Quick Summary
Shockwave therapy comes in two distinct forms: radial (RSWT), which spreads pressure waves across a broader, more superficial area, and focused (ESWT), which channels energy to a precise point at depths of up to 12cm. Radial remains the most widely used option for surface-level conditions like plantar fasciitis and trigger points, while focused shockwave is gaining traction for deeper, more targeted treatments — from stress fractures to calcifications. Clinical research shows the two aren't mutually exclusive: combining focused and radial shockwave produces the strongest outcomes, particularly for calcific tendinopathy.
Healthcare professionals throughout Canada, including chiropractors, physiotherapists, massage therapists, veterinarians, sports medicine specialists, and urologists, are now recognizing the essential nature of integrating shockwave therapy into their practices. Shockwave therapy has garnered significant renown and is regarded as an optimal strategy for addressing a spectrum of musculoskeletal disorders, fostering healing, and elevating physical performance.
While the term "shockwave therapy" often evokes thoughts of Radial Pressure Wave therapy (Radial Shockwave) among clinicians and patients, it's worth noting that shockwave therapy actually encompasses two distinct forms. Although radial shockwave therapy remains the prevalent form of shockwave treatment for musculoskeletal conditions here in North America, focused shockwave therapy is experiencing a surge in popularity. This trend is attributed to its expanded treatment options, greater treatment depth, enhanced treatment precision, and improved patient results, especially in combination with radial shockwave. In this article, you'll discover the distinctions between radial and focused shockwave therapies, and the compelling case for integrating both approaches synergistically.
Focused Shockwave vs. Radial Shockwave: Quick Comparison
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| Comparison | Focused Shockwave | Radial Shockwave |
|---|---|---|
| Technology | Focused extracorporeal shockwave therapy (ESWT) | Radial pressure wave therapy (RPW/RSWT) |
| Wave Generation | Electromagnetic coil generating opposing magnetic fields | Pneumatic; compressed air drives a projectile against a transmitter |
| Energy Pattern | Converges to a precise focal point at depth | Disperses radially outward from the point of contact |
| Peak Energy Location | At the targeted depth, adjustable via attachments | At the skin surface, diminishing with depth |
| Reported Penetration Depth | Up to approximately 12 cm, depending on attachment | Superficial; energy drops off quickly beneath the surface |
| Precision | High — pinpoint targeting of a specific structure | Lower — broader, more general treatment area |
| Typical Applications | Deep tendinopathies near bone, stress fractures, calcifications, delayed unions/non-unions, ED/urological indications | Plantar fasciitis, calcific tendinitis, myofascial trigger points, chronic neck/back pain |
| Use in Combination | Combined with radial shockwave shown to improve calcification reduction in calcific tendinopathy | Frequently paired with focused shockwave as part of a combination protocol |
Focused Shockwaves — Smaller Focal Point for Greater Accuracy and Depth
- Achieves penetration depths of up to 12cm, contingent on the utilized attachments.
- Delivers precise energy to targeted areas with pinpoint accuracy.
- Rapid impulse generation.
- Exhibits a notable high-energy density.
- A greater investment is required due to the utilization of more sophisticated technology.
Focused shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive procedure that employs high-energy acoustic waves to treat a variety of musculoskeletal conditions. Focused shockwaves possess the capability to penetrate tissues at great depths, channeling all of their potency precisely to the intended level. These shockwaves are produced electromagnetically using a cylindrical coil, which generates opposing magnetic fields upon application. Shockwaves propagate through the medium (submerged membrane) with negligible energy loss and feature a precise focal area. The energy dispersion at the point of wave origination remains minimal, effectively minimizing potential harm to the skin and underlying soft tissues.
Modifying the energy output or adjusting the attached standoff on the handpiece allows the clinician to regulate the treatment depth, enabling precise targeting for specific conditions. Focused shockwave therapy is extremely effective for treatments that require precise targeting of tissues at greater depths, such as areas near bones, calcifications, and cases involving delayed unions and non-unions. Patients who may find radial treatments challenging to tolerate in the context of acute injuries can also experience notable benefits from focused shockwave therapy.
Mechanism of action: Focused shockwaves are generated by an electromagnetic device, which converts electrical energy into mechanical pressure pulses. The shockwaves induce microtrauma at the cellular level, promoting neovascularization, collagen synthesis, and increased metabolic activity — ultimately leading to tissue regeneration and pain relief.
Focused shockwave therapy uniquely possesses the capacity to induce cavitation and trigger the release of nitric oxide. This process elevates cell metabolism, encourages neoangiogenesis, and generates an anti-inflammatory response. Focused shockwave therapy also holds the capability to stimulate the production of growth factors within the body.
Focused Shockwave Applications
- Acute injuries in elite athletes
- Knee & joint arthritis
- Bone and stress fractures
- Shin splints
- Osteitis pubis (groin pain)
- Insertional Achilles pain
- Tibialis posterior tendon syndrome
- Medial tibial stress syndrome
- Haglund's deformity
- Peroneal tendon injuries
- Tibialis posterior ankle sprain
- Tendinopathies and enthesopathies
- Urological indications — erectile dysfunction (ED), chronic pelvic pain, Peyronie's disease
- Delayed bone unions/non-unions and bone healing
- Wound healing and other dermatological and aesthetic indications
Radial Pressure Wave / Radial Shockwave — Larger Treatment Area for Superficial Indications
Now onto the most popular form of shockwave therapy: radial shockwave therapy (RSWT), also referred to as radial pressure wave therapy. It shares some basic principles with focused shockwave therapy, but with distinct differences. In RSWT, the shockwaves are delivered radially, meaning they spread outward from the point of application, covering a broader treatment area. Radial pressure waves reach their peak intensity and energy density at the surface of the transmitter, with their power gradually diminishing as they penetrate deeper into the body. RSW, often referred to as "soft shocks," excels at treating larger surface areas for more superficial indications.
When shockwaves interact with the affected tissues, they trigger several biological responses, including increased blood flow to the area, stimulation of cell metabolism, and the release of substances that promote tissue repair and reduce inflammation. The intensity, frequency, and treatment parameters of radial shockwave therapy can be adjusted based on the specific condition being treated and the individual patient's needs.
Clinicians often ask how pressure waves are generated. Radial shockwaves originate from compressed air created within the primary module, which is subsequently directed into the handpiece. Within the handpiece, a projectile collides with a transmitter positioned at the barrel's end — the point of contact with the patient's skin. This collision produces a high-energy acoustic wave.
Depending on the specific medical condition being treated, clinicians can also adjust the projection and intensity of these pressure waves by switching to different transmitters. Storz Medical designs each transmitter with unique materials and shapes tailored to produce specific types of pressure waves. For instance, they've introduced the Atlas Silicone applicator, ideal for treating highly sensitive areas like craniomandibular dysfunction (CMD) or trigger points in the muscles of the cervical spine — one of the many reasons Storz Medical stands apart from competitors. The capacity to personalize and adapt treatments empowers therapists to harness the full potential of shockwave therapy.
Mechanism of action: Radial shockwaves are generated pneumatically. Unlike focused shockwaves, radial shockwaves exhibit a lower peak pressure but possess a broader energy distribution. This results in a "radial explosion" effect, where energy is dispersed across a wider region of tissue.
Radial Shockwave Applications
- Plantar fasciitis
- Tendinopathies
- Calcific shoulder tendinitis
- Achilles tendinopathy
- Patellar tendinopathy (jumper's knee)
- Trochanteric bursitis
- Medial tibial stress syndrome (shin splints)
- Myofascial trigger points
- Chronic neck and back pain
- Hip pain
BROWSE RADIAL SHOCKWAVE DEVICES
Combining Radial and Focused Shockwave Therapy
Now let's dive into the realm where genuine magic takes place. Imagine combining these two powerful technologies for a harmonious treatment approach — leveraging the unique mechanisms and applications of both focused and radial shockwave therapy within a single practice.
This randomized controlled trial compared the effectiveness of three shockwave therapy approaches (focused, radial, and combined) for treating calcific shoulder tendinopathy. A total of 45 patients were enrolled and divided into three groups, each receiving four sessions of shockwave therapy over one week. Group I received focused shockwaves, Group II received radial shockwaves, and Group III received a combination of focused and radial shockwaves. Patients were evaluated before treatment, one week after treatment, and three months later using musculoskeletal ultrasound (MSK US), assessing shoulder pain, range of motion (ROM), and shoulder function.
The results showed significant improvement in shoulder pain, active range of motion, and shoulder function for all three groups at both the one-week and three-month follow-up points, along with a notable reduction in calcification size across all groups. Comparatively, Group III (combined focused and radial shockwaves) demonstrated the most substantial reduction in calcification size compared to Groups I and II — supporting the case for combining both modalities in clinical practice.
