Radial Shockwave Therapy: Myths, Energy Delivery, and Applicator Choice

At Venn Healthcare, we often hear the same questions from clinicians using radial shockwave therapy:

“Does a lower frequency go deeper?”
“Does a higher frequency only work on superficial tissues?”

These ideas sound logical at first glance, but they are myths. To achieve the best results from radial pressure wave (RPW) shockwave therapy, it is not the bar pressure or the frequency that matter most. It is the total energy delivered to the tissue.

Frequency: Speed, Not Depth

Frequency simply determines how quickly shockwave pulses are delivered. A lower frequency fires more slowly, while a higher frequency delivers pulses at a faster pace.


Think of it like this: a very low frequency can feel like a hammer repeatedly striking the same spot—heavy, spaced-out, and sometimes uncomfortable. A higher frequency, by contrast, feels lighter and more tolerable, more like a rapid “pins and needles” sensation. The energy per pulse remains the same, but because it’s delivered faster, the treatment experience is often smoother and more pleasant for patients.

Crucially, frequency does not determine how deep the treatment goes. Believing otherwise may cause clinicians to focus on the wrong treatment variables.

The Real Key: Total Energy Delivered

What actually determines treatment depth and effectiveness is the total energy delivered into the tissue. This is shaped by three main factors:

  1. Applicator size – Smaller applicators concentrate energy into a narrow area, producing higher intensity. Larger applicators distribute energy more widely, reducing intensity.
  2. Number of pulses – The total number of pulses dictates how much energy accumulates within the tissue during a session.
  3. Material of the applicator – Denser applicators (such as gold tips) transmit energy more efficiently and allow deeper penetration compared to plastic or silicone tips.

Together, these factors, not frequency or bar setting, determine how effective a shockwave session will be.

Choosing the Right Applicator Head

Applicator heads are designed for specific tissue depths and therapeutic targets. Using the right head can significantly improve outcomes:

  • D20 (20 mm head): Best for large, superficial muscles such as the quadriceps and hamstrings.
  • R15 (15 mm head): Ideal for medium-depth tendons, including the patellar tendon, plantar fascia, and lateral epicondyle (“tennis elbow”).
  • DI15 (15 mm gold head): Similar in size to the R15, but denser. Designed to transmit energy deeper, suited for gluteal tendinopathy, hamstring origins, and hip-related structures.

You can read more about applicator heads here.

By matching the applicator to the target tissue, practitioners can deliver the right amount of energy at the correct depth, optimising treatment results.

Simple Rules for Better Outcomes

To get the most from radial shockwave therapy, follow these practical rules:

  1. Do not overemphasise bar or frequency settings when thinking about treatment depth.
  2. Always think in terms of total energy delivered.
  3. Match the applicator head to the tissue type:
    • D20 for surface muscles
    • R15 for tendons
    • DI15 for deeper tendons and hip structures

Clinical Application Examples

Consider two scenarios:

  • Patellar tendinopathy: An R15 applicator at moderate pressure and 2,000 pulses provides sufficient energy to stimulate tendon healing without excessive discomfort.
  • Gluteal tendinopathy: Using a DI15 gold applicator ensures deeper penetration into the thick gluteal fascia, delivering the necessary energy where standard applicators may fall short.

In both cases, adjusting applicator choice and total pulses is more important than altering frequency.

The Takeaway for Shockwave Users

If you are using radial shockwave therapy in clinical practice, remember this:
Think of frequency as how fast pulses are delivered, while the overall energy defines how much treatment the tissue actually receives.

By shifting focus away from “bar” and “Hz” and towards energy delivery, applicator selection, and pulse count, clinicians can:

  • Improve patient outcomes
  • Maximise treatment efficiency
  • Use their shockwave device to its full potential