Spoiler alert: Exercise and Shockwave therapy are both excellent non-surgical treatment options but a combination of both provides even better results [combined Shockwave and Exercise saw 82% improvement!] Read on for more information regarding some of the approaches we use at
Parkway Physiotherapy + Performance Centre.


By chronic Achilles pain we mean pain that is persistent or recurrent and by many definitions, any pain that has lasted longer than 6 months. If you have any painful nodules, lumps or swelling in the Achilles then we can be fairly sure that there are changes in the tendon structure and recommend that you be seen for a consultation without question.


Non-surgical options for Achilles treatments have long been eccentric exercise. The most popular protocol has been the Alfredson Protocol which is well described elsewhere and is shown in brief in the picture above. In short, it requires 2 sessions per day, 90 repetitions per session; half the exercises are performed with a straight knee and half with a bent knee. This is a time consuming yet excellent protocol however in our experience and from the author as well, it does not help everyone.


A more recent non-surgical option has been shockwave therapy. Evidence for shockwave by the way includes the insertional types of Achilles pain where the injury is directly at the heel bone and even those with Haglunds deformity or the “pump bump” deformity at the back of the heel. Note 3 Shockwave sessions are provided with one week between session. 2000 shocks per treatment session with a pressure of 3 bar (energy of 0.1 mJ/mm2).


If both these conservative treatment methods work, why not compare a combination to see if results are even better? This is exactly what Rompe et al. did, publishing their results in the American Journal of Sports Medicine. They studied Achilles patients who had failed at least 3 months of therapy and placed them into either an exercise or an exercise plus shockwave group. The combined Shockwave and Exercise group had 82% improvement (“much improved” or “fully resolved” on a Likert scale) whereas the Exercise only group had 56% improvement. After one year the differences between these groups was no longer significant which shows how much we still need to learn about managing these injuries.


Come see one of our team at Parkway Physiotherapy + Performance Centre for an assessment of your Achilles injury, discussion of possible risk factors, a progressive exercise regime and Shockwave Therapy and we'll have you back on your feet in no time.

The Parkway Physiotherapy & Performance Centre Difference

Parkway Physiotherapy & Performance Centre is an integrative healthcare clinic offering physiotherapy, chiropractic, concussion management, athletic therapy, kinesiology, fitness and personal training, high performance consulting, women's pelvic health, pilates and massage therapy since 2008. We stress pertinent patient education, community support, and the promotion of research and continual learning for our team to provide our clients with best of breed technology, treatment and outcome. We are passionate about giving you the best quality health care to relieve pain, release tension and restore fluidity to your body.

We look forward to helping you!

Click To Call