Focused vs Radial Shockwave Therapy: Which One Does Your Injury Actually Need?
- Jonathan Hall
- Sep 8, 2025
- 10 min read
Updated: Jul 28
If you’ve been recommended shockwave therapy, or you’ve already had a course that didn’t deliver, there’s a question very few Auckland patients are ever asked: which type of shockwave does your injury need?
Most clinics can’t ask it, because most clinics only own one type: a radial device. Radial shockwave is an excellent tool with strong evidence, for the right conditions. But radial energy physically cannot reach every structure that shockwave can treat.
At Movement Mechanics in Browns Bay, we run both EMS DolorClast® radial and focused shockwave, currently the only clinic in New Zealand with the EMS DolorClast® focused device. That means we choose the technology to fit your injury, not the other way around. Here’s how the two differ, and how to work out which your condition needs.
The short version
Radial shockwave spreads pressure waves outward from the skin surface. Energy is highest at the skin and decreases with depth. Best for superficial, broader tissue: plantar fascia, tennis elbow, mid-portion Achilles.
Focused shockwave converges acoustic energy to a precise point that can be set deep inside tissue. Best for deep, small or specific targets: deep gluteal tendons, bone-level problems, deep calcific deposits, Dupuytren’s nodules.
They are not interchangeable. The right choice depends on how deep the injured structure sits and how precisely energy needs to be delivered.
Comparative clinical trials, including double and even triple-blind RCTs, demonstrate no significant differences in outcomes between radial and focused devices when the target tissue is reached using EMS DolorClast® devices (Stania et al., 2021; Schmitz et al., 2015).
👉 In other words, it’s not about whether radial or focused shockwave is “better”, it’s about choosing the right tool for the anatomy in question. Remember, not all shockwave devices are equal. Picking a device that can deliver energy consistently across all its frequencies and produce cavitations is key.
How radial shockwave works, and where it excels
Radial shockwave is generated ballistically: a projectile strikes the handpiece applicator, sending pressure waves radiating into the tissue. Energy is greatest at the surface and disperses as it travels, effective treatment depth is roughly 3–4 cm. That profile is ideal when the target is superficial and relatively broad:
Plantar fasciitis and heel pain
Tennis elbow and golfer’s elbow
Mid-portion Achilles tendinopathy
Patellar tendinopathy
Shin splints and calf overload
Trigger points and broader myofascial pain
For these conditions, radial shockwave is well supported by evidence and is often all you need. If a clinic has offered you radial treatment for one of these, the type is right though device quality still matters.
How focused shockwave works, and what only it can treat
EMS DolorClast® Focused shockwave delivers high-energy acoustic waves using piezoelectric technology. These Shockwave converges tcan reach a depth of around 80 - 120 mm. Instead of energy scattering from the skin inward, maximum energy is delivered at the target, sparing the tissue above it. That changes what’s treatable:
Deep gluteal and hip tendinopathy - the gluteus medius/minimus insertions sit beneath substantial soft tissue; radial energy largely dissipates before arriving. (Hip pain treatment)
Proximal hamstring tendinopathy - the sitting-bone insertion is deep and notoriously stubborn. (More)
Deep calcific deposits in the rotator cuff - focused energy can be placed directly on the calcification. (Rotator cuff)
Bone-level presentations - delayed-healing stress injuries and bone marrow-level changes (with imaging).
Dupuytren’s contracture - precise dosing of palmar nodules, an application radial devices aren’t suited to.
Cases where radial has plateaued - if superficial treatment helped partially then stalled, the unresolved driver often sits deeper than radial can reach.
This is the practical problem with radial-only care: if your injury is on this list, a radial-only clinic cannot deliver adequate energy to the target, no matter how good their device or practitioner is. The honest options are referral onward, or under-dosed treatment that looks like “shockwave didn’t work for you.”
“I had shockwave and it didn’t work” read this first
We regularly see patients who’ve completed a radial course elsewhere with little result, and understandably concluded shockwave has failed them. Before writing the modality off, three questions are worth asking:
Was the target within radial’s reach? Deep hip, hamstring-origin and deep shoulder presentations frequently aren’t. The treatment type, not the treatment concept, may have been the mismatch.
Was the dose adequate? Shockwave is dose-dependent. Independent bench testing (Reinhardt et al., Scientific Reports, 2022) found significant differences in energy output between radial devices at higher frequencies, some devices can’t sustain the energy the research protocols used.
Was there a diagnosis and a loading plan? Shockwave without progressive loading and a clear diagnosis underperforms across the tendinopathy literature.
If any of those three were missing, your injury hasn’t necessarily failed shockwave, the delivery may have failed your injury. An assessment can establish which.
Which type do you need? A quick guide
Your presentation | Likely type |
Heel pain / plantar fasciitis | Radial (focused in resistant cases) |
Radial | |
Radial | |
Focused | |
Radial | |
Radial ± focused | |
Focused (deep target) | |
Focused | |
Focused for deep deposits | |
Stress injury with delayed healing | Focused (with imaging) |
Focused | |
Previous radial course plateaued | Reassess — often focused |
Indicative only, depth, irritability and diagnosis determine the final choice, which is why every course at Movement Mechanics starts with an assessment. You don’t need to choose the technology yourself.
Same device family, same evidence base, both types
One more distinction that matters: we run radial and focused from the same evidence-leading platform. EMS DolorClast® devices appear in more high-quality studies on the PEDro physiotherapy evidence database than any other shockwave system. Because both our radial and focused devices sustain their rated energy delivery, if we can reach the target tissue, we can achieve the intended tissue effect, and we choose the handpiece purely on your anatomy.
Where clinically useful, we combine either type with high-power laser therapy the modalities work through different mechanisms (mechanical stimulus vs photobiomodulation) and complement each other, particularly in stubborn tendon presentations.
Biological Mechanisms Activated by Shockwave Therapy
The reason ESWT is so effective isn’t magic; it’s biology. Here’s what happens when we deliver controlled shockwaves to injured tissues:
1. Angiogenesis & Improved Blood Supply
Shockwaves stimulate the growth of new blood vessels (neovascularisation) in tendon and tendon–bone interface tissues, thereby improving oxygen and nutrient delivery to damaged areas (Wang et al., 2003).
2. Collagen Remodelling & Scleraxis Upregulation
Healthy tendons require strong, organised collagen type I fibres. Shockwave Therapy boosts collagen I synthesis and promotes a shift away from weaker type III collagen (Notarnicola & Moretti, 2012).
Scleraxis (SCX), a transcription factor essential for tendon development, has been shown to increase in response to both mechanical loading (Steffen et al., 2022; Chen et al., 2004) and shockwave therapy.
Without scleraxis, tendons fail to regenerate effectively. Laboratory research indicates that inflammatory molecules, such as IL-1β and TNF-α, suppress scleraxis expression, thereby preventing tendon stem cells from attaching to scaffolds and facilitating tissue repair (Brandt et al., 2018).
Resolving neurogenic inflammation, often driven by IL-1β and TNF-α (Ansel et al., 1993; Inoume et al., 1999), is therefore a key prerequisite for tendon regeneration.
This means ESWT plays a dual role: reducing pain and inflammation while promoting the very repair pathways tendons need to recover.
3. Lubricin Expression & Extracellular Matrix Support
Laboratory studies have shown that ESWT can increase lubricin (PRG4) expression. Lubricin is a glycoprotein that reduces shear stress and improves tendon gliding, helping reduce friction-related microtrauma (Zhao et al., 2019).
4. Substance P Reduction & Pain Modulation
ESWT reduces concentrations of substance P and calcitonin gene-related peptide (CGRP) in treated tissues and dorsal root ganglia, disrupting neurogenic inflammation and lowering pain signalling (Maier et al., 2003; Hausdorf et al., 2008).
5. Muscle Regeneration After Injury
Shockwaves don’t just help tendons; they can stimulate muscle repair, too. In a surgical rat model, radial ESWT accelerated muscle regeneration after injury, leading researchers to recommend clinical trials for sports trauma recovery (Langendorf et al., 2020). This suggests shockwave therapy may support rehabilitation in muscle strains as well as tendon injuries.
Together, these mechanisms explain why shockwave therapy doesn’t just dull pain; it stimulates genuine tissue repair.
What an assessment looks like
Your first appointment establishes the diagnosis: history, hands-on orthopaedic testing, and imaging referral (ultrasound or X-ray) if needed. From there we’ll tell you plainly:
whether shockwave is appropriate at all,
which type your condition needs,
how many sessions to expect (typically 4–8), and
what rehabilitation runs alongside it.
Radial and focused shockwave are both $130 per single site / $200 multi-site you’re never charged extra for needing the deeper technology. Full pricing.
Book a shockwave assessment or call Ava on 09 884 0935. No referral needed. Patients travel to us from across Auckland, and for focused shockwave, from across New Zealand, because the EMS DolorClast® focused device is currently available nowhere else in the country.
The Osteopathic Perspective
At Movement Mechanics, shockwave therapy is never delivered in isolation. We integrate it with manual osteopathic treatment and exercise rehabilitation to correct mechanical overload, restore normal movement patterns, and improve long-term resilience. This whole-body approach ensures the injured tissue heals in the context of your wider biomechanics, not just at the symptomatic site.
Frequently asked questions
What is the difference between focused and radial shockwave therapy?
Radial shockwave disperses pressure waves from the skin surface inward, with energy highest at the surface, suited to superficial, broader tissue up to roughly 3–4 cm deep. Focused shockwave converges energy to a precise focal point that can be set up to ~12 cm deep, delivering maximum energy at the target rather than at the skin.
Is focused shockwave better than radial?
Neither is “better”, they treat different problems. Radial is well-evidenced for superficial conditions like plantar fasciitis and tennis elbow. Focused is required for deep structures such as gluteal tendons, deep calcific deposits and bone-level presentations. The right question is which one your injury’s depth and anatomy require.
Where can I get focused shockwave therapy in New Zealand?
Movement Mechanics Osteopathy in Browns Bay, Auckland is currently the only clinic in New Zealand with the EMS DolorClast® Focused Shockwave device, offered alongside EMS radial shockwave and high-power laser therapy. No referral is needed.
I’ve already had radial shockwave and it didn’t help. Is focused worth trying?
Possibly, particularly if your injury involves a deep structure (hip, proximal hamstring, deep shoulder) that radial energy struggles to reach, or if your previous course lacked a clear diagnosis or loading programme. An assessment can establish whether under-dosing or target depth explains the poor result before you invest in further treatment.
Does focused shockwave cost more than radial?
Not at Movement Mechanics, both are $130 per single site and $200 multi-site, and we select the type purely on clinical need.
Final Word: It’s Not the Machine, It’s the Method
At Movement Mechanics Osteopathy, we use Swiss EMS DolorClast® radial and focused shockwave devices, the most researched ESWT systems worldwide.
Whether radial or focused, EMS DolorClast® shockwave therapy works. The key is not whether the treatment is “radial” or “focused,” but whether the energy is reaching the injured tissue at the correct dose, by targeting the right tissue and stimulating the appropriate biological responses. From angiogenesis and scleraxis expression to muscle regeneration and pain modulation,
ESWT offers a scientifically grounded approach to address not only symptoms but also the underlying biology of chronic musculoskeletal pain.
📍 If you’re looking for shockwave therapy in Auckland, book your consultation today and let’s target the root cause of your pain so you can move freely again.
Jonathan Hall *M.Ost, BAppSci (Human Biology), PGCertHSc (Acupuncture), GradDipHeal*
Jonathan Hall is the founder and principal Osteopath at Movement Mechanics Osteopathy. Jonathan specialises in Shockwave Therapy and Western medical acupuncture. A fully qualified Osteopath registered with OCNZ, PNZ, PAANZ and ACC, Jonathan also founded Auckland Shockwave Therapy to help bring evidence-based Shockwave treatment to New Zealand using the industry-leading EMS Radial Shock Wave device.
Contact Us: hello@movementmechanics.nz
Book an appointment with Jonathan here.
References
Ansel, J. C., Armstrong, C. A., Song, I., Quinlan, K. L., Olerud, J., Caughman, S. W., & Bunnett, N. (1993). Interleukin-1 and tumour necrosis factor-alpha play a pivotal role in the regulation of neurogenic inflammation in the skin. Journal of Immunology, 150(10), 4478–4485.
Brandt, J., et al. (2018). Effects of pro-inflammatory cytokines on tendon stem cells and their ability to express scleraxis. International Journal of Molecular Sciences, 19(9), 2549. https://doi.org/10.3390/ijms19092549
Chen, Y. J., Wang, C. J., Yang, K. D., Kuo, Y. R., Huang, H. C., Huang, Y. T., & Sun, Y. C. (2004). Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-β1 and IGF-I expression. Journal of Orthopaedic Research, 22(4), 854–861. https://doi.org/10.1016/j.orthres.2003.11.005
Hausdorf, J., Lemmens, M. A., Kaplan, S., Marangoz, C., Milz, S., Odaci, E., & Schmitz, C. (2008). Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Research, 1207, 96–101. https://doi.org/10.1016/j.brainres.2008.02.067
Inoume, N., Takeshita, S., Arioka, Y., & Ochi, T. (1999). The role of tumour necrosis factor-alpha and interleukin-1beta in the development of neurogenic inflammation in arthritis. Journal of Neurochemistry, 73(5), 2206–2213.
Langendorf, E. K., Klein, A., Drees, P., Rommens, P. M., Mattyasovszky, S. G., & Ritz, U. (2020). Exposure to radial extracorporeal shockwaves induces muscle regeneration after muscle injury in a surgical rat model. Journal of Orthopaedic Research, 38(7), 1386–1397. https://doi.org/10.1002/jor.24589
Maier, M., Averbeck, B., Milz, S., Refior, H. J., & Schmitz, C. (2003). Substance P and prostaglandin E2 release after shockwave application to the rabbit femur. Clinical Orthopaedics and Related Research, 406, 237–245. https://doi.org/10.1097/00003086-200301000-00033
Notarnicola, A., & Moretti, B. (2012). The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles, Ligaments and Tendons Journal, 2(1), 33–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/
Schmitz, C., et al. (2015). Efficacy and safety of extracorporeal shockwave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database. British Medical Bulletin, 116(1), 115–138. https://doi.org/10.1093/bmb/ldv047
Stania, M., Król, P., Gajewski, M., & Słupik, A. (2021). A comparative study of radial and focused shockwave therapy for tennis elbow: a randomized controlled trial. Archives of Medical Science, 17(2), 362–369.
Steffen, D., Mienaltowski, M. J., & Baar, K. (2022). Scleraxis and collagen I expression increase following pilot isometric loading experiments in a rodent model of patellar tendinopathy. Matrix Biology, 109, 34–48. https://doi.org/10.1016/j.matbio.2022.02.004
Wang, C. J., Wang, F. S., Yang, K. D., Weng, L. H., Hsu, C. C., Huang, C. S., & Yang, L. C. (2003). Shock wave therapy induces neovascularisation at the tendon–bone junction. Journal of Orthopaedic Research, 21(6), 984–989.
Zhao, Z., Wang, J., Han, Y., Chen, G., & Wang, J. H. C. (2019). Mechanobiological responses of tendon to low‐energy shock wave therapy. Journal of Orthopaedic Research, 37(5), 1220–1230. https://doi.org/10.1002/jor.24284
Disclaimer: This content is for educational purposes and is not a substitute for professional medical advice.
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