Shockwave for Achilles Tendinitis

Rest,stretching and massaging w creams and oils. Doctor will not give me a cortisone shot out of fear it would be to painful. I really do need something done.

Partial tear of Achilles playing competitive tennis. Still feeling the effects over two years afterwards. Have tried many treatments. Orthodics, NSAIDs, and high quality brace have been the most helpful but not enough to resume competitve play. Discouraged.

Have tried many things including the non FDA approved Shockwave Theapy which has not been effective after the four recommended treatments. I find the best thing for pain relief is REST which is nearly impossible as I work on my feet all day in healthcare. Dynamic stretching especially the kind that Yoga can give is also temporarily effective.

I suffered an Achilles injury right after Boston Marathon this year...partial vertical tear. I tried a bunch of things for a few months (eccentrics, rest, prolotherapy, massage, etc.) with zero improvement (based on ultrasound of the tendon). Finally gave PRP a shot in mid August. I should note that it was incredibly painful. Felt markedly WORSE for a couple weeks after the injection, no anti-inflammatories allowed, but was told this is normal as that is part of the healing process. Resumed the heel drops afterwards and slowly improved. The tendon tear DID heal in about 8 weeks after the PRP treatment (based on ultrasound), but was still quite sore. The doc recommended EPAT, and I had 5 sessions of that. Started run-walking again in early October (after starting EPAT), very gradually building up the mileage...just did a 12 mile easy run this weekend as part of a 30mpw block. Not discomfort free but Id call it 85-90% better. I think the combination of PRP and EPAT was phenomenal for my situation.

If you don't have a tear, maybe give the EPAT a try first...it is relatively painless, quick, and no recovery period. The PRP is likely gonna set you back a bit before you get better.

All the non-invasive PT treatments failed, although Graston temporarily felt great for few minutes right after the sessions ended.

PRP did zero for me other than HURT a real lot. Big needle, big platelets. Threw up about 5 minutes afterwards from the trauma (HTFU, I've heard it before). Not too expensive, maybe $500 cash out of pocket for the procedure. Health insurance covered the blood draws.

ESWT worked and repaired about 70% of the injury. Outpatient procedure under general anesthesia. Paid 100% cash out of pocket because it's experimental and not a covered procedure. Paid $3k cash. Totally worth it. It was really nice not being in pain just from walking. I think the Ossatron branded device is manufactured in the US, which is administered as a single treatment. The French machine requires 3 dosesx1 per week, to get the same effect. My podiatrist did not own the machine, so it became logistically too difficult to line up a second treatment. I could still use another round to clear all of the scar tissue.

I changed my diet and went mostly gluten-free and low carb. The lesser discomforts went away, which for me gets to about 95% injury repaired. Achilles tendinosis is not inflammation, but there was something going on involving diet and the affect on healing.

I'm still doing eccentric drops, but now just beginning to look a running again. But with a lot of focus on technique and form. I can run on the treadmill for a mile and have zero achilles issues.

I have been managing insertional achilles tendinopathy in my right ankle for four years.
I could write an twenty page essay here, but to be succinct the things that have helped the most are: eccentric exercise, ART/MFR, shockwave therapy, night splint.

The things that have not helped are: RICE, rest (not running makes the pain go away, but as soon as I start running again, it comes back), NSAIDs (including topical diclofenac), orthotics, shoe changes (Minimal/low-drop shoes definitely made it worse though), heel lifts, self-administered deep tissue massage.

I would not expect to see any long-term results with treatment designed to reduce inflammation, in most cases (including mine), inflammation is a secondary factor, a response to dysfunctional tissue in the tendon. The key to success is breaking up the scar tissue and collagen, and then rebuilding it correctly. Eccentric exercises are the best thing that you can do to do this at home. They will hurt initially. It's going to get worse before it gets better.

If it impacts my training again, I'm going to try PRP injections. They are considered experimental and not covered by insurance, but the success rate has been very high. It's $500 per shot and I may need up to 5 shots, but if it fixes my tendon, I'll consider it the best bargain I've ever had.

I would highly recommend working with an orthopedist, ideally one with a specialty in sports medicine.