Comparing Focused and Radial Shockwave Devices in Clinical Practice
Overview Of Extracorporeal Shockwave Therapy
Extracorporeal shockwave therapy is widely used across musculoskeletal and soft tissue disorders. The two main device classes that are in clinical use are focused shock waves and radial shockwaves.
Focused Shockwave Devices
Focused shockwave devices produce a pressure wave that converges to an internal focal zone at a defined depth energy flux density. The focal depth can be controlled and can deliver higher peak pressures and is best suited to target deep lesions.
Radial Shockwave Devices
Radial shockwave devices generate a projectile that is produced by a pressure wave that spreads radially from the skin surface. Radial waves have maximal energy superficially and progressively less penetration with distance. They generally deliver lower peak pressures and lower energy flux density than focused devices.
Key Differences Between Focused And Radial Therapy
The key difference between radial and focused shockwave therapy is energy distribution and penetration, dose control, clinical handling, and the overall cost and logistics of the devices.
Clinical Applications Of Focused Shockwave Therapy
Focused shockwave therapy has a focal energy concentrated at a definable depth and is very useful for deep tendon insertions, bone tendon junctions, and focal calcifications and can deliver low to high energy flux density depending on the device. Focal extracorporeal shockwave is more precise in dosing, especially in the depth, and allows titration. Focal extracorporeal shockwave requires accurate localizations; sometimes utilization of ultrasound or palpation to target the focal spot is utilized.
Clinical Applications Of Radial Shockwave Therapy
Radial extracorporeal shockwave has the highest energy at or near the applicator’s surface with rapidly decreasing penetration, making it better for superficial structures and broader tissue areas such as superficial tendinopathies (plantar fasciitis). Radial extracorporeal shockwave’s dose is defined by air pressure and the number of pulses, and there is less precise focal dosing. Radial extracorporeal shockwave often is used for sweeping or broad application without an internal focal target.
Cost And Portability Comparison
Overall, focused shockwave devices are typically more complex and expensive, and radial devices are generally less costly and more portable. The device costs and availability may widely vary between manufacturers and regions.
Contraindications To Shockwave Therapy
Absolute Contraindications For Both Radial And Focused Extracorporeal Shockwave Devices
Malignancy in the treatment field or active tumor
Fetal area
Infection at target site
Open growth plates in children
Relative Contraindications To Shockwave Therapy
Coagulopathy or concurrent use of anticoagulants
Pacemakers or implantable cardiac devices
Areas of known major nerves or vessels
Side Effects Of ESWT
Transient pain during or after treatment, local erythema, swelling, petechiae, small hematomas, transient numbness or tingling. Serious complications such as tendon rupture are extremely rare according to expert consensus but have been reported. Overall safety profile is very favorable when the devices and the protocols are used appropriately.
How Do Shockwaves Work Clinically?
When shockwaves enter the human body, different mechanical effects will be generated at the interface of different tissues due to different contact media such as fat, tendon, ligament, and bone tissue, and finally, different forces will be generated on cells. In these forces, tensile stress can relax tissues. It promotes microcirculation while compressive stress can change the elasticity of cells and increase their ability to absorb oxygen.
Cellular and Therapeutic Mechanisms of Shockwave Therapy
For therapeutic purposes, extracorporeal shockwave therapy causes a large number of tiny bubbles to be created in the tissue which rapidly expand and burst under the action of the shockwave producing a high-speed fluid microjet and a shock effect. This cavitation effect is particularly effective in reopening occluded microvasculature and releasing soft tissue adhesions.
How Shockwave Therapy Reduces Pain and Inflammation
The exact mechanism of pain relieving and functional properties of extracorporeal shockwave therapy is not fully understood. Several studies have attempted to elucidate the mechanisms of shock waves from basic science and clinical studies have shown that energy released by extracorporeal shockwave therapy is able to stimulate pain receptors located in the skin, muscle, connective tissue, bone, and joints and activate unmyelinated C and delta fibers to initiate the pain control system and block nerve transmission resulting in analgesic effects. In addition, extracorporeal shockwave therapy has been shown to significantly downgrade the levels of IL-1, TNF-alpha, MMPs in degenerated joint tissues thereby reducing the local inflammatory response. Additionally, extracorporeal shockwave therapy also promotes the secretion of pain-reducing channels such as endorphins which inhibit the release of pain factors such as substance P and calcitonin-generated peptides which reduce peripheral nerve sensitivity and increase overall pain threshold levels.
Which ESWT Is Better Radial Or Focused?
Effectiveness of focused shockwave therapy versus radial shockwave therapy for noncalcific rotator cuff tendinopathies
Biomed Res Int 2021 Jan 9:2021:6687094 PMID 33506031
Background: The superiority of focused shockwave therapy versus radial shockwave therapy for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of focused shockwave therapy versus radial shockwave therapy for the management of noncalcific rotator cuff tendinopathies.
Conclusions: Both focused shockwave therapy and radial shockwave therapy are effective in patients with noncalcific rotator cuff tendinopathies. However, focused shockwave therapy proved to be significantly superior to radial shockwave therapy at long-term follow-up which is more than 24 weeks.
Comparative effectiveness of focused extracorporeal versus radial extracorporeal shockwave therapy for knee osteoarthritis
Int J Res Public Health 2022 Jul 24;19(15):9001 PMID 35897371
Background: Both focused extracorporeal shockwave therapy and radial extracorporeal shockwave therapy can alleviate symptoms in patients with knee osteoarthritis, but no clinical trials have directly compared focused extracorporeal shockwave therapy with radial extracorporeal shockwave therapy for knee osteoarthritis. This study aims to compare the effectiveness of focused and radial extracorporeal shockwave therapy on knee osteoarthritis.
Conclusion: Both groups showed significant improvement in secondary outcomes. However, the focused extracorporeal shockwave therapy group yielded greater improvement in the VAS score, WOMAC score, and six-minute walk test. Our results showed that focused extracorporeal shockwave therapy was more effective than radial extracorporeal shockwave therapy in improving pain and physical function in patients with knee osteoarthritis.
Radial versus focused extracorporeal shockwave therapy in lateral epicondylitis
J Phys Med Rehabil 2024 Oct 16;71(1):19-27 PMID 40270634
Objectives: This study aimed to compare the acute effects of radial extracorporeal shockwave therapy and focused extracorporeal shockwave therapy on pain, muscle strength, and function in patients with lateral epicondylitis.
Conclusions: Both groups showed a decrease in pain levels, but the effects were superior in the focused extracorporeal shockwave therapy group. However, the radial extracorporeal shockwave therapy group was found to present better results in terms of its effect on isokinetic muscle strength while focused extracorporeal shockwave therapy may be more effective in reducing pain, the radial extracorporeal shockwave therapy may be more effective in increasing the muscle strength in this group.
Authors note: The muscle group is not a focused target and larger in size. Radial ESWT is more diffuse. This explains the findings here.
Comparative effects of radial and focused extracorporeal shock wave therapies in coccydynia
J Phys Med Rehabil 2023 Feb 4;69(1):97-104 PMID 37201007
Objectives: This study was conducted to compare the effects of radial and focused extracorporeal shockwave therapy for patients with coccydynia.
Conclusions: Radial and focused extracorporeal shockwave therapy are both effective in treating coccydynia compared to sham extracorporeal shockwave therapy. However, radial extracorporeal shockwave therapy may be more effective in the treatment of coccydynia.
Authors note: Coccydynia is a larger area of treatment and not a focused area.
Focused extracorporeal shockwave therapy for the treatment of low back pain
Front Med 2024 Aug 29:11:1435504 PMID 39267973
Introduction: Low back pain is a common condition affecting up to 84% of people in their lifetime with a prevalence of 11.9% and a high reoccurrence rate within the first year. Furthermore, chronic low back pain syndrome has been described in up to 7%, making it a significant health and socioeconomic problem. Among non-operative treatment options, the recently used focused extracorporeal shockwave therapy devices generate waves that converge at a precise depth in the body thereby revealing the potential to affect pathology remotely from the contact surface. This article aims to present a systematic literature review with a critical discussion on treating low back pain using this modality.
Conclusion: Focused extracorporeal shockwave therapy is a modern physiotherapeutic method that can potentially treat a broad spectrum of conditions responsible for low back pain. Despite a small number of low evidence studies, there is sufficient data on the effectiveness and safety of this therapeutic modality and with future well designed trials the bias risks would be diminished and the indications for its use would expand.
Use of extracorporeal shockwave therapies for athletes and physically active individuals
Br J Sports Med 2024 Feb 7;58(3):154-163 PMID 38228375
Objective: To determine the efficacy of extracorporeal shockwave therapy and investigate outcomes following the use of extracorporeal shockwave therapy for athletes and physically active individuals.
Conclusion: Based on the studies, extracorporeal shockwave therapy may be effective alone in plantar fasciitis, lateral epicondylitis, proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated extracorporeal shockwave therapy with minimal side effects. The conclusion is that extracorporeal shockwave therapy may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports related injuries and without major adverse effects. Focused shockwaves were used in these studies.
Extracorporeal shockwave therapy for tendinopathies around the hip and pelvis
HSS J 2025 Apr 23:15563316251332189 PMID 40292269
Discussion: Previous review has shown short or mid term results in this area due to the use of radial systems. This review looked at both focused and radial systems and outcomes.
Conclusion: Although extracorporeal shockwave therapy protocols for hip and pelvis related tendinopathies continue to vary, findings from this systematic review suggest that extracorporeal shockwave therapy can be used safely and effectively to treat lesions of the hip and pelvis region. Both focused extracorporeal shockwave therapy and radial extracorporeal shockwave therapy led to improvements in pain and functional outcomes with minimal side effects, however focused extracorporeal shockwave therapy provided significant longer-term outcomes when compared to the use of the radial devices.
Focused and Radial Systems Offered by Juventix
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Juventix offers both the Radial PhysioPRO and the FOCUS Shockwave System. As evidenced from the studies and literature, both devices are efficacious. However, the FOCUS Shockwave System is far more successful in attaining the desired result with more long term disease modification and remission. The focused system penetrates deeper, with higher energy making it the clear choice in musculoskeletal applications. In low back pathology, treating patients with pelvic pathology or patients with a higher BMI, the focused system far surpasses the radial system. Also, in calcific tendinopathies, especially in the pelvic region, the greater power of the focused system is needed to achieve disease remission.
Restore, Revive, Regenerate – Juventix Regenerative Medical
Regenerative regards,
Dr. Robert McGrath
