263. Shockwave Therapy for Achilles Tendinopathy w/ Peter Malliaras

Shockwave therapy for Achilles tendinopathy lacks robust evidence of specific biological efficacy when compared to sham treatments. A recent systematic review and meta-analysis reveals that shockwave therapy provides no significant benefit for insertional Achilles tendinopathy, while findings for mid-portion tendinopathy remain inconclusive. Much of the perceived clinical improvement likely stems from placebo or expectation-based mechanisms rather than the energy delivery itself. Given the financial costs and potential discomfort associated with the procedure, clinicians should prioritize evidence-based exercise interventions. While corticosteroids offer short-term pain relief, they carry risks of long-term tendon degradation, making them a last-resort option. Physiotherapist Peter Malliaras emphasizes that although shockwave therapy is not inherently harmful, its routine use lacks a strong scientific foundation, necessitating a patient-centered approach that balances clinical expectations with current research limitations.