ObjectivesTo investigate the immediate effects of radial shockwave therapy versus sham on movement evoked pain in people with insertional Achilles tendinopathy.DesignRandomised controlled trial.SettingPrivate clinic.ParticipantsPeople diagnosed with insertional Achilles tendinopathy who were over 18 years old with a symptom duration of greater than 3 months.InterventionSeventy-six participants (53% female, mean age 51 years) were randomly allocated to a radial shockwave (n = 38) or sham (n = 38) group. Three sessions of radial shockwave or sham (no pressure) to the most affected side in 5-to-10-day intervals. All participants received identical education and exercises.Main measuresThe primary outcome measure was movement evoked pain (measured on a 100 mm visual analogue scale) at the first, second and third session immediately after each application.ResultsThere was 96% follow up of participants at the third session. Over half of the participants believed they were receiving the 'real' treatment (average 58%). The mean movement evoked pain scores improved each session by 0.6 points for the radial shockwave therapy and 0.7 points for the sham group. There was no difference between the groups after the first (-0.4, 95% confidence interval (CI) -1.6 to 0.8), second (0.4, 95% CI -0.8 to 1.6) or third session (-0.4, 95% CI -1.6 to 0.8).ConclusionsIn adults with insertional Achilles tendinopathy, radial shockwave therapy demonstrated no more efficacy than a sham in reducing immediate movement evoked pain. These results do not support the use of radial shockwave therapy for immediate pain relief among people with this condition.Clinical trial registrationACTRN12620000035921.