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Shock! Our turn for a webinar on shockwave for Achilles tendinopathy

This webinar session, with John Ostrovskis, presents patient case studies for the treatment of achilles tendinopathy and shockwave therapy.

Presented by John Ostrovskis, Physiotherapist, Sonographer and Clinical Director at 919 Clinic

Running Injury

I think it is safe to say that using shockwave is one of the most commonly used treatment interventions alongside eccentric exercise for Achilles tendinopathy – agreed? Good!

Now we know the research and clinical efficacy is there – albeit at times it is hit and miss! Genuinely, the research is not in great agreement with using shockwave for Achilles. That said, over lockdown and beyond, we have seen and will continue to see webinars on the clinical evidence and application of shockwave for Achilles tendinopathy. So naturally, Physiquipe wanted to get involved!

But, as always, we like to do it a little differently.

We thought, “why not present a new speaker to the world, one who is experienced in using radial and focused shockwave, from a private practice, and have them share a case study?”

Present something on a real-life patient with REAL-LIFE problems to show how the technology can be used in the REAL WORLD!!!

So, we invited John Ostrovskis to the “stage” (webinar screen) to present his experience. John has over 30 years of experience as an Osteopath, has a post-grad sonography degree and has been using shockwave since 2015. His experience also extends to elite sport with posts at Sheffield Wednesday FC and Sheffield Eagles Rugby Club, so he had some pedigree.

He also has loads of case studies to share, one of which being an Achilles. During the session, John presented the history of the patient’s injury and what they were experiencing along with the scans where we officially diagnosed the insertional tendinopathy.


Using focused shockwave, 1st shockwave session:

  • Energy Level L6-L11 out of L20 = 0.12- 0.22 mJ/mm2
  • 4000 pulses with 5mm focus
  • Total Energy Dose = 0.17 mJ/mm2 x 4000 = 680 mJ/mm2

Alongside this, a progressed exercise regime was prescribed, primarily focusing on eccentric loading.


2nd shockwave session:

  • Energy Level 11-17 out of 20
  • 4000 pulses with 5mm focus
  • Total Energy Dose = 0.28 mJ/mm2 X 4000 = 1120 mJ/mm2

3rd shockwave session

  • Energy Level 17 out of 20
  • 3500 pulses at 5mm focus
  • Total Energy Dose = 0.34 mJ/mm2 x 3500 = 1190 mJ/mm2


We are going to have watch the webinar to find out. But a sneak preview, the results aren’t too bad!

We won’t ruin the surprise on the answers, but we are nice folk at Physiquipe and have hyperlinked the times (below webinar) for the questions so you can find the answers easily. Hope you enjoy the webinar and hope to see you on our next session, visit our upcoming webinar schedule.

Watch the full webinar below:


  • Start of John Presentation – 3:05
  • Treatment intervention; Do the same changes he made apply the same to radial – 24:58
  • Do you prefer focused to radial? – 26:32
  • Radial vs. focused Cleveland paper 2007 (acoustic field) – 27:55
  • Did you do anything else to shockwave and progressed exercise? – 29:37
  • Was it distal Achilles tear or tendinopathy? – 31:05
  • On Achilles tendinopathy research is mixed, does he see a difference in non-insertional to insertional tendinopathy? – 32:05
  • Is there an optimum frequency for radial/focused? – 34:05
  • Is using diagnostic ultrasound required for using focused shockwave? – 36:46
  • Have you used shockwave further up the structures? – 38:45
  • Dosage – you use a high dose on this case, do you do this regularly? – 39:44
  • Can shockwave cause damage? – 41:32
  • Athlete population vs. general public – this affects your shockwave treatment? – 43:00
  • Have you ever seen the sonographic appearance of a tendon change in the short term after shockwave? – 45:44
  • Any other precautions to using ESWT? – 47:17
  • Using it around the spine? – 48:24
  • Around Achilles tendinopathy is a defined diagnosis – are we limiting our scope of using shockwave – can we be using it on more? – 50:07
  • Radial vs. focused which one do I get? – 53:52
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