Focused vs. Radial Shockwave Therapy

Clinics use the term "shockwave therapy" for two families of device: focused extracorporeal shockwave therapy and radial extracorporeal shockwave therapy. Both send pressure pulses through the skin from a handheld applicator, and both are non-invasive. The way each one produces its wave, and where that wave delivers its energy, is quite different.

If you are new to shockwave, start with what focused shockwave therapy is.

A focused device produces a wide field of pressure waves that is shaped so it converges at a particular depth inside the body, called the focus. The pressure is highest at that point, not at the skin. Commercial focused devices make the pulse in one of three ways: electrohydraulic (a spark in water), electromagnetic, or piezoelectric (crystals that change shape with electricity).

The pulse from a focused device has the physical features that define a true shockwave: it rises to peak pressure extremely fast and reaches a high peak pressure.

A radial device works more like a tiny hammer. Compressed air, or in some devices an electromagnetic coil, drives a small projectile against the applicator tip, and the tip passes the pressure wave into the body. The pressure is greatest right at the skin and fades as the wave spreads outward into deeper tissue.

Because the projectile moves far slower than sound travels through tissue, the wave rises more slowly and peaks lower than a focused shockwave. For that reason, researchers note that a radial wave is not a true shockwave in the physics sense, and some prefer the name radial pressure wave therapy.

These are differences in how the devices work, not in how well they work.

How the physical measurements translate to living tissue is not fully known, and it depends on the specific device and the energy setting used.

Research has not settled this. A systematic review of randomized trials found no scientific evidence favoring either radial or focused shockwave in terms of results. Another review concluded that the physical differences are substantial, but their effect on clinical results is unclear, and that no recommendation could be given on which type to use.

Comparing studies is hard. Trials used different devices, energy levels, numbers of pulses and numbers of sessions, so a result from a radial study cannot simply be applied to a focused device, or the other way around. When you read about shockwave research, it is worth checking which kind of device was used.

Whatever the device, results vary and not everyone responds.

The device at Innovare Tx is a focused shockwave device. We are not claiming it is better than radial; it is simply the type of device we offer, and the articles on this site describe focused shockwave.

Before any session, a provider (Charles Ortega, PA-C, or Rowena Calleja, PT) evaluates you and decides whether shockwave is appropriate. If it is, the provider sets the plan and trained medical staff perform the sessions. See what to expect.