if symptoms are severe or longstanding. Most patients do not feel instant relief after a single treatment; instead, improvements tend to appear gradually over several weeks as the tendon goes through its healing phases. You might notice a small decrease in pain or morning stiffness after 2-3 sessions (about a month into treatment). The real gains often occur 6-12 weeks after starting shockwave, once new collagen has had time to mature. This is why sticking with your exercise program during this period is crucial – the exercises help align and strengthen the new tendon tissue. In terms of success rates, studies report that a significant percentage of chronic Achilles tendinopathy sufferers (often 65–80% in various trials) experience notable pain relief and functional improvement with shockwave therapy. However, there is variability: some people get back to full activity pain-free, while others may see moderate improvement but not a complete resolution. A small percentage unfortunately may not respond to shockwave – if you’ve had no change at all after, say, 4-6 sessions, your therapist might reconsider the approach or investigate other underlying factors. Overall, though, the evidence suggests shockwave therapy can be a game-changer for many with recalcitrant Achilles tendinopathy, offering a chance to heal without surgery when traditional rehab alone isn’t enough.
At Unpain Clinic, shockwave therapy is one of our core tools for treating Achilles tendon issues – but it’s never used in isolation. Our philosophy is holistic and root-cause oriented. We start by thoroughly assessing why your Achilles tendon is under strain. Often, the true cause of Achilles tendinopathy isn’t in the Achilles itself. As Unpain Clinic founder Uran Berisha likes to say, we don’t just ask “Where does it hurt?” – we ask “Why does it hurt?”. For example, if you come in with Achilles pain, we will examine your whole lower body alignment and movement: are your glute muscles activating properly? Is there tightness in your hamstrings or calves? Could an old ankle or knee injury be altering your gait? It’s common to find that a patient’s weak hips or imbalanced leg muscles have been overloading the Achilles, creating the perfect storm for tendon injury. By identifying these factors, we can treat the cause of the problem, not just the symptoms.
Shockwave therapy session – what it looks like: Once we’ve pinpointed the contributing issues, we incorporate shockwave therapy into the treatment plan to directly target the damaged tendon and any related soft tissues. A typical shockwave session at Unpain Clinic is relatively quick. You’ll be positioned comfortably (lying on your stomach or belly with your foot accessible). The therapist applies a handheld shockwave device with some ultrasound gel on the skin, focusing on the Achilles tendon and sometimes the calf muscles where there may be tension or trigger points. Both radial and focused shockwave machines are available – radial shockwave covers a broader, more superficial area, while focused shockwave penetrates deeper to a specific point. We choose the type (or a combination) based on your condition, and adjust the energy intensity to your comfort level. Most patients describe the sensation as a series of rapid taps or thuds on the skin. It can be a bit uncomfortable (especially over very tender spots), but it should never be unbearable – we constantly communicate with you and dial the intensity up or down so that it’s tolerable. In fact, about 90% of patients in one clinic’s survey rated the discomfort only 2–3 out of 10. No anesthesia or injections are needed; the treatment is non-invasive. Each session typically delivers a few thousand pulses in just a few minutes. Afterward, the area might feel warm, tingly, or slightly achy, but you can walk out and resume normal light activities immediately since there’s no downtime.
Frequency and total number of sessions: At Unpain Clinic, we usually start with a protocol of one shockwave treatment per week. The total number of sessions varies by individual, but many Achilles tendinopathy cases get about 3–5 sessions over 3–6 weeks, then we reassess. Mild cases or people who respond very quickly might need only 3 sessions; tougher, longstanding cases might go for 6 or occasionally more. We schedule a follow-up evaluation after a few treatments to check your progress. Our therapists will measure improvements in your pain levels, tendon thickness, flexibility, and functional tests (like single-leg calf raises or hop tests). If you’re improving as expected, we complete the planned sessions; if not, we might tweak the approach (for example, add a different therapy or refer for imaging if something doesn’t add up).
Whole-body treatment approach: A crucial part of our Achilles tendinopathy program is what happens alongside the shockwave therapy. Remember, shockwave is addressing the tendon’s biology – but we also need to correct the mechanics that led to injury. So, your session may also include hands-on manual therapy (e.g. releasing tight calf or hamstring muscles, mobilizing stiff ankle joints) and a customized exercise program. You’ll be guided in specific rehabilitation exercises such as eccentric heel drops, isometric calf holds, or glute strengthening movements, depending on what your assessment found. We often do the shockwave first (to stimulate healing and reduce pain sensitivity) and then immediately follow it with exercises in the clinic so you can move better with less pain. This combination echoes the research: shockwave “primes” the tendon for repair, and exercise then helps build strength and alignment in the new tissue. Our approach might also incorporate advanced modalities like EMTT (Electromagnetic Transduction Therapy) or therapeutic neuromodulation in some cases, but true shockwave therapy remains the centerpiece for chronic tendon healing.
To illustrate the approach, Uran Berisha shared in the Unpain Clinic podcast “Erase your Achilles Pain with the Unpain Method” (Episode #4, July 3, 2021) that “one of the most powerful tools we use to treat chronic Achilles problems is true shockwave therapy… it stimulates real healing at the cellular level… breaking down scar tissue, increasing blood circulation, and triggering the body’s natural repair mechanisms. In that same episode, he emphasizes that they don’t treat the Achilles in isolation – they release tight calves, activate the glutes, and fix movement patterns so the pain won’t come back. In practice, this means your treatment plan is very comprehensive. By the end of your program, not only do we aim for a healthier Achilles tendon, but you’ll likely notice improvements in your overall mobility, balance, and strength. We’ve had clients say that the biggest relief was finally understanding their body – knowing what was causing the pain and having a clear plan to prevent it from returning.
Realistic outcomes: While we can’t guarantee results (no ethical clinic can), many of our Achilles tendinopathy patients do very well with this approach. Most see significant pain reduction within the first month of treatment and continue to improve over the next 2-3 months as they build strength and the tendon finishes remodeling. We have been able to help avid runners return to distance running after they’d nearly given up hope, and help people avoid surgical interventions. In our experience, combining whole-body assessment with shockwave therapy gives people a much better shot at beating that cycle of “rest, relapse, repeat.” We also keep the treatment plan individualized – for example, if someone has insertional Achilles pain, we adjust the exercises (no deep heel drops off a step) and might focus shockwave a bit more at the musculotendinous junction rather than directly on a large bone spur. It’s not a one-size-fits-all protocol. But overall, by following evidence-based guidelines (like using both radial & focused shockwave as needed, doing ~4–6 sessions, and reinforcing with exercise), we aim to deliver the best possible outcome safely.
For more on our approach, you can listen to “Erase Your Achilles Pain with the Unpain Method” (Unpain Clinic Podcast, 2021), where Uran Berisha discusses how shockwave fits into a holistic Achilles rehab plan.)
To illustrate how shockwave therapy can make a difference, let’s look at a realistic example of a patient (name changed for privacy). Meet Sarah, a 45-year-old recreational runner. She had been battling Achilles tendinopathy in her right leg for nearly a year. Every morning, her pain was about 7 out of 10 when she got out of bed, and she had to give up her beloved weekend jogs because the tendon would flare up fiercely afterward. Sarah tried rest, calf stretches, and saw a physiotherapist who advised eccentric exercises. Those helped a bit, but after 6 months she was still in pain and frustrated. She even got one PRP (platelet-rich plasma) injection in the tendon at one point, which hurt a lot and only provided minor relief.
By the time Sarah came to Unpain Clinic, she described her experience as “I feel like I’ve tried everything, but nothing has fixed it.” Our assessment found that Sarah had incredibly tight calf muscles and very weak glutes. Her left hip was also limited from an old injury, which was altering how she walked and putting extra stress on the right Achilles. We decided she was an excellent candidate for shockwave therapy combined with a full-body treatment plan.
Treatment plan: Sarah underwent five weekly shockwave therapy sessions on her Achilles. In each session, we treated not only the tendon but also the calf muscle and soleus (lower calf) with shockwave, since those areas were contributing to tension. We also did manual myofascial release on her calves and guided her through glute activation exercises. Importantly, we had her continue a modified eccentric heel-drop exercise at home (on flat ground initially, since her pain was partly insertional).
Improvements: After about 3 sessions (3 weeks), Sarah noted her morning pain was significantly better – down to about 3/10 and sometimes completely gone after she moved around a bit. She was no longer limping first thing out of bed. By week 6, she reported being able to jog lightly for 2–3 km without a pain flare-up, which was a huge milestone for her. We conducted a reassessment at that point: her single-leg calf raise endurance had improved, and the Achilles tendon felt less thick and sensitive on exam. We decided to space out two more shockwave treatments biweekly over the next month to solidify the progress. At the 12-week mark (around 3 months), Sarah was back to running 8–10 km at a time with minimal discomfort. She rated her pain as 1/10 or zero on most days. Equally important, she felt confident again – she knew how to manage her training load and continue her exercises to keep the tendon healthy.
Sarah’s story highlights a best-case scenario outcome. Not everyone will respond that quickly or dramatically, but it’s a powerful example of how combining shockwave with a structured, personalized plan can lead to recovery even after a year of chronic pain. It wasn’t magic or luck – it was the result of addressing the root causes (in her case, muscle imbalances and mobility restrictions) and healing the tissue with the right modality. We always remind patients that staying consistent with the rehab plan is key. Sarah kept up with her glute and calf exercises diligently, and that consistency paid off. Today, she continues to do maintenance strength training and short stretches after runs, and her Achilles has been pain-free for many months.
(Note: This story is an illustrative example. Individual results vary, and we make no guarantees. Always seek professional guidance for your specific condition.)
Managing Achilles tendinopathy isn’t just about in-clinic treatments – what you do between appointments matters, too. Here are some safe, evidence-based at-home tips to support your recovery (to be used alongside medical care, not as a substitute). Always consult your provider before starting new exercises, especially if you’re unsure about technique or intensity.
Modify Your Activities (But Keep Moving): Complete rest isn’t usually the answer for tendinopathy. Instead, practice relative rest – cut back on or temporarily stop high-impact activities that aggravate your Achilles (like running or jumping) and opt for lower-impact cardio (cycling, swimming) to maintain fitness. Continue daily activities as pain allows; gentle movement actually encourages blood flow. A good rule of thumb is the “pain <4/10 rule” – keep activity pain mild (under 4/10) and avoid any exercise that makes your pain sharply worse the next day. Also, follow the 10% rule for training: increase your running distance or workout intensity by no more than ~10% per week to give your tendon time to adapt.
Isometric Calf Holds: Isometric exercises can reduce pain and begin to strengthen the tendon without excessive strain. Try this simple move: Stand on both feet and rise up onto your tiptoes, then gently shift weight to the injured side and hold that single-leg heel-up position for about 30–45 seconds. Use a countertop for balance support. Lower down, rest, and repeat about 4–5 times. These long holds engage the calf and Achilles without movement, which can help calm tendon pain (via the Golgi tendon organ reflex) and maintain muscle capacity. Aim to do 1–2 sets per day. If holding your full body weight is too hard, do a double-leg hold (keep both feet down) and simply emphasize the injured side a bit.
Heel Drop Eccentric Exercises: Eccentric loading is the gold-standard exercise for Achilles rehab. If your pain is mid-portion or mild insertional, perform heel drops off a step: Stand with the balls of your feet on a step and your heels free. Use both feet to rise up onto tiptoe, then lift your healthy leg and slowly lower your affected heel down over 3–5 seconds. Go down until you feel a stretch or until your foot is just below the step level. (For insertional tendinopathy, do not drop the heel below the level of the step – stop at neutral to avoid compressing the tendon against the heel bone.) Use your good leg to help raise back up and repeat. Do 3 sets of 15 reps once or twice daily if you can. Expect some mild discomfort (pain up to 4 or 5/10 during exercise is usually okay), but it should settle afterwards. This eccentric work has been shown in numerous studies to stimulate collagen repair and improve Achilles strength over time. Consistency is key – it can take several weeks to see a difference, but stick with it.
Gentle Stretching and Mobility: Keeping the calf muscles flexible helps reduce tension on the Achilles. Do a calf stretch with your knee straight (to target the gastrocnemius muscle) and another with your knee bent (to target the soleus muscle). For example, a wall stretch: lean against a wall with one leg back (knee straight) and press your heel down – you should feel a stretch in the upper calf; then bend that back knee, keeping heel down, to feel a lower calf stretch. Hold each for ~30 seconds, and repeat 2–3 times per leg. Perform stretching 2–3 times a day. The stretch should be gentle – you’re aiming for mild tension, not sharp pain. If a standard calf stretch is too intense, do a seated towel stretch (loop a towel around your forefoot and pull gently). In addition to stretching, you can do light self-massage or foam rolling on the calf muscle to improve tissue mobility. Avoid aggressive stretching of the Achilles itself (like hanging fully off a step) in the early stages, especially for insertional pain, as that can irritate the tendon.
Footwear and Orthotics: What you wear on your feet can make a notable difference in Achilles strain. During recovery, choose supportive, cushioned shoes with a slight heel lift (a few millimeters higher at the heel). This takes some load off the Achilles by keeping it in a slightly shortened position. Avoid very flat shoes, flip-flops, or barefoot walking on hard surfaces for long periods, as these can stretch the tendon and aggravate pain. Some patients benefit from a simple heel insert in their shoe (a gel or foam heel cup) to raise the heel and reduce tension. If you have significant biomechanical issues like overpronation, a custom orthotic may be considered – but note that orthotics are usually a temporary aid, not a cure, and you should simultaneously work on strengthening your foot and leg muscles.
Cold Therapy for Symptom Relief: While icing won’t heal a degenerative tendon, it can help with pain flare-ups. After exercise or at the end of the day if your Achilles is throbbing, apply an ice pack or ice bath to your Achilles region for 10–15 minutes. This can reduce excessive inflammation in the surrounding tissues and numb pain receptors for a little while. Make sure to have a cloth between ice and skin to avoid frostbite. Some people also find contrast baths (alternating warm and cold water) help stimulate blood flow; just be cautious with extremes of temperature. And remember, icing is for comfort – the real healing comes from the rehab and treatments.
Load Monitoring and Progress Tracking: Keep a simple log of your pain and activities. For instance, each morning rate your stiffness/pain on a 0–10 scale, and note what exercise you did the day prior. Over time, you should see trends like “morning pain dropping from 7/10 to 3/10” or “able to walk 30 minutes now with mild pain, whereas before 10 minutes was hard.” These improvements mean the tendon’s capacity is increasing. If you notice setbacks (a spike in pain or new symptoms), you might be overdoing it – scale back and consult your therapist. Also pay attention to functional gains: perhaps you can do more single-leg calf raises, or your calf circumference is growing from strength work – all positive signs. By tracking progress, you’ll stay motivated and also know when it might be time to progress your exercises or return to certain activities.
(Always remember: these guidelines are general. It’s best to get exercises and advice tailored to your specific case from a professional. If any home exercise causes sharp pain or swelling, stop and seek guidance.)
Yes – shockwave therapy is considered very safe for Achilles tendinopathy when performed by a qualified practitioner. It is a non-invasive treatment, meaning there’s no surgery, no injections, and no medications involved. The most common side effects are mild and short-lived, such as slight redness, soreness, or swelling in the treated area, which usually resolve within a day or two. In fact, those effects are often a sign that the body’s healing response has been activated. Unlike steroid injections (which carry risks of tendon weakening) or surgery (with risks of infection or nerve injury), shockwave doesn’t structurally damage the tendon – when applied at therapeutic settings, it stimulates repair without cutting or breaking anything. That said, it’s important that a proper evaluation is done beforehand to ensure you’re a good candidate (for example, see the next question on who shouldn’t get it). At Unpain Clinic, we screen each patient for any contraindications and adjust the treatment intensity to ensure safety. Overall, decades of clinical use have shown ESWT to be a safe modality for chronic tendon disorders, with a very low complication rate. Bonus: There’s no anesthetic needed and no downtime after a session, so the safety profile is far better than invasive procedures. Of course, you should always follow your provider’s instructions – e.g. you might be advised to avoid taking anti-inflammatory medications during the shockwave treatment period (because inflammation is part of the healing process we want to encourage). But in summary, shockwave therapy is a low-risk, safe option for treating Achilles tendinopathy.
The optimal number of sessions can vary based on the individual, but most treatment plans range from about 3 to 6 sessions for Achilles tendinopathy. Research suggests that around 3 sessions, spaced one week apart, may be an ideal minimum protocol for many patients. Many clinical studies on Achilles tendinopathy have used 3 weekly sessions (with great results in pain reduction), while others have used up to 5 or 6 sessions if needed. In practice, we usually start with a series of 3–5 sessions and then re-evaluate. At Unpain Clinic, a typical plan lasts about 6–8 weeks, with one shockwave session per week and a reassessment every few sessions to check progress. If the tendon is improving well and there’s still some residual pain, we might do an extra one or two sessions to solidify the healing. If you have a very chronic, severe tendinopathy (say, pain persisting for years), you might require the higher end of that range (6+ sessions). On the other hand, a fresher injury or a mild case might respond after just 2 or 3 sessions. It’s also worth noting that the healing process continues even after the sessions are done – shockwave kick-starts tissue repair that can unfold over 2-3 months. So don’t worry if you’re not 100% pain-free after the last session; you should see continued improvements in the weeks following your treatments. Your provider will tailor the number of sessions to your needs and will stop or change course if it’s not helping. But generally, expect a course of several treatments (not just one) to achieve the best outcome.
This is a common concern for anyone considering a new treatment – especially one that involves “shock waves.” The honest answer: there can be some discomfort, but it’s usually quite tolerable. Patients often describe the sensation of shockwave therapy as a rapid tapping or thumping feeling on the skin. When treating Achilles tendinopathy, the probe is applied to a sensitive area, so you’ll definitely “feel it,” but it’s not typically described as a sharp or excruciating pain. Most people rate the discomfort as only 2 or 3 out of 10 on a pain scale. The intensity of the shockwave can be adjusted by the therapist. We always start at a low energy and gradually increase it to a therapeutic level you can handle. If at any point it feels too intense, we dial it down – the goal is to reach an effective energy level just below your pain threshold. The treatment pulses are very brief and delivered in sequences, which most people get used to after the first few seconds. Sometimes the first minute is the most tender, and then the area becomes a bit numb or desensitized (shockwave can have an analgesic effect as it stimulates the nerves). Each session is also short – the uncomfortable part may last only 3-5 minutes while the shocks are being delivered. After the session, you might feel a bit achy or sore in the area, similar to if you had a deep tissue massage, but this usually fades within hours. There’s no lingering intense pain. In summary, shockwave therapy for Achilles tendinopathy might hurt a little during treatment, but it’s manageable for the vast majority of patients. No anesthesia is needed, and many are pleasantly surprised that it was easier than expected. If you are very pain sensitive, communicate with your therapist – they can use a lower setting and still achieve benefits over a slightly longer course. We find that patients are willing to accept a brief period of mild discomfort given the potential long-term relief it can lead to. And remember, any treatment discomfort is short-lived; shockwave does not create ongoing pain or damage (unlike the condition itself, which if left untreated can hurt indefinitely).
Yes, absolutely. In fact, shockwave therapy is often targeted toward chronic, hard-to-heal tendinopathies, so having a long history of Achilles pain does not disqualify you from benefiting. Chronic Achilles tendinopathy is characterized by that failed healing cycle we discussed – the tendon is stuck in a degenerative state and the body hasn’t successfully repaired it. Shockwave is designed to disrupt that stagnation and reinitiate healing, even if the issue has been lingering for a long time. There’s encouraging evidence that shockwave may be more effective in the later stages of tendon degeneration (chronic cases) than in acute inflammation. Many of the research studies on Achilles tendinopathy, for instance, specifically included patients who had symptoms for 6+ months, or even several years, and they still saw improvements with shockwave. At Unpain Clinic, we have treated patients with 5+ years of Achilles pain who finally got relief after shockwave and comprehensive rehab. Of course, every case is unique – chronic tendinopathy can involve significant tendon thickening or calcification in some instances, which might require a longer treatment course and tempered expectations. But generally, the chronicity of your condition is actually what makes you a good candidate for shockwave. It’s intended for those “stubborn” cases that aren’t healing on their own. We often see people who have tried rest, night splints, months of exercises, etc., and they’re frustrated that it’s still an issue. Shockwave therapy can give that needed stimulus to progress the healing. It’s worth noting that if you’ve had Achilles tendinopathy for years, you’ll likely need to be patient with the treatment – it might take a full 3 months or more to see maximal results, as the tendon will undergo gradual changes. But to summarize: Yes, even if you’ve “had it forever,” shockwave therapy can often help chronic Achilles tendinopathy when other approaches have fallen short. It offers a chance to finally break the cycle of chronic pain (provided you also correct any underlying biomechanical causes).
Shockwave therapy is safe for most people, but there are some contraindications and situations where it’s not recommended. You should generally avoid shockwave therapy if:
You are pregnant: Out of an abundance of caution, shockwave is not used on pregnant patients, especially not near the pelvic or abdominal area. While Achilles is far from the womb, most clinics will still err on the side of safety and avoid elective shockwave during pregnancy.
You have a bleeding disorder or are on blood thinners: Because shockwave can cause tiny blood vessel changes, if you have hemophilia or are on anticoagulant medication (like warfarin), the risk of bruising or bleeding is higher. It’s not an absolute contraindication in every case, but it requires clearance from your physician.
You have a pacemaker or certain types of electronic implants: Focused shockwave in certain body regions might interfere with electronic implants. For Achilles (far from the chest), this is usually not an issue, but if someone has a pacemaker or defibrillator, we are cautious with any medical device that generates pulses. Generally, shockwave is not applied near electronic implants.
There is an active infection or open wound in the area: If your Achilles area has an infection (cellulitis) or a wound, we wouldn’t do shockwave over it until that’s resolved. Shockwave is also avoided if you have active Deep Vein Thrombosis (DVT) in the calf.
You have a tumor or cancer in the treatment area: Shockwave should not be done over a known malignant tumor or if you have a cancer in the region, as a precaution.
**You’re a child or adolescent with open growth plates in the area: For example, in very young athletes, the growth plate at the heel (calcaneus) is still open; some manufacturers advise against high-energy shockwave directly over growth plates. Tendinopathy is rare in children though – it’s more of an adult issue.
**You have severe peripheral neuropathy or loss of sensation: If you can’t provide feedback on the sensation because of neuropathy (for instance, in advanced diabetes), shockwave might be used with caution or not at all, to avoid causing tissue irritation without your awareness.
Acute complete tendon rupture: This is a different scenario – if the Achilles is fully torn, shockwave won’t be used as the first-line treatment (that typically needs surgical or casting intervention). Shockwave is for chronic, partial injuries and tendinopathies.
During your initial assessment, the therapist will review your medical history to screen for these contraindications. The good news is that these situations are relatively uncommon. For the average person with Achilles tendinopathy, shockwave therapy is a suitable and low-risk option. But if any of the above conditions apply to you, be sure to inform your provider. They will determine if shockwave is safe or if it should be avoided. Sometimes it’s not a black-and-white yes/no – for example, if you’re on a mild blood thinner, we might still proceed but monitor for bruising. The key is personalized medical advice. In summary, shockwave shouldn’t be used in certain cases (pregnancy, bleeding disorders, active cancer/infection, electronic implants near treatment, etc.), but for most people it’s fine. When in doubt, consult your healthcare professional.
It depends on your insurance plan and where you live. Shockwave therapy for Achilles tendinopathy is often provided by physiotherapists, chiropractors, or sports medicine clinics. In many cases, there isn’t a separate “shockwave therapy” insurance code; instead, the treatment is billed under the practitioner’s normal therapy codes. For example, if a physiotherapist administers the shockwave as part of your session, it may be covered under your physical therapy benefits. Many extended health insurance plans do cover shockwave when it’s within a physio or chiro treatment session. You’d want to verify that the clinic will invoice it as physiotherapy or chiropractic treatment. At Unpain Clinic, for instance, shockwave is done by licensed providers so it can be submitted under those services.
However, some insurance plans have specific exclusions or limits. It’s a good idea to call your insurance provider and ask: “Is extracorporeal shockwave therapy for tendinopathy covered under my plan?” They may say it’s covered if done by certain provider types, or up to a certain dollar amount. Government health plans (like public healthcare in Canada) typically do not cover shockwave therapy, as it’s considered a specialized treatment – for example, provincial plans like OHIP or AHS don’t pay for it. But private insurance / employer benefits often will, up to your paramedical limits. If you lack coverage, some clinics offer package pricing or self-pay rates. It’s worth noting that even when covered, you might have a co-pay. Also, if a physician (MD) performs shockwave in certain jurisdictions, there might be different rules (in many places it’s done by allied health instead).
In summary, shockwave therapy may be covered by insurance, but it varies. If you have extended health insurance for physio or chiro, odds are good it will be reimbursed as part of those visits. Always check with your insurance to be sure. And don’t hesitate to ask the clinic – at Unpain Clinic, our staff can help clarify coverage questions since we’ve worked with many insurance plans.
Shockwave therapy has the advantage of minimal side effects, especially compared to medications or surgery. The most common side effects are localized and temporary. You might experience some:
Mild pain or soreness at the treatment site after a session (often described as a dull ache). This usually subsides within 24–48 hours.
Redness or skin irritation where the probe was applied, which again is short-lived.
Swelling or bruising: Occasionally, some people get a bit of swelling or a small bruise on the Achilles or calf area, particularly if they have sensitive skin or were on blood thinners (which we usually know in advance). The bruise, if it occurs, is typically minor and resolves in a few days.
Tingling or numbness: rarely, patients report a slight tingling down the limb for a short time after treatment – this is due to nerve stimulation and is not harmful, usually resolving quickly.
These side effects are actually indications that the body is responding (increasing blood flow, etc.). Unlike many medical treatments, there are no serious or long-term side effects associated with shockwave when applied properly. It does not harm or “tear” the tendon, it doesn’t affect other organs, and there’s no risk of infection since nothing is being inserted into the body. There’s also no anesthesia or drugs involved, so you avoid side effects like drowsiness or allergic reactions.
After treatment, we advise patients to avoid anti-inflammatory medications for a day or two (to let the body’s natural inflammation-healing cycle run its course). You also wouldn’t want to do another aggressive treatment to the area on the same day (like heavy deep tissue massage) to avoid compounding soreness. But you can go about your normal routine. Serious adverse events from shockwave are extraordinarily rare – there have been isolated reports of temporary nerve irritation or tendon rupture in cases where excessively high energies were used, but in the hands of trained professionals using evidence-based protocols, this is not a concern. In fact, studies over decades have not found any long-term damage from therapeutic shockwave.
So, to recap: the side effects of shockwave therapy are usually limited to minor, short-term aches or skin irritation in the treated area. Most people find it no big deal – especially when weighed against the ongoing pain of the condition itself. Your practitioner will review these with you and ensure you know what to expect. If you ever experience something unexpected (extreme pain or swelling – which is uncommon), you should inform your therapist or doctor. But the vast majority of patients undergo shockwave with only mild after-effects, if any, and can continue with their day.
Achilles tendinopathy can feel like an endless road – but with the right approach, it is a condition you can overcome. If you’ve been stuck in the cycle of rest and relapse, it’s time to consider a more comprehensive strategy. Modern research and clinical experience show that a combination of progressive exercise therapy and targeted treatments like shockwave therapy can restore the health of a chronically irritated Achilles tendon. Shockwave therapy, in particular, offers a non-surgical option to stimulate healing in the tendon, helping to reduce pain and improve function by addressing the problem at a biological level. We’ve seen that shockwave therapy for Achilles tendinopathy has solid evidence for mid-portion Achilles injuries (the most common type) and can be especially useful for people who haven’t found relief with standard care. While results may vary from person to person, many patients experience significant relief and a return to activity with shockwave – all without the risks and downtime of surgery.
At Unpain Clinic, we take things a step further by combining shockwave with a whole-body assessment and personalized rehab plan. By looking at why your Achilles is hurting (weaknesses, imbalances, movement patterns), we create a treatment program that not only calms the tendon pain but also prevents it from coming back. If you’ve been frustrated by Achilles pain that just won’t quit, and you’re seeking a safe, effective, and research-backed solution, shockwave therapy might be the answer you’ve been waiting for. It’s non-invasive, relatively quick, and can be the catalyst that finally helps your injury heal after months (or years) of stubborn pain.
Remember, no treatment is magic – you’ll still need to put in the work with exercises and activity modifications as advised. But you won’t be doing it alone; our team guides you every step of the way. The goal is that a few months from now, you’re not only pain-free, but also stronger and wiser about how to care for your body. Achilles tendinopathy may be tough, but it’s not permanent. With tools like shockwave therapy, we can help your body reboot the healing process and get you back on your feet – literally.
Ready to take the next step toward finally resolving your Achilles pain? Keep reading below – our enhanced initial assessment could be your starting point to a pain-free Achilles.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Feeney, K.M. et al. “The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review.” Cureus. 2022 Jul;14(7):e26960. This review of 7 RCTs found shockwave therapy to be safe and effective for chronic mid-portion Achilles tendinopathy, especially when combined with eccentric exercisepubmed.ncbi.nlm.nih.gov.
2. Stania, M. et al. “The Efficacy of Extracorporeal Shock Wave Therapy as a Monotherapy for Achilles Tendinopathy: A Systematic Review and Meta-Analysis.” J Chiropr Med. 2023;22(4):294-301. Concluded that overall evidence quality is low and results are mixed, highlighting the need for combined approaches and further researchsciencedirect.comsciencedirect.com.
3. Paantjens, M.A. et al. “Extracorporeal Shockwave Therapy for Mid-portion and Insertional Achilles Tendinopathy: A Systematic Review of RCTs.” Sports Med Open. 2022; 8(1):23. Reported moderate evidence that adding shockwave to exercise improves mid-portion Achilles tendinopathy, but no added benefit in insertional caseslink.springer.comlink.springer.com.
4. Rompe, J.D. et al. “Shockwave therapy for chronic Achilles tendinopathy: a randomized trial.” Am J Sports Med. 2007;35(3):374-383. A key study showing patients who received shockwave plus eccentric training had better 12-week outcomes than those with exercise aloneunpainclinic.com.
5. Frontiers Vet Sci (Yang et al. 2022) – “Biological response of extracorporeal shock wave therapy in tendinopathy (review).” Summarizes that ESWT stimulates tendon healing by promoting angiogenesis (new blood vessels) and collagen production, especially in chronic stagesfrontiersin.orgfrontiersin.org.
6. Unpain Clinic Podcast – Episode #4: “Erase your Achilles pain with the Unpain method.” (July 3, 2021). Uran Berisha discusses how true shockwave therapy breaks down scar tissue, increases circulation, and kick-starts healing in Achilles tendon injuries, and the importance of assessing the whole kinetic chainunpainclinic.comunpainclinic.com.
7. Unpain Clinic – Achilles Tendinopathy: Causes, Treatments & Self-Care Tips (Blog, Oct 9, 2025 by Uran Berisha). An evidence-based guide noting that progressive loading exercise is the first-line treatment and shockwave therapy has strong evidence for mid-portion Achilles tendinopathy (with mixed results for insertional)unpainclinic.comunpainclinic.com. It also provides home exercise examples and a patient recovery storyunpainclinic.comunpainclinic.com.
8. Multnomah Medical Clinic – Shockwave Therapy FAQ (Accessed 2025). Provides patient-friendly info: shockwave devices are FDA-cleared, most patients rate treatment discomfort 2–3/10multnomahmedical.com, typical protocol is 6–12 sessions for chronic casesmultnomahmedical.com, and side effects are minimal (transient soreness, redness) with contraindications noted (no shockwave for pregnant, bleeding disorders, active cancer, pacemaker, etc.)multnomahmedical.com.
9. PhysioPlus Health – FAQ: Is shockwave therapy covered by insurance? (Accessed 2025). Explains that shockwave therapy can be covered under extended health insurance when billed as physiotherapy or chiropractic treatment, as it falls under the license of the treating therapistphysioplushealth.com.
