Direct answer: Chronic tendinopathy — in the Achilles, patellar tendon, elbow (tennis or golfer's elbow), or elsewhere — is tendon tissue that has failed to fully remodel after repeated strain, leaving disorganized collagen fibers and adhesion between the tendon and surrounding sheath instead of the organized structure a healthy tendon has. Rest alone rarely resolves it, because tendon tissue heals slowly and disorganized structure doesn't reorganize itself just by being left alone. At Novo Soft Tissue in the Denver Tech Center, an exam identifies the specific tendon and depth involved and whether focused ESWT, radial ESWT, or combining both fits the case.
By the time someone reaches out about chronic tendinopathy, they've usually already tried rest, ice, NSAIDs, an eccentric-loading exercise program, bracing or straps, and often a cortisone injection — which can weaken tendon tissue further rather than help it remodel. Some have been told surgery is the only option left.
Chronic tendinopathy involves both disorganized collagen fibers inside the tendon itself and adhesion between the tendon and the surrounding sheath or paratenon — part of why pain and stiffness persist even once acute inflammation has settled. The tendon has effectively healed back down in a less mobile, less organized state, which is a different problem than ongoing inflammation and doesn't respond the same way to rest or anti-inflammatories.
The choice depends on depth and location. Focused ESWT reaches deep, discrete tendon insertions and calcific deposits; radial ESWT suits broader, more superficial tendon origins, like the common extensor tendon at the elbow. For tendons with both a superficial paratenon component and a deeper substance component, such as the Achilles, combining both wave types is sometimes used. The exam — not a fixed protocol matched to a diagnosis — decides.
A 2026 systematic review and meta-analysis pooling 9 randomized trials and 530 patients with upper and lower limb tendinopathy found focused ESWT produced a statistically significant edge in pain reduction over radial as a standalone treatment, an advantage that tracks with focused energy's ability to reach a specific, identifiable depth. Separately, for Achilles tendinopathy that hadn't responded to exercise therapy, a retrospective study found 89.7% of patients receiving combined radial-plus-focused treatment reached a clinically meaningful improvement, compared with 63.8% on radial alone (p = .022) — evidence that combining depths can matter for tendons where both a surface and a deeper component are part of the problem.
A new-patient comprehensive exam is $270 and includes a full history, physical examination, and an explanation of the diagnosis; no treatment is performed on the first visit. Follow-up visits are $90 and typically run 10-15 minutes. Novo Soft Tissue does not bill insurance directly, but accepts cash, check, major credit cards, HSA, and FSA, and provides documentation you can submit for possible reimbursement.
Request an appointment to have the tendon evaluated, or read more on how radial and focused shockwave compare and the four tools used across all conditions.
Last reviewed: September 2026