Radial Shockwave Therapy vs. Focused Shockwave Therapy: Understanding the Difference

Radial Shockwave Therapy vs. Focused Shockwave Therapy: Understanding the Difference


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 will discover the distinctions between Radial and Focused shockwave therapies, as well as the compelling necessity of integrating both approaches synergistically.



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Focused shockwaves – Smaller focal point for greater accuracy and greater treatment 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.

Focus 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 the precise targeting for specific conditions. Focused shockwave therapy is extremely effective for addressing treatments that need precise targeting of tissues at greater depths, such as areas near bones, calcifications, as well as cases involving delayed unions and non-unions. Moreover, 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: Focus 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. This ultimately leads to tissue regeneration and pain relief.

Focused shockwave therapy uniquely possesses the capacity to induce cavitation and trigger the release of nitric oxide. Consequently, this process elevates cell metabolism, encourages neoangiogenesis, and generates an anti-inflammatory response. Additionally, focused shockwave therapy holds the capability to stimulate the production of growth factors within the body.

Focus 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
  • Haglunds Deformity
  • Peroneal Tendon
  • Tibialis Posterior Ankle Sprain
  • Tendinopathies and Enthesopathies
  • Urological indications (ED) – Male Impotence or Erectile Dysfunction / Chronic Pelvic Pain / Peyronie’s
  • Delayed Bone-Non Unions / Bone Healing
  • Wound Healing and other Dermatological and Aesthetic indications



Radial Pressure Wave / Radial shockwave – Larger treatment area of superficial indications

Now onto the most popular form of shockwave therapy, Radial shockwave therapy (RSWT), also referred to as radial pressure wave therapy, shares some of the same basic principles as focus shockwave therapy, but with some distinct differences. In RSWT, the shockwaves are delivered radially, meaning they spread outwards 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, excel in treating larger surface areas for more superficial indications.

When shockwaves interact with the affected tissues, they trigger several biological responses. These include increased blood flow to the area, stimulation of cell metabolism, and the release of substances that promote tissue repair and reduce inflammation. It’s important to note that 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 inquire about the generation of pressure waves. 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, serving as the point of contact with the patient’s skin. This collision results in the production of a high-energy acoustic wave.

However, the customization doesn’t end there. Depending on the specific medical condition being treated, clinicians have the flexibility to 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 have introduced the Atlas Silicone applicator, which is ideal for treating highly sensitive areas like Craniomandibular Dysfunction (CMD) or trigger points in the muscles of the cervical spine. This is one of the many reasons that sets Storz Medical apart from their competitors. The capacity to personalize and adapt treatments empowers therapists to harness the complete 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 the 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 BursitisMedial Tibial Stress Syndrome (Shin Splints)
  • Myofascial Trigger PointsChronic Neck and Back Pain
  • Hip Pain



Combining Radial and Focus Shockwave Therapy


Now, let’s dive into the realm where genuine magic takes place! Imagine combining these two powerful technologies, yielding a harmonious treatment approach. Lets examine the intricacies of focused shockwave and radial shockwave therapies, their unique mechanisms, diverse applications, and the advantages of integrating them within your practice!

This randomized controlled trial aimed to compare the effectiveness of three different 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 shock wave therapy over a period of one week. Group I received focused shock waves, Group II received radial shock waves, and Group III received a combination of focused and radial shock waves. Patients were evaluated before treatment, one week after the end of 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. Additionally, there was a notable reduction in the size of calcifications observed through ultrasound in all groups. Comparatively, Group III (combined focused and radial shock waves) demonstrated the most substantial reduction in calcification size compared to Groups I and II.





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