• Clinician Portal
  • Partner Portal

(573) 745-1086

How to Order
Contact Us

Lower-Limb Tendon Pathway (Achilles & Patellar): Integrating Laser & Shockwave Inside a Graded Loading Framework

Clinician applying laser or shockwave near the Achilles or patellar tendon within a structured graded loading session.
Lower-limb tendon presentations, especially involving the Achilles and patellar tendons, require structured, repeatable visits to guide progression. This pathway outlines how laser and shockwave can be integrated inside a graded loading framework without disrupting the priority of load.

Why Focus on a Visit-Level Pathway for Lower-Limb Tendons?

Achilles and patellar tendon cases frequently require multi-week progression, but each 20–30 minute follow-up visit still needs structure. A predictable session design helps clinicians:
  • Maintain schedule integrity
  • Reduce unnecessary variability
  • Capture comparable data across providers
  • Make informed progression decisions
A brief, intentional laser or shockwave block can fit neatly inside this structure—without replacing or overshadowing the graded loading plan.

How Should Clinicians Define the Aim of Today’s Visit?

Each session starts with one key clinical decision: What is today’s aim? The original pathway outlines three potential aims:
  • Enable the day’s planned loading
  • Reduce provocation during a specific task
  • Confirm tolerance from the previous loading step
Documenting the aim first ensures clarity for the entire visit. It also helps the clinician determine when and how a modality block should be used within the session.

What Measurement Should Be Used for Achilles or Patellar Tendons?

The pathway emphasizes selecting one test and holding it constant across sessions. The test should match the tendon’s functional demands.

For Achilles Tendon Presentations:

Common options include:

  • Number of heel raises performed in a fixed interval
  • Repetitions until form change, using the same surface and cadence

For Patellar Tendon Presentations:

Recommended option:

  • Single-leg decline squat repetitions performed at a consistent depth and tempo

Regardless of the test, the clinician must use:

  • The same instructions
  • The same equipment
  • The same recording method
This consistency creates meaningful data that can be compared from visit to visit.

How Are Shockwave and Laser Used Inside the Visit?

The intervention block is kept short and fixed in duration, allowing the clinician to integrate a modality without disrupting the schedule or overshadowing the loading priority.

  • Shockwave (Focal Application)

    Shockwave is applied as a brief, targeted treatment directly over the most tender or pathological zone when symptoms are

    • Localized
    • Task-provoked
    • Easily reproduced during loading

    This aligns with scenarios where clinicians want to see whether focal mechanical stimulation influences task performance during the re-test.

  • Laser (Regional Application)

    A short regional laser application is used when symptoms are:

    • More diffuse
    • Related to general irritability
    • Present in patients needing comfort or preparation for loading

    Laser therapy is FDA-cleared for increasing circulation, stimulating tissue, and pain relief, which may support readiness for the planned loading progression.

  • Why a Fixed Window?

    Regardless of modality choice, the intervention uses the exact same time window each visit. This keeps documentation predictable and preserves schedule flow.

What Happens After the Modality Application

Immediately following the shockwave or laser block, clinicians:
  • Re-test the same measurement selected earlier
  • Record the result
  • Add a short descriptor of perceived change (e.g., “no change,” “improved,” “more comfortable”)
  • Document start/stop times for the modality block
After re-testing, the clinician proceeds with the day’s planned graded loading and patient education.

Why Does This Pathway Improve Clarity and Workflow?

The pathway emphasizes one repeated measure and one fixed intervention window, which together create:
  • Interpretable data
  • Reduced variability across providers
  • Clearer return-to-load decision-making
  • Concise, consistent documentation
  • Better control of clinical schedules
Instead of adding complexity to tendon care, this approach simplifies decisions—making each visit efficient and productive for both the clinician and the patient.

Explore our Class 4 Lasers and Shockwave Therapy Device

Laser

Medray Class 4 laser device for circulation, tissue stimulation, and pain relief support.
Explore Medray’s Class 4 Lasers

Medray’s Class 4 therapeutic lasers are designed to support circulation, tissue stimulation, and pain relief through a streamlined, repeatable workflow. Discover how laser therapy integrates seamlessly into busy clinics while providing a contact-free option for sensitive presentations.

Explore our Class 4 Lasers

Shockwave

Softshock 2.0 radial pressure wave shockwave therapy device for musculoskeletal care.
Explore Softshock 2.0 (RPW)
The Softshock 2.0 radial pressure wave device delivers a targeted mechanical stimulus that supports circulation, tissue stimulation, and pain relief. Learn how shockwave fits into daily clinical routines as a focal, efficient intervention for localized musculoskeletal presentations.
Explore our Shockwave

Support for structured tendon workflows

Take the Next Step Toward Organized Tendon Visits

Ready to bring more structure to Achilles and patellar tendon care? Our team helps clinics integrate graded loading plans with clearly timed laser and shockwave blocks, so every visit follows a consistent, defensible framework.

We can walk your staff through visit-level pathways, parameter sets, and simple re-test routines that fit inside a 20–30 minute follow-up. Call us at (573) 745-1086 or visit our Contact Us page to schedule a conversation about your clinic’s tendon workflow.

Schedule a tendon workflow consult
Disclaimer:

Medray Laser & Technology manufactures and distributes FDA-cleared medical devices designed to support circulation, tissue stimulation, and pain relief. Our products are intended for use by licensed healthcare professionals. While clinical research and practitioner experience support the use of laser and radial pressure wave (RPW) therapy in various applications, some uses described in this article may be considered off-label and are not explicitly cleared by the FDA. Patients should consult their healthcare provider to determine the best treatment for their individual needs. The information provided in this article is for educational purposes only and should not be considered medical advice or a substitute for consultation with a licensed medical professional.

Educational content is for licensed healthcare providers and may include discussion of clinical uses not cleared by the FDA. Provided for scientific exchange and not intended as promotional.

The FDA has cleared therapeutic lasers and shockwave devices for increasing circulation, tissue stimulation, and pain relief. Some of the use cases described in this article reflect how clinicians may apply shockwave therapy in practice, based on peer-reviewed research. This information is provided for educational purposes only and does not imply FDA clearance or approval for specific conditions.

Share the post:
Scroll to Top