Radial Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy: Energy Matters

Radial extracorporeal shock wave therapy (rESWT) is an established modality in the management of Achilles tendinopathy. A recent study published in Clinical Rehabilitation reported that the addition of rESWT to exercise and education did not lead to improvements in pain, function or other outcomes compared to the addition of sham rESWT at 6 or 12 weeks post-baseline in individuals with insertional Achilles tendinopathy. The authors concluded that any benefits of rESWT in the management of insertional Achilles tendinopathy may be explained by a placebo mechanism. We respectfully suggest that this conclusion, though likely justified in the light of the results obtained, is to be restricted to rESWT performed in this study, but should not be generalized to all rESWT: the energy of the radial extracorporeal shock waves applied in this study is not high enough to result in a positive clinical outcome.