Shockwave therapy
Shockwave Therapy for Achilles Tendinopathy
One of the most rewarding injuries to treat with shockwave — and one of the most frustrating to live with.
What this condition is
Midportion Achilles tendinopathy is pain and thickening in the middle section of the Achilles tendon, typically two to six centimeters above the heel bone. It is the classic stubborn runner's injury: sore and stiff for the first steps in the morning, warming up during activity, then worse again afterwards. Left alone for months it does not simply resolve, because the tendon settles into a degenerated state rather than an inflamed one — which is why anti-inflammatories tend to disappoint.
How shockwave helps
Achilles tendinopathy is among the best-researched applications of shockwave therapy. A 2022 systematic review found consistent supporting evidence across four randomized controlled trials — a stronger research base than most alternatives can claim for this condition, and the reason shockwave has become a mainstay for tendon pain that will not settle.
Worth knowing. Pain in the middle of the tendon and pain right at the heel bone are slightly different problems and respond differently. Part of the first visit is working out which one you have, so your course is aimed at the right tissue.
Does this sound like you?
- Pain and stiffness in the Achilles tendon for the first steps in the morning
- A tender, sometimes visibly thickened section two to six centimeters above the heel
- Pain that eases as you warm up and returns, often worse, afterwards
- Months of symptoms that rest alone has not resolved
- Calf raises or hopping reproduce the pain
What we would do alongside it
Shockwave works best paired with progressive loading — a structured strengthening program for the tendon. We build that into your plan rather than leaving you to find it, because the combination consistently outperforms either on its own.
← Back to shockwave therapy: everything it treats, and what a course involves
What a course actually involves
Despite the name, there is no electrical shock involved and nothing to do with muscle stimulation. A "shockwave" here is a pressure wave traveling through tissue — the same physics as sound, which is why the treatment is also called acoustic wave therapy. No current passes through you. What you feel is a rapid mechanical tapping against the skin, firmest directly over the sore spot.
A single session
10 to 20 minutes. Gel goes on, a handheld applicator moves over the area delivering rapid pulses. Most people describe a firm tapping that is strongest over the sorest spot. The intensity is set to what you can tolerate.
A full course
Usually 3 to 6 sessions, about a week apart. The tissue response builds across the course rather than arriving at once. Many people notice a change partway through.
Afterwards
None. You walk out and back into your day. No needles, no anesthesia, no medication. The area may be sore, slightly red or a little swollen for a day or two — that is the expected response. We usually suggest easing off high-impact training briefly.
Safety and who it suits
Shockwave has a strong safety record across millions of treatments, and side effects are mild and short-lived — usually a day or two of tenderness in the treated area. As with any treatment there are situations where we would not use it, and we review your history before starting. We would hold off if any of these apply:
- An active infection in or over the area to be treated.
- A known blood clot in the area, or a clotting disorder without clearance from your physician.
- Over or near a known or suspected tumor.
- Over an open growth plate — which rules out anyone still growing, generally under 18.
- Pregnancy, where the treatment area is anywhere near the abdomen or lower back.
- A tendon that is close to fully torn. That needs imaging and an orthopedic opinion first, not shockwave.
- Significantly reduced bone density in the treatment area, until it has been assessed.
What it costs
Every course is built around the specific problem, so the cost depends on how many sessions you need and what we are treating. There is no single price we can put on a page and have it be true for everyone.
What we can do is give you the full figure up front. After the examination you get the total for your course in writing — not a per-session number that leaves you guessing at the end. Call the office on (805) 496-4469 and we will talk you through it.
Where we are, and who travels in
Dr. Nick Brock, DC practices at in Thousand Oaks, just off the 101. Mon, Wed, Thu 8:00–5:30 · Tue 2:00–5:30 · Closed Fri–Sun
Patients come in from across the Conejo Valley — Westlake Village and Newbury Park are about ten minutes out, Oak Park and Agoura Hills around fifteen, and Calabasas is the farthest at roughly twenty-five minutes eastbound. That distance is worth thinking about here in a way it is not for a single adjustment: a shockwave course is three to six visits about a week apart, so it is a drive you make repeatedly rather than once.
If you have been told your options are injections, surgery or living with it, this is worth a conversation first.
The first step is an examination — a proper look at the tissue, X-rays where they will tell us something useful, and a clear plan with a realistic timeframe before anything begins. Call the office and we will get you in.