Shockwave for Achilles and Patellar Tendinopathy

A tendon connects muscle to bone. When it is loaded more than it can adapt to, it can become painful, thickened and less able to handle force. This is called tendinopathy. You may also hear tendinitis or tendinosis; they describe the same problem.

The Achilles tendon connects your calf muscles to your heel bone. Achilles tendinopathy comes in two types, which can occur separately or together. Mid-portion (noninsertional) tendinopathy affects the middle of the tendon, a few centimeters above the heel, and is common in runners and active younger people. Insertional tendinopathy affects the spot where the tendon attaches to the heel bone, and can happen at any activity level.

The patellar tendon runs from the bottom of your kneecap to your shinbone. Patellar tendinopathy, often called jumper's knee, causes pain at the front of the knee where the tendon starts, just below the kneecap. It is common in sports with a lot of jumping, such as basketball and volleyball.

These problems usually build up gradually. A sudden jump in training, more hills or jumping, a new sport, a tight calf, or not enough recovery time between sessions are common triggers.

For both conditions, the main treatment is a structured exercise program that loads the tendon gradually so it can adapt. Complete rest tends to weaken the tendon, so the aim is to adjust activity rather than stop all of it.

Tendons adapt slowly, so a program often runs for three months or more. A Cochrane review notes that exercise is the main treatment for patellar tendinopathy, although even the exercise trials are small. A physical therapy program can set the right starting level and progression.

Shockwave has been studied mostly in people whose tendon pain has lasted six months or more despite exercise and other care. In those studies it was usually added to an exercise program, not used on its own. The American Academy of Orthopaedic Surgeons notes that recent studies report improvement in pain and function with shockwave for Achilles tendinitis, especially when combined with other nonsurgical treatment such as eccentric exercise.

If you have had pain for only a few weeks, or have not yet tried a proper loading program, a provider will usually start there.

For the Achilles tendon, the evidence is moderate at best:

For patellar tendinopathy, the evidence is thinner. The same 2015 review rated it as limited. A randomized trial in volleyball, basketball and handball players who kept competing found that shockwave on its own gave no benefit over a placebo treatment.

Put simply: shockwave may add something to exercise for some people with long-lasting Achilles pain, the evidence for jumper's knee is weak, and it does not replace the exercise program. Results vary, and not everyone responds.

You start with an evaluation by a provider, Charles Ortega, PA-C, or Rowena Calleja, PT, a Texas-licensed physical therapist. They ask about your training, your work and what you have tried, examine the tendon, and check for a tear or other cause of pain. For the knee, they also look for other sources of front-of-knee pain; see knee pain for those.

If shockwave seems appropriate, the provider sets the plan, usually alongside a loading program or physical therapy. Trained medical staff perform the sessions: they locate the most tender area, apply gel and focus the waves there for about 15 to 30 minutes. Mild, temporary discomfort is common. Your provider may ask you to avoid anti-inflammatory medicines and high-impact activity such as running and jumping during the course; do not stop a prescribed medicine without asking the prescriber. Your provider sets the number and spacing of sessions; in studies, courses were commonly 3 to 5 sessions about a week apart.

Most insurance plans do not cover shockwave therapy, so the sessions are self-pay; your office visit may be billable to insurance. See cost and memberships.

Seek urgent care, and avoid putting weight on the leg, if: