An Article By Cecilia Brennan, Podiatrist – New Step Podiatry.
Achilles Pain Not Improving? Why Shockwave Therapy May Help You Break Through a Plateau
You’ve been doing your exercises. You’ve cut back your activity levels. You’ve been trying to do all the right things. Yet your Achilles still isn’t where you want it to be.
At New Step Podiatry, we often see patients who have already started treatment, are doing their strengthening exercises, and have made some progress but feel like they’ve hit a plateau.
The important thing to understand is that this doesn’t mean your exercises aren’t working.
In fact, strengthening remains one of the most important parts of Achilles rehabilitation.
Sometimes, however, the tendon needs an additional stimulus to help keep recovery moving forward. That’s where shockwave therapy may help.
What Is Shockwave Therapy?
Shockwave therapy involves delivering high-energy acoustic waves through the skin into injured tissue.
The treatment aims to increase blood flow, stimulate healing responses within the tendon and surrounding tissues, and influence pain pathways that can contribute to ongoing symptoms. In Achilles tendinopathy, shockwave is often used to support the healing process when progress has plateaued despite appropriate rehabilitation.
Treatment is completely non-invasive and usually takes between five and ten minutes. Unlike injections, there are no needles involved and no downtime afterwards. Most patients are able to walk straight out of the clinic and continue with their normal day.
Many patients ask whether shockwave is painful. The answer is: it can be uncomfortable, particularly when treating an already sensitive tendon. However, the treatment should not be excessively painful. The settings can be adjusted throughout the session to keep the discomfort at a manageable level, and we often start more conservatively before increasing the intensity over subsequent treatments.
Most patients require a minimum of four treatment sessions, spaced approximately one week apart, to achieve a therapeutic effect. Depending on the severity and duration of symptoms, some patients may benefit from up to six sessions.
While some people notice improvements within a few days, shockwave is not usually an instant fix. The benefits often continue developing over several weeks as the tendon responds to treatment and rehabilitation. In many cases, the therapeutic effects can continue for up to 12 weeks following the final treatment, particularly when combined with an appropriate strengthening and loading program.
Shockwave Is Not a Magic Wand
One of the biggest misconceptions about shockwave therapy is that it works equally well at every stage of an Achilles injury.
In reality, timing matters.
If your Achilles is in a significant flare-up, painful with everyday walking and highly irritated, shockwave is often not our first step.
Before we start stimulating the tendon, we usually want to calm things down first.
This may involve reducing aggravating activities, modifying training loads, using heel raises, temporary bracing, footwear changes and, where appropriate, anti-inflammatory strategies such as topical anti-inflammatory creams or short courses of oral anti-inflammatory medication discussed with your healthcare provider.
The goal is to reduce irritation and allow the tendon to become more tolerant to load. Once symptoms have settled and strengthening is underway, shockwave often becomes a much more valuable treatment option.
Shockwave Doesn’t Replace Loading. It Enhances a Good Loading Program.
This is probably the most important thing we tell patients. Shockwave is not a substitute for strengthening exercises. It’s not a quick fix and it’s not something we recommend instead of rehabilitation.
The best results occur when shockwave therapy is combined with an appropriate loading program. The exercises are still doing the heavy lifting. Shockwave simply helps support the healing process and can assist patients who feel like their progress has stalled.
If you’re looking for a treatment that allows you to stop exercising altogether, shockwave probably isn’t the answer. If you’re already putting the work in, however, shockwave may help you get more out of your rehabilitation.
Shockwave Works Best When Your Ducks Are Lined Up
One of the phrases we often use in the clinic is: “Shockwave works best when all your ducks are lined up.”
What do we mean by that?
Strengthening Is Already Underway: Shockwave works best alongside a structured exercise program. The tendon still needs appropriate loading to become stronger and more resilient.
Biomechanics Are Under Control: If something is continually overloading the Achilles, whether that’s foot posture, ankle stiffness or movement patterns, it needs to be addressed as part of the overall treatment plan.
Mobility and Flexibility Are Improving: Improving ankle mobility and calf flexibility can help reduce unnecessary stress through the Achilles and support long-term recovery.
Load Management Is Appropriate: The Achilles needs the right amount of load. Too much can keep it irritated, while too little may slow progress.
Symptoms Are Trending in the Right Direction: The patients who often benefit most from shockwave are those who have already made some progress but feel like they’ve hit a roadblock.
Ultimately, shockwave is designed to stimulate healing and tissue remodelling within the tendon. If the tendon continues to be overloaded by poor biomechanics, inadequate strength, restricted mobility or inappropriate training loads, that healing response may not be as effective. That’s why we focus on getting all the important pieces in place first—so the tendon has the best possible environment to recover.
If you’d like to learn more about the common causes and risk factors for Achilles injuries, you can read our guide on Achilles tendon injury risk factors and management here.
Why We Treat More Than Just the Achilles
The Achilles tendon is part of a larger calf-Achilles complex. When we perform shockwave therapy, we commonly work through the calf muscles as well as the tendon itself. We often start more gently through sensitive areas before progressing treatment as tolerance improves.
Over the course of treatment, we gradually increase the settings as symptoms allow.
By treating the entire calf unit rather than only the painful section of tendon, we’re often able to address contributing muscle tightness and improve overall function throughout the system.
Do Orthotics Help Achilles Tendinopathy?
Not everybody with Achilles pain needs orthotics. However, some patients have foot mechanics that place additional stress on the Achilles tendon every time they walk or run.
As part of your assessment, we’ll determine whether orthotics are likely to reduce tendon load and support your recovery.
If we think they’ll help, we’ll explain why. If we don’t think they’re necessary, we’ll tell you that too.
Conclusion
Shockwave therapy isn’t a miracle cure for Achilles tendinopathy.
But when used at the right time, alongside a strengthening program and a well-structured rehabilitation plan, it can be an excellent tool for helping patients move beyond a recovery plateau.
Wondering Whether Shockwave Therapy Could Help Your Achilles Recovery?
Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve.
Easily BOOK ONLINE or give us a call on 02 6198 4818.
