Have you been struggling with a painful tendon for a while – in your heel, Achilles tendon or knee, for example? Then you may have heard of shockwave therapy: a treatment using pressure waves that is increasingly used for persistent tendon complaints. But when do you benefit from it most? The right timing turns out to be at least as important as the treatment itself.
Scientific research shows that shockwave therapy can certainly help with tendon complaints. The evidence is particularly strong for heel complaints (plantar fasciopathy). For complaints in the Achilles tendon or the patellar tendon the results are more variable and depend more on your personal situation and the combination with exercises. That does not mean shockwave does not work. It does mean that when you receive the treatment makes a difference. What counts is whether the treatment actually helps you at that moment to have less pain, to load the tendon more and to recover better.
In practice, shockwave is sometimes applied quite early. But research increasingly shows that a painful tendon is not the same for everyone. Two people can receive the same diagnosis and yet, at that moment, have a completely different load tolerance and recovery capacity. The right question is therefore not “does shockwave work for this complaint?”, but: “is shockwave the right step for me right now?”
A painful tendon is not simply “inflamed” or “worn out”. Scientific research shows that a tendon can be in various states: from highly irritable and reactive to changed over the long term. These states can also blend into one another or even occur at the same time in different parts of the same tendon. That is why a standard treatment does not work equally well for everyone.
What does that mean for you? A tendon that still reacts strongly to load, becomes irritated quickly or clearly flares up after a small increase in activity, probably first needs rest, better dosing and carefully built-up loading. A tendon that has been giving complaints for longer but is less irritable may actually benefit from an extra impulse such as shockwave. So it is not about waiting as long as possible, but about choosing the right moment: when does shockwave match what your tendon can handle at that time?
Your practitioner does not only look at an ultrasound or a protocol, but above all at how your body responds. How do you react to walking, jumping or sport? Does the pain increase and linger for more than a day? Is your tendon still clearly irritable, or is it a persistent complaint that is not getting worse but is not improving either? Based on those signals, your practitioner determines together with you what the best next step is. Scientific guidelines emphasise that learning to load your tendon well, explanation about your complaint and gradually building up activity form the basis of good treatment. Shockwave can be a valuable addition to that, but not separate from the whole.
A well-timed shockwave treatment can provide an extra impulse within a broader plan of build-up and recovery. But if shockwave is applied too early or out of habit, it can actually cause unnecessary irritation or raise expectations that are not yet realistic at that point.
This article is certainly not against shockwave. On the contrary. Shockwave has clear advantages: it is non-invasive, relatively safe and, for the right complaints, can contribute to less pain and better functioning. In sports medicine, shockwave is increasingly used as a complement to active rehabilitation. International guidelines do emphasise that shockwave should not be seen as a quick fix, but as part of a well-considered treatment plan.
That is also why it makes sense to think along critically as a patient. Shockwave costs time and money. You are entitled to a treatment that fits your situation as well as possible. Better timing does not mean less treatment, but smarter treatment: with a greater chance of results.
Your practitioner first looks at how your complaint behaves. Below is an overview that can help you prepare the conversation with your practitioner.
In that case it is often better to first work on dosing load well, reducing irritability and gradually building up activity.
Then shockwave as an additional step can make the difference.
Your podologist, podiatrist or physiotherapist is ideally placed to assess this. These practitioners combine load analysis, examination, exercise therapy and guidance in daily movement. This allows them to use shockwave as part of a total plan in which you are central. Feel free to ask your practitioner whether shockwave is the right step for your situation at this moment.
Shockwave deserves a serious place in the treatment of tendon complaints, but not as an automatic first step. Science increasingly points towards a careful, personalised approach, in which the right timing, your load tolerance and your recovery together determine whether shockwave is worthwhile now. Not treating faster, but choosing better: that is what ultimately benefits you most.
Not treating faster, but choosing better: a well-timed shockwave treatment within a broader recovery plan gives you the best chance of results.
This article previously appeared on hielpijncentrum.nl .
