Modalities in Physical Therapy come and go. Many clinics have closets full of old, outdated, and unproven modalities that were once the next best thing for pain. In my experience, the worst thing about these modalities outside of their ineffectiveness is they displace proven and effective interventions such as manual therapy and exercise. Currently, this process is evident in the clinical management of tendon injuries or tendinopathy. Strong evidence exists for the utilization of graded, progressive exercise to improve pain and disability in patients with this diagnosis. Clinicians also must determine the precipitating or perpetuating factors causing the tendon overload. Conversely, modalities such as shockwave therapy have no place in the treatment of these injuries.
Korakakis and colleagues published their findings on the effectiveness of shockwave therapy for achilles tendinopathy, both insertional and mid portion, in the Journal of Orthopedic and Sports Physical Therapy (2026). Researchers conducted a systematic review and meta analysis including 9 randomized controlled trials of 557 participants. In participants with achilles tendinopathy, shockwave therapy showed no clinical benefit over placebo. Authors concluded, “At present, shockwave therapy should not be considered a routine treatment for either insertional or mid portion achilles tendinopathy and alternative treatments should be provided.”
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