Extracorporeal shockwave therapy versus sham extracorporeal shockwave therapy for chronic Achilles tendinopathy: a meta-analysis of randomized controlled trials

Tingting Ni; Yanmin Zhao; Long Pang; Weili Fu

doi:10.7717/peerj.20506

Extracorporeal shockwave therapy versus sham extracorporeal shockwave therapy for chronic Achilles tendinopathy: a meta-analysis of randomized controlled trials

PeerJ. 2026 Jan 6:14:e20506. doi: 10.7717/peerj.20506. eCollection 2026.

Authors

Tingting Ni^{1

2}, Yanmin Zhao^{2

3}, Long Pang^{4

5}, Weili Fu^{4

5}

Affiliations

¹ Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
³ Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁴ Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁵ Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Abstract

Background: Chronic Achilles tendinopathy is a persistent and debilitating condition. Extracorporeal shockwave therapy (ESWT) is widely used, but its true effectiveness and safety for chronic Achilles tendinopathy remains debated. This study aimed to compare the effectiveness and safety of ESWT and sham ESWT for chronic Achilles tendinopathy.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs) comparing ESWT with sham ESWT in chronic Achilles tendinopathy. Primary outcomes included pain reduction (change in Visual Analog Scale (ΔVAS), minimal clinically important difference (MCID) 1.1/10) and functional improvement (change in Victorian Institute of Sports Assessment-Achilles (ΔVISA-A), MCID 8/100; change in American Orthopaedic Foot and Ankle Society (ΔAOFAS), MCID 12/100). Secondary outcomes encompassed adverse events. Risk of bias was assessed via Risk of Bias 2 (RoB2). Meta-analysis used RevMan 5.4.1, with weighted mean differences (WMD) and odds ratios (ORs) for continuous and dichotomous outcomes, respectively. Hypothesis-generating subgroup analyses explored ESWT type, tendinopathy classification, and symptom duration.

Results: Eight RCTs (458 participants) were included. No significant differences were observed between ESWT and sham groups in ΔVAS or ΔVISA-A, ΔAOFAS across follow-ups all P > 0.05). Adverse events were higher with ESWT (4.5% vs. 1.2%), though non-significant (P = 0.12). Subgroup analysis found that ESWT led to significant VAS reduction in patients with symptom duration < 12 months at 1-month (WMD: -0.76, P = 0.03) and 3-month (WMD: -1.23, P = 0.001) follow-ups than Sham ESWT.

Conclusions: ESWT showed no clear overall benefits compared to sham ESWT for chronic Achilles tendinopathy, but exploratory analyses hint at possible short-term pain relief for patients with symptoms lasting less than 12 months. More high-quality evidence is needed.

Keywords: Achilles tendinopathy; Extracorporeal shockwave therapy; Meta-analysis; Placebos; Randomized controlled trial.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Achilles Tendon*
Chronic Disease
Extracorporeal Shockwave Therapy* / adverse effects
Extracorporeal Shockwave Therapy* / methods
Humans
Randomized Controlled Trials as Topic
Tendinopathy* / therapy
Treatment Outcome