Focused vs Radial Shockwave Therapy: What’s the Difference and Why Should You Care?
- Jonathan Hall
- Sep 8
- 6 min read
At Movement Mechanics Osteopathy Auckland, we see patients every week with stubborn tendon injuries, chronic heel pain, or shoulder issues that won’t resolve with exercise or rest alone. One of the most effective tools we use to help restore movement and reduce pain is shockwave therapy (extracorporeal shockwave therapy, ESWT).
But not all shockwaves are the same. You may have heard of radial and focused devices. So, what’s the difference, and which one do you actually need?
Both Radial and Focused Work—If They Reach the Target Tissue when using EMS DolorClast® devices
Research indicates that the effectiveness of ESWT depends on delivering the correct amount of energy to the injured tissue.
Radial shockwave therapy is ideal for superficial structures near the skin, such as the plantar fascia or mid-portion of the Achilles tendon.
Focused shockwave therapy penetrates deeper, making it better for conditions like supraspinatus or rotator cuff tendinopathy.
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.
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.
Conditions Treated with Shockwave Therapy at Movement Mechanics
Because osteopathy considers the whole musculoskeletal system, we apply shockwave therapy across a wide range of conditions:
Foot & ankle: plantar fasciitis, heel spurs, Achilles tendinopathy, chronic ankle sprains
Knee & leg: patellar tendinopathy (jumper’s knee), ITB syndrome, shin splints, quadriceps or calf injuries
Hip & pelvis: gluteal tendinopathy, proximal hamstring tendinopathy, adductor pain
Shoulder & arm: rotator cuff tendinopathy (including calcific), biceps tendinopathy, tennis/golfer’s elbow, De Quervain’s tenosynovitis
Hand: Dupuytren’s contracture, chronic tendon or fascial restrictions
Spine: myofascial back pain, sacroiliac-related dysfunction
What to Expect in a Session
Sessions last 10–15 minutes.
Typically, 3 to 5 treatments are recommended.
Mild soreness may occur for 24–48 hours, but there’s no downtime.
Improvements often continue to build for weeks after the final session.
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.
Final Word: It’s Not the Machine, It’s the Method
At Movement Mechanics Osteopathy, we use Swiss DolorClast® radial and focused shockwave devices, the most researched ESWT systems worldwide. Whether radial or focused, 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.
With osteopathic expertise in anatomy, biomechanics, and whole-body movement, we ensure your treatment is delivered precisely and effectively.
📍 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
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. https://doi.org/10.1046/j.1471-4159.1999.0732206.x
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. https://doi.org/10.5114/aoms/102255
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. https://doi.org/10.1016/S0736-0266(03)00104-9
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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