Shockwave vs Strength: What Really Heals Runner’s Achilles Tendinopathy? | Find Your Stride | Edinburgh Podiatrist

Introduction

Achilles pain is one of the most frustrating injuries for runners. It limits speed, blocks explosive power during push-off, and can derail race prep for months. In recent years, shockwave therapy has been promoted as a fast-track treatment to “stimulate tendon healing” but does it actually work?

A new 2025 randomised controlled trial set out to answer that question, comparing recommended-dose radial shockwave therapy with a minimal-dose sham treatment, on top of a structured exercise plan, in people with chronic Achilles tendinopathy.

shockwave therapy has been promoted as a fast-track treatment to “stimulate tendon healing” but does it actually work?

Key takeaway:

Both groups improved — but real shockwave did not outperform sham treatment. “Recommended-dose rESWT is not superior to minimal-dose rESWT, significant within-group improvements were seen in both groups”

Study Summary (Plain English)

Participants: 57 patients with chronic Achilles tendinopathy

Treatment: 3 weekly radial shockwave sessions vs. minimal dose

Both groups did: Structured Achilles rehab program

Outcome: Pain & function tracked over 6 months

Result: No difference between real and sham shockwave

What This Means for Runners

This study reinforces a message elite rehab specialists already know:

Exercise loading is still the #1 treatment for Achilles tendinopathy

Progressively strengthening the calf-Achilles complex drives tendon remodeling and improves running performance.

Shockwave alone won’t fix tendon pain

Shockwave isn’t magic, and it shouldn’t replace structured loading or strength work.

Shockwave may help some athletes — but expectations need managing

Shockwave can sometimes reduce pain sensitivity short-term, which may assist early rehab — but this study suggests it’s not reliably superior to doing exercise rehab alone.

For athletes, that means:

• Don’t pay for shockwave expecting a quick cure

• Build a consistent calf-strength & plyometric program

• Use shockwave only as an adjunct if recommended by a sports clinician

Critical Thoughts

Study Strengths

• High-quality randomised trial

• Real-world chronic injury population

• Both groups got proper rehab (great control)

• 6-month follow-up period

Limitations

• Patients were not specifically runners (mixed activity population)

• Shockwave protocol was only 3 sessions (some practitioners use more)

• Results apply to radial shockwave — not necessarily focused shockwave

• People had symptoms for ~18 months — chronic tendon changes take time

Bottom Line

Shockwave did not beat sham therapy — likely because rehab alone works extremely well when done properly.

Practical Takeaways for Athletes

Do this first:

✅ Heavy slow calf raises (bent-knee & straight-leg)

✅ Plyometrics once pain decreases

✅ Daily Achilles mobility & isometrics early phase

✅ Gradual return to running load

Optional add-ons:

🟡 Shockwave — may help, but don’t rely on it

🟡 Orthoses — if biomechanics contribute

🟡 Manual therapy — symptom management

Avoid:

❌ Passive treatments without exercise

❌ “Running through it” without adapting load

❌ Expecting a quick fix

🏁 Final Word

If you’re battling persistent Achilles pain, the foundation is progressive strength training, not gadgets or quick-fix therapy. A podiatrist or sports physio should guide you through proper loading progressions to get you back to strong, fast, pain-free running. Shockwave may have a role — but your calf raise routine is still the real MVP.

Find Your Stride!