Radial pressure wave is the most common type of shockwave therapy, used in most MSK clinics. However, Focused is growing in popularity, due to the increased treatment options, treatment depth, treatment precision and patient comfort in more acute cases. Shockwave Therapy expert and Physio Specialist Benoy Mathew discusses the differences between the two types of Shockwave Therapy ESWT – Radial Pressure Wave (RPW) and Focused Shockwaves (FSW).

Focused and Radial shockwaves differ not only in regard to their physical properties and mode of generation, but also in terms of the magnitude of the standard parameters (pressure amplitude, pulse duration, impact) used and the therapeutic tissue penetration depths achieved.

Radial Pressure Wave / Radial shockwave (soft shock) – Larger treatment area of superficial indications

radial shockwave therapy device handpiece
  • Superficial 3-4 cm treatment depth
  • Spreads to treat larger areas
  • Slow impulse
  • Low energy density

The radial shockwave comprises three parts – Ultrasonic pulse, audio acoustic pulse and the relatively slow shear wave.

Radial pressure wave have their greatest energy at its source and weakens the farther it travels. Radial waves are generated by means of a pneumatic system. Using compressed air, a projectile is accelerated to a high-speed then suddenly decelerated by a transmitter, which is held to the area being treated. The generated kinetic energy is than transmitted to the tissue from where it propagates outwards aspherically as a radial wave into the tissue.The transmitter surface constitutes the highest pressure and highest energy density.

The pressure waves lose power the deeper they enter the body. For treatments where the targeted tissue is superficial, radial pressure waves will give patients good results, such as plantar fasciitis, tennis elbow or the Achilles tendon. The Storz radial systems offer a wide range of transmitters, including fascia and spine applicators, which allows for both local treatments and the treatment of broad superficial areas. Muscle chains can be treated functionally in the course of the chain. Pressure waves mobilise the tissue layers, which in turn breaks up adhesions and trigger points. The shifting of the tissue layers brings about myofascial release, which is the prerequisite for fascia therapy.

Focused shockwaves (hard shock) – Smaller focal point for greater accuracy and greater treatment depth.

focused shockwave machine storz medical
  • Deep reach up to 12cm dependent on the attachments used
  • Precise energy delivery to the exact area
  • Fast impulse
  • High energy density

Focused shockwaves are able to penetrate deeper into the tissues and provides all of its power at the designated depth. Focused shockwaves are generated electromagnetically through a cylindrical coil creating opposing magnetic fields when current is applied. This causes a submerged membrane to move and generate a pressure wave in the surrounding fluid medium. These propagate through the medium without any loss in energy with a small focal zone. At the site of actual wave generation the amount of energy dispersed is minimal. This limits damage at the skin and to underlying soft tissues.

The focusing mechanism directs each shock to a defined point within the body. The location within the body is adjusted by altering the energy output of the machine or by adjusting the focusing mechanism. A stand off applicator can be used to adapt the depth of energy. Treatments that require targeting tissue at a deeper level such as tissue close to bone, calcifications or delayed unions and non unions benefit from focused shockwaves. Patients who are unable to tolerate radial treatments for acute injuries will also benefit from focused shockwave therapy.

What are the biological effects of focused shockwave and radial pressure waves?

Focused shockwave AND radial pressure waves:

  • Increase of cell wall permeability
  • Stimulation of Microcirculation (Blood, Lymph)
  • Release of Substance P Neurotransmitter responsible for pain modulation.
  • It is a powerful vasodilator, causing considerable hypotension

Focused shockwaves ONLY:

  • Cavitation Release of nitric oxide (increased cell metabolism, neoangogenesis, anti-inflammatory effect)
  • Stimulation of growth factors
radial vs focused shockwave energy density graphs

Focused shockwave indications

F-SW is used for the treatment of but not limited to:

  • 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
  • Tibbialis posterior ankle sprain
  • Tendinopathies and Enthesopathies
  • Urological indications (ED) Male Impotence or Erectile Dysfucntion / Chronic Pelvic Pain / Peyronie’s
  • Delayed bone-non unions/bone healing
  • Wound Healing and other dermatological and aesthetic indications
focused shockwave patellar tendinopathy demo

Diagnostic imaging is sometimes used to exactly localise the point of energy concentration. The STORZ devices can be purchased with an Ultrasound diagnostic module (black/white or colour). Alternatively continuous patient feedback is used during the treatment to locate the ‘pain’ spot.

Focused shockwave indications

In more recent years the use of both modalities on a patient has become the gold standard for many advanced shockwave providers; treating the superficial and shallower structures with radial pressure waves and then targeting the source of the injury with focused shockwaves. Those clinics who are combining radial and focused shockwave are seeing fantastic results.

“I have 2 clinics that use shockwave, one has focused and radial devices and the other only radial. Despite the clinic with only radial being a multi disciplinary clinic treating elite professional athletes, including premier league footballers and having luxurious surroundings, I feel totally insufficient there because the focused device is at my other clinic. I know I can offer better treatments when having the focused device, it’s just not the same with only radial, I end up advising all the patients to go to the other clinic for better results no matter what part f the body. Focus can treat things that radial can’t and combined the two modalities are even better!”.
Stuart Brown, Podiatrist, Midlands Shockwave

“As a combination therapy focused shockwave with radial is providing my patients with outstanding results. I already have numerous case studies from using the device after only a few months. I treat a lot of runners and thanks to our excellent success rate with focused, the focus shockwave therapy word has spread through the running community in my area. It’s not only runners I have had great success with, one chap who suffered terribly with back pain is now enjoying his passion of Golf”.
Helen How, How Clinic Edinburgh.

More on Focused Shockwave from expert Benoy Mathew: