What Is Achilles Tendinopathy?
Achilles tendinopathy refers to chronic degeneration and thickening of the Achilles tendon — the strong tissue connecting your calf muscles to your heel.
It typically presents in two forms:
- Mid-portion tendinopathy: 2–6 cm above the heel bone
- Insertional tendinopathy: At the tendon’s attachment to the heel
Common symptoms include:
- Stiffness or sharp pain with the first steps in the morning
- Pain or swelling along the back of the heel
- Discomfort during running, jumping, or stair climbing
- Pain worsens with activity, improves with rest — but may return quickly
Why Is Achilles Tendinopathy So Hard to Treat?
- The Achilles tendon absorbs high repetitive loads, especially in runners and field athletes
- Blood supply is limited, particularly in the mid-portion
- Tendinopathy involves collagen breakdown, not inflammation — so anti-inflammatories alone often fail
- Rest alone leads to further tendon weakening without resolving the root cause
How Shockwave Therapy Helps Achilles Tendinopathy
Extracorporeal Shockwave Therapy (ESWT) delivers acoustic energy into the damaged tendon, stimulating biological repair. Shockwave therapy may:
- Promote collagen regeneration and tendon remodelling
- Stimulate neovascularisation (new blood vessel formation)
- Reduce pain-mediating substances like Substance P
- Enhance mechanotransduction, making the tendon more responsive to rehab loading
Shockwave therapy doesn’t replace rehab — but it primes the tendon for better adaptation and recovery.
What Does the Research Say?
Rompe et al. (2007, Am J Sports Med)
RCT comparing ESWT + eccentric exercise vs eccentric loading alone.
→ Outcome: The shockwave group experienced faster and more complete pain reduction.
Saxena et al. (2011, Foot & Ankle Int)
Prospective study of patients with chronic Achilles tendinopathy treated with radial ESWT.
→ Result: High satisfaction and significant pain reduction at 12-month follow-up.
Mani-Babu et al. (2015, Br J Sports Med)
Systematic review of ESWT for chronic tendinopathies.
→ Conclusion: Shockwave therapy improves pain and function when combined with progressive loading.
Gerdesmeyer et al. (2008, Am J Sports Med)
Multicentre RCT on focused ESWT for Achilles tendinopathy.
→ Outcome: Sustained pain relief and improved function at 1-year follow-up.
Chiropractors in Sydney’s Clinical Perspective
At Tensegrity Sports Clinics, leading chiropractors in Sydney, we recommend shockwave therapy for patients with persistent Achilles pain lasting over 6–8 weeks, especially when:
- Symptoms haven’t improved with rest or stretching
- Eccentric loading alone hasn’t resolved the issue
- Imaging (e.g. ultrasound) confirms tendinosis without rupture
- You’re ready to commit to a rehab program combining strength and mobility
Our clinical approach combines:
- Radial shockwave therapy targeted to the mid-tendon and surrounding fascia
- Eccentric-concentric loading, based on the Alfredson protocol
- Isometric calf holds to reduce pain and improve tolerance early
- Foot biomechanics and ankle mobility retraining
Treatment Plan & What to Expect
| Treatment Phase | What to Expect |
| Sessions | 1 per week for 4–6 weeks |
| Per Session | 10–15 minutes of shockwave + targeted rehab exercises |
| Initial Response | Reduced morning stiffness and soreness in 3–4 sessions |
| By 8–10 Weeks | Jogging and light training may resume |
| Full Course | Typically 6 sessions with ongoing progressive loading |
Recovery Timeline
- 3–4 weeks: Less morning pain, easier heel raises
- 8–10 weeks: Increased tolerance for jogging, jumping, or loading
- 3–6 months: Return to full activity and sports
- 6–12 months: Full tendon remodelling and strength recovery (depends on severity)
Even with optimal care, full tendon healing is gradual, especially for those with long-term or insertional tendinopathy.
When to Consider Shockwave Therapy
Shockwave therapy may be right for you if:
- You’ve had Achilles pain for over 6 weeks
- Rest, massage, or medication haven’t resolved it
- You want to stimulate natural tissue healing, not just reduce symptoms
- You’re ready to follow a structured tendon rehab plan
Final Thoughts
Achilles tendinopathy can be a stubborn and frustrating injury.
But when treated properly — with a combination of shockwave therapy and progressive rehab — full recovery is not only possible, but likely.
Book Your Shockwave Consultation
Don’t let heel pain hold you back. Call Tensegrity Sports Clinics or book online at www.tensegrity.com.au
Step forward stronger, faster, and pain-free.