How Does Shockwave Therapy for Achilles Tendonitis Actually Work?
- Just Healthy
- Jun 22
- 12 min read
✓ Reviewed by Just Healthy
If you’ve had nagging Achilles pain for months, and stretching, rest, or physical therapy haven’t done the job, you’re probably wondering if shockwave therapy is real help or just another overpriced buzzword. The Answer is simple.
Yes, shockwave therapy works for many people with Achilles tendonitis. It’s not magic.
It’s not hype. But it’s also not a miracle for everyone. Let’s break it down.
Key Highlights
Shockwave therapy helps chronic Achilles pain, especially when stretching, rest, or PT haven’t worked.
It’s most effective when combined with tendon-loading exercises like slow calf raises.
Most people feel results within 2–3 sessions and stay pain-free long-term if they stick to rehab.
Table of Contents
What the research says
Multiple randomized controlled trials, the kind of studies where one group gets the real treatment and another gets a fake version, show that shockwave therapy (officially called Extracorporeal Shockwave Therapy, or ESWT) can significantly reduce pain and improve mobility for people with chronic Achilles tendon problems.
And not just any Achilles problem, this is about mid-portion Achilles tendinopathy, which means the part of the tendon that hurts is a few centimeters above your heel, not where it attaches to the bone.
And tendinopathy isn’t inflammation, it’s more like long-term wear and breakdown of the tendon’s fibers.
A 2022 systematic review , that’s a study that compiles results from lots of other high-quality trials, found that when you combine ESWT with something called loading therapy (a rehab method where you slowly strengthen the tendon with bodyweight or resistance exercises), people saw their VISA-A scores jump by 9 to 10 points.
The VISA-A score is a 100-point scale that measures how well your Achilles tendon is doing, 100 means you’re running, walking, and going up stairs with zero pain. A 10-point jump isn’t just “a little better”, it’s the difference between limping and living normally again.
So If your tendon’s been hurting for months and physical therapy alone hasn’t helped, this could be your turning point. For plantar fasciitis, the therapy is actually already FDA approved.
What real patients experience
Okay, so that’s the research. What about real people?
Anecdotally, patients, especially runners say they start to feel something shift after just a few sessions. About 1 in 10 people feel what they describe as “sharp relief” after the first session.
And by week six? Many report being 70% to 80% better. These are people who had tried physical therapy and still couldn’t get back to running.
Even in qualitative interviews, the kind where researchers sit down and talk to people after their treatment, patients describe ESWT as a relief simply because it’s non-invasive.
No needles. No surgery. No downtime. Even if they didn’t fully understand how it worked, most were happy to combine it with stretching, calf raises, and whatever else helped them heal.
How it compares to doing nothing
One of the simplest ways to judge any treatment is to compare it to doing… nothing. And that’s been done.
In placebo-controlled trials, where some people get fake shockwaves and others get the real thing, the ESWT group always comes out ahead. Less pain. More function. Better outcomes. And the sham group? Not much improvement.
Which tells you everything you need to know: shockwave therapy isn’t a placebo. It’s not a gimmick. It’s a real treatment that helps the right people, especially those stuck in that frustrating “I’ve tried everything” phase.
If your Achilles has been nagging for months and nothing’s helped, shockwave therapy is worth your attention. It’s backed by data, supported by patients, and miles ahead of sitting around hoping it just goes away.
How Long Does It Take to Feel Better?
Let’s be realistic, this isn’t a one-and-done fix. But that first session can give you a glimpse of what’s coming.
Especially with radial shockwave therapy, that’s the type where the energy spreads out across the surface of the tendon, rather than targeting one pinpoint deep inside, some patients report 10% to 20% less pain almost immediately. It’s not permanent yet, but it’s a sign the tissue is responding.
You might feel a bit sore later that day , that’s normal. Think of it like your tendon getting “woken up.” It’s not about numbing the pain. It’s about triggering your body to start healing what it’s been ignoring.
When most people start noticing results
If shockwave therapy is going to work for you, you’ll usually feel a clear difference by the second or third session.
By this point, your tendon is beginning to rebuild, literally. The sound waves stimulate tiny micro-injuries in the tissue (controlled ones, nothing dangerous), which tells your body: “Hey, let’s send blood, cells, and collagen to fix this.”
Most studies show measurable improvements in pain and function within 4 to 6 weeks, usually tracked by things like the VISA-A score (which we explained earlier) or the VAS pain scale.
(The VAS, short for Visual Analog Scale, is a simple tool where you rate your pain from 0 to 10. It’s how doctors measure whether something’s actually working beyond just “feels better.”)
How many sessions are usually needed
You’re not in this forever. Most treatment plans involve 3 to 6 sessions, done once per week. Each session lasts about 15–20 minutes and delivers around 2,000 shockwave pulses. No recovery time needed, just a bit of rest from heavy impact activity.
It’s not just about the sessions, though. What actually makes shockwave therapy work. really work, is when you combine it with tendon-loading exercises.
These are structured movements (like slow, controlled calf raises) designed to rebuild strength and structure in the tendon over time. Shockwaves wake up the healing process. Loading exercises give your body the tools to rebuild correctly. It’s a one-two punch.
What’s the Success Rate?
Nothing works for everyone. But if you’re looking for odds, shockwave therapy has a solid track record, especially for people who’ve been dealing with Achilles pain for a while.
Most studies say the same thing: about 60% to 80% of patients see significant improvement. That means either their pain drops by half or their VISA-A score, that’s the
Achilles-specific score from 0 (can’t walk) to 100 (pain-free and fully functional). jumps by at least 20 points.
That kind of gain isn’t just noticeable. It’s the difference between limping through the day and getting back to the gym.
And we’re not talking about just short-term relief. Many people keep those gains for months, even a year later, especially if they follow up with the right rehab.
Who tends to respond best
The best results come from people with chronic mid-portion Achilles tendinopathy, the kind of pain that lives in the middle of your tendon, not down where it attaches to your heel bone. And it’s chronic, meaning the pain’s been dragging on for 3 months or more.
If you’ve already tried physical therapy or anti-inflammatory meds (like ibuprofen) and they didn’t help much, you’re exactly the kind of person this treatment was designed for.
Because shockwave therapy doesn’t treat inflammation. It treats degeneration, the slow breakdown of tendon fibers that happens over time. That’s what tendinopathy actually is.
Who doesn’t see results and why ?
About 20% to 30% of patients don’t respond well to shockwave therapy.
Why not?
Sometimes it’s because the tendon damage is too advanced. In those cases, there might be structural tearing or calcification that needs surgical intervention. Other times, people have acute injuries, the kind where the body is already in a natural healing phase, and shockwave isn’t the right fit.
And honestly? Sometimes it just comes down to poor follow-through. Shockwave therapy isn’t magic, it works best when it’s paired with tendon-loading rehab. Skip the exercises, and you’re cutting your chances short.
Is It Better Than Physical Therapy or PRP Injections?
Sometimes, yes. Sometimes, no. It depends on what you’ve already tried, what kind of Achilles problem you have, and how consistent you are with rehab.
If you’re looking for relief fast, shockwave therapy tends to beat physical therapy, especially if your pain is down where the tendon meets the heel bone. That’s called insertional Achilles tendinopathy, and it’s notoriously stubborn.
One study found that 76% of patients with insertional pain improved after shockwave therapy, compared to only 28% with eccentric exercises alone.
(Eccentric exercises are the slow, controlled heel drops and calf raises you do to strengthen the tendon. They’re the gold standard in PT, and they work, but they take time.)
So if you’re stuck with insertional pain and haven’t seen progress after weeks of heel drops, shockwave therapy may get you moving again faster.
For mid-portion tendinopathy, the pain that shows up a few inches above the heel, physical therapy should be your first stop. It works for most people, and it’s low-cost, low-risk. But if you’ve already tried it and you’re still limping, that’s when shockwave comes in strong.
Which has better long-term results?
In the long run, both ESWT (that’s Extracorporeal Shockwave Therapy) and physical therapy with loading exercises tend to show similar outcomes, especially if the shockwave is combined with rehab.
Most studies follow patients for 6 to 12 months and show that pain relief and function hold steady over time in both groups.
So if you’re deciding between the two, the real question isn’t which lasts longer, but which gets you there faster and fits your life better.
What about PRP injections?
PRP, short for Platelet-Rich Plasma, is when they draw your blood, spin it down to isolate the platelets, and inject that concentrated mix back into your injured tendon. Sounds fancy. And expensive. Usually $500 to $1,000 or more per injection, and often not covered by insurance.
The evidence for PRP in Achilles tendon problems is weak.
In fact, a major study published in JAMA found no difference between PRP and a saline placebo when used alongside physical therapy. Patients got poked. They paid. But their outcomes weren’t any better than people who got salt water instead.
Meanwhile, shockwave therapy has consistently shown better pain relief, better function, and lower risk, without the needle.
When is one better than the other?
If you’re choosing between shockwave, physical therapy, and PRP, here’s how it shakes out:
Start with PT (it’s cheap, effective, and safe).
Add shockwave if PT stalls, especially for insertional pain.
Skip PRP unless you’ve exhausted the other two and still want to try something.
When used at the right time, shockwave therapy doesn’t just compete, it often wins.
Any Risks or Side Effects?
Yes, shockwave therapy is safe.
But like anything that actually does something, it comes with a few tradeoffs. Let’s walk through what’s normal, what’s rare, and how it stacks up against the alternatives.
So yes, it’s completely normal to experience:
Redness around the treatment area
Mild bruising
A bit of temporary numbness or tingling
Maybe some soreness that lasts a day or two
These aren’t side effects. They’re signs your body is responding.
What’s the Catch? Why Doesn’t Everyone Get It?
If shockwave therapy works, why doesn’t every clinic offer it? Why isn’t it covered by your insurance? And why does it still feel like this “optional” extra?
1. Insurance doesn’t usually cover it.
Even though the science behind shockwave therapy is solid, especially for stubborn cases of Achilles tendon pain, most U.S. insurance companies still call it “investigational.”
That doesn’t mean they think it’s a scam. It means the evidence isn’t totally uniform across all studies, or it hasn’t been around long enough for the bean counters to green-light it for reimbursement. In their world, “good but not perfect” often translates to “we’re not paying for that.”
So unless you’re in a rare plan that covers it, you’ll likely pay out of pocket.
2. What it actually costs
Let’s be honest, it isn’t cheap.
Most shockwave therapy sessions run between $150 and $400 each. You’ll usually need 3 to 6 sessions, depending on your condition and your clinic. That puts the total somewhere between $600 and $1,500.
Price varies based on:
The type of machine used (some are higher-energy, more advanced, or FDA-cleared)
The provider’s location (big city clinics tend to charge more)
Whether they bundle it with rehab sessions or other services
It’s not pocket change, but it’s still cheaper than surgery or a year of physical therapy with minimal results.
There are also a bunch of Shockwave Therapy Machines for home use. However, most of the time, they are being used to self-treat conditions like ED.
But, there is no scientific proof that treating erectile dysfunction with ESWT works or that the machines for home use are effective enough. Find a professional provider in your city easily and compare prices with JustHealthy.
3. Some clinics push it harder than others
Here’s something you probably already guessed:
Clinics that own shockwave machines are more likely to offer, and promote shockwave therapy.
And that’s not necessarily a bad thing. But it’s worth noting. These machines cost tens of thousands of dollars, so once a clinic buys one, of course they want to use it.
Just make sure the provider is being transparent with you, not just selling a machine session, but explaining how it fits into a real plan for healing, which should always include rehab.
Because remember, shockwave isn’t a solo act. It’s most effective when paired with loading exercises, those controlled, tendon-strengthening movements you build into your recovery.
So yes, shockwave therapy works. But like anything worthwhile in medicine, there’s nuance:
It’s effective for the right kind of Achilles pain.
It’s not usually covered.
And it needs to be combined with smart rehab to really work.
Will it Fix My Achilles Long Term, or Will the Pain Just Come Back?
Great question, because short-term relief is nice, but what you really want is to stop
limping around every few months like it’s Groundhog Day for your Achilles.
The good news? Shockwave therapy can create long-term change, if you do your part.
What the long-term results show
Let’s start with the data. Studies that tracked patients for 12 to 24 months, yes, a full year or two after treatment, found that most people who responded well to shockwave therapy were still doing well a year or more later. Less pain. More movement. No need for surgery.
The key phrase there is: “who responded well.”
We’re talking about people with chronic mid-portion Achilles tendinopathy, the kind where the tendon is worn down (not inflamed), a few centimeters above your heel. And importantly, they didn’t just get the shockwaves and walk out. They kept doing their rehab.
What real people say, months later
It’s not just the studies. Case reports, those are basically detailed stories of real patients written up by doctors ,show the same thing.
Runners who thought their careers were over went back to training and stayed there. Hikers
stopped limping on stairs. One guy described himself as “basically fixed,” even a year later.
He was still doing his calf raises a few times a week, and guess what? That’s not coincidence. That’s commitment.
What you have to do
This is where the long-term magic happens, and where a lot of people fall off.
Shockwave therapy restarts your healing. But it doesn’t finish the job on its own.
To lock in results, you need to:
Keep doing your loading exercises, those are slow, controlled movements (like calf raises and heel drops) that rebuild tendon strength
Stretch regularly, especially your calves and ankles, to avoid re-tightening the area
Modify your activity, at least for a while. That means easing back into running or sports with a plan, not jumping straight into sprinting a 10K.
In plain English: if you treat your Achilles like it’s bulletproof again after 3 pain-free weeks, you’ll probably be back where you started. But if you stay smart and consistent, the odds are in your favor.
Bottom Line: Should You Try Shockwave Therapy?
If your Achilles pain has been dragging on for more than three months and nothing else has worked, not physical therapy, not rest, not the usual anti-inflammatories, then yes, shockwave therapy is absolutely worth considering.
It’s not a magic fix. But for the right kind of problem, chronic, stubborn tendon pain that just won’t quit, it can be the push your body needs to finally start healing. Especially if you’re looking for something non-invasive and you’re willing to stick with the rehab afterward.
On the other hand, if your injury is new, if you’re already seeing progress with basic exercises, or if the cost is a major burden, then this might not be the right step right now. And that’s okay, not every tool is for every stage.
But if you’ve hit that frustrating point where nothing seems to work, and you’re ready to try something that’s backed by data, tested in real clinics, and trusted by athletes and doctors alike shockwave therapy deserves a spot on your shortlist.
Frequently Asked Questions
Does shockwave therapy actually work for Achilles pain?
Yes, especially for chronic mid-portion Achilles tendinopathy. Studies show 60–80% of patients get significant relief when it’s combined with rehab exercises.
How fast will I feel better?
Most feel improvement within 2–3 sessions. Some even notice reduced pain after the first session, but real change builds over 4–6 weeks.
How many sessions do I need?
Usually 3 to 6 sessions. One per week, each lasting 15–20 minutes.
Is it a permanent fix or will the pain come back?
It can lead to long-term relief, if you stick to the rehab. The shockwaves trigger healing, but the exercises lock it in.
What kind of Achilles pain does it help with?
Chronic, mid-portion tendinopathy. Not fresh injuries or pain right where the tendon attaches to the heel.
Who should NOT get shockwave therapy?
People with advanced tendon tears, calcification, or poor follow-through on rehab won’t get good results.
Is it better than physical therapy or PRP?
Depends. PT should be your first step. Shockwave helps if PT stalls. PRP is expensive and not proven to work better.
Are there side effects?
Mostly mild ones: redness, soreness, or tingling that goes away in a day or two. It’s non-invasive and safe.
Why isn’t it covered by insurance?
Most insurers label it “investigational.” That means not enough long-term uniform data, even though it clearly works for many.
How much does it cost?
Usually $150–$400 per session. Total cost ranges from $600–$1,500, depending on clinic and region.
Is it worth it?
If nothing else has worked and your pain’s been around for 3+ months, yes. Especially if you want to avoid surgery and get back to real movement.
