Focused or Radial Shockwave? A Clinician’s Guide to Choosing the Right Type for Your Condition

Jonathan Hall
6 days ago
8 min read

Short answer: radial shockwave generates a pressure wave that is strongest at the skin and disperses with depth appropriate for superficial tendinopathies such as plantar fasciitis, tennis elbow and mid-portion Achilles. Focused shockwave generates a true shockwave that converges at a controlled depth inside tissue, and is what international guidance specifies for calcific deposits, bone-related conditions and deep tendon insertions. They are different technologies for different targets, not competing brands of the same thing.

We’ve written previously about why device quality matters and why we chose EMS DolorClast®. This article answers the next question, which patients and referring clinicians ask us constantly: not which brand, but which type and how do you know which one your condition needs?

I’m the EMS DolorClast® Key Opinion Leader for Aotearoa, and Movement Mechanics currently operates the only EMS DolorClast® focused shockwave device in the country, alongside radial shockwave and high-power laser (as at 2026). That gives me an unusual vantage point: I select between these tools daily rather than fitting every patient to the one machine in the building.

The physics, in plain English

Radial pressure waves

Radial devices are ballistic. Compressed air accelerates a projectile down a guide tube; it strikes an applicator held against the skin; the impact generates a pressure wave that radiates outward from the contact point.

Key characteristics:

Energy is maximal at the skin surface and decreases with depth
Effective treatment depth is generally cited as up to around 3–4 cm
The wave covers a broad area rather than a point
Rise time is comparatively slow and peak pressure lower than a true shockwave
Excellent for tissue that is superficial and broad

Strictly speaking, a radial device produces a pressure wave rather than a shockwave a distinction that matters physically even though the whole category is marketed as “shockwave.”

Focused shockwaves

Focused devices generate a genuine shockwave: an extremely rapid rise in pressure that propagates through tissue and is geometrically converged to a focal zone at a defined depth. EMS DolorClast® focused technology is piezoelectric hundreds of crystal elements fire simultaneously, and their individual waves sum precisely at the focal point.

Key characteristics:

Energy is maximal at the focal point inside the body, not at the skin
Treatment depth is selectable, reaching structures well beyond radial’s range
The treated volume is small and precise
Much higher peak pressures and energy flux density are achievable at depth
Piezoelectric generation allows direct focusing with minimal energy loss on the way in

The practical difference is captured in one image: radial is a stone dropped in a pond, strongest where it enters. Focused is a magnifying glass, strongest where you aim it.

What this means clinically

Depth determines everything. If the pathology sits 2 cm down, radial delivers ample energy there. If it sits 5 cm down a calcific deposit in the supraspinatus, a proximal hamstring insertion, a stress reaction in the tibia radial energy has substantially dissipated before it arrives, and no amount of turning the machine up changes the physics. It simply makes the skin hurt.

Conversely, treating a broad superficial fascial problem with a small focal zone is inefficient. Neither device is “better.” They are answers to different questions.

Condition-by-condition: which type does your problem need?

When using an EMS DolorClast® Shockwave device, radial or focused, as long as you can reach the target tissue and provide enough energy you will have the same effect. The table provides a good starting point based off of typical anatomy and tissue depth. Note that for irritable tissue we often use focused in place of radial and/or combine with Laser Therapy.

Condition	Usual first choice	Notes
Plantar fasciitis / plantar heel pain	Radial ± focused	The multicentre RCT supporting FDA approval used radial (Gerdesmeyer 2008). Focused considered for deep or non-responsive cases. More →
Mid-portion Achilles tendinopathy	Radial	Rompe 2009 used radial DolorClast® alongside eccentric loading. More →
Insertional Achilles tendinopathy	Radial ± focused	Deeper insertional pathology and bone interface may benefit from focused
Tennis / golfer’s elbow	Radial	Superficial, well supported by radial trials. More →
Patellar tendinopathy	Radial ± focused	Deep or long-standing cases often escalate to focused. More →
Calcific tendinopathy of the shoulder	Focused (high energy)	Guideline-recommended; focused energy can disintegrate the deposit. More →
Gluteal tendinopathy / greater trochanteric pain	Radial or focused	Depends on body composition and depth to the tendon insertion. More →
Proximal hamstring tendinopathy	Focused	Deep ischial insertion frequently beyond radial’s effective depth. More →
Bone stress injuries / delayed union / non-union	Focused (high energy)	Recognised bone indication; requires energy delivered into bone
Bone marrow oedema conditions	Focused	Depth and energy requirements exclude radial
Trigger points, broad muscular overload	Radial	Large surface area, superficial target
Dupuytren’s contracture	Focused or radial by presentation	More →
Knee osteoarthritis (adjunct)	Focused or radial	Selected by target structure subchondral bone vs peri-articular soft tissue. More →

The International Society for Medical Shockwave Treatment (ISMST) maintains published indication lists and specifically recommends focused generators at high energy levels for calcifications, alongside bone-healing indications including delayed union, non-union and stress fracture. Where guidance is that specific, the device you’re treated on stops being a marketing detail.

Not sure which type your condition needs?

Bring your imaging. Book an assessment with Jonathan Hall (M.Ost) EMS DolorClast® Key Opinion Leader for Aotearoa for a straight answer, including when radial is the better tool, or when shockwave isn’t indicated at all. Book an appointment → · Browns Bay · Referrals from GPs and allied health welcome

“I had shockwave and it didn’t work”

This is one of the more common things we hear, and it’s worth unpacking, because it’s rarely a simple treatment failure. In our experience the usual explanations are:

The wrong type for the target. Deep or calcific pathology treated radially the energy never reached the tissue in a therapeutic dose.
Insufficient dose. Shockwave is dose-dependent: energy flux density, impulse count, number of sessions. Under-dosing produces under-response. Independent bench testing (Reinhardt et al., Scientific Reports, 2022) found significant differences in acoustic output between ballistic devices at higher frequency settings, meaning nominal settings on different machines are not equivalent.
No loading programme. Across the tendinopathy literature, shockwave performs best combined with progressive loading Rompe’s Achilles trials showed the combination beating loading alone. Shockwave without rehabilitation is half a treatment.
Wrong diagnosis. Shockwave applied to a misdiagnosed problem fails reliably.
Too few sessions, or judged too early. Outcomes typically continue improving for around 12 weeks after a course. Concluding failure at week three is premature.

If you’ve had shockwave elsewhere without success and your condition is on the focused-indication list, a reassessment is genuinely worthwhile not because the previous clinician did anything wrong, but because they may not have had the right tool available.

Does focused hurt more?

Generally, no and often less than patients expect. Because energy converges at depth rather than concentrating at the skin, focused treatment can be more comfortable than high-intensity radial treatment at equivalent therapeutic dose. High-energy focused treatment of a calcific deposit is the exception and can be genuinely uncomfortable, which is why intensity is titrated to the individual and sessions are short (typically 3–5 minutes per site).

Both modalities are non-invasive, require no anaesthetic, and involve no downtime. Common side effects are transient local soreness, occasional bruising or skin reddening.

What we do differently at Movement Mechanics

Having radial shockwave, focused shockwave and high-power laser therapy in one clinic means treatment selection follows the tissue rather than the inventory. In practice that means:

Assessment and diagnosis before device selection including imaging referral where warranted, via the GP and imaging pathways at Bays Health
Modality matched to depth, tissue state and irritability laser where mechanical loading isn’t yet tolerated, shockwave where remodelling is the goal, and both where indicated (the rationale is set out in our article on the therapeutic synergy of laser and shockwave)
Loading and osteopathic care integrated from session one, because passive treatment alone doesn’t produce durable outcomes
Defined review points, so non-response triggers reassessment or referral rather than more sessions

We invested in the full range for one reason: so patients could access genuine non-invasive alternatives to injections and surgery including the ones that require a device most clinics don’t have.

For referring clinicians

We welcome referrals for focused-shockwave-specific indications calcific tendinopathy, bone stress injuries, delayed bone healing, deep tendon insertions and are happy to co-manage alongside your existing rehabilitation plan, reporting back at agreed points. Contact us via our contact page or on 09 884 0935.

Frequently asked questions

What is the main difference between focused and radial shockwave therapy?

Radial devices produce a pressure wave that is strongest at the skin and disperses with depth, treating a broad superficial area. Focused devices produce a true shockwave converged to a focal point at a selectable depth inside tissue, allowing precise, high-energy treatment of deeper structures such as calcific deposits and bone.

Which is better, focused or radial shockwave?

Neither is universally better. Radial is appropriate for most superficial tendinopathies and has strong randomised evidence in those conditions. Focused is required for calcifications, bone-related conditions and deep insertions, where international guidance specifies focused, high-energy treatment.

Where can I get focused shockwave therapy in New Zealand?

Focused shockwave remains uncommon in New Zealand. Movement Mechanics in Browns Bay, Auckland currently operates the only EMS DolorClast® focused shockwave device in Aotearoa (as at 2026), alongside radial shockwave and high-power laser therapy.

How many sessions of focused shockwave are needed?

Most conditions are treated over 4–8 sessions at weekly intervals, with reassessment built in. Bone-related indications may follow different protocols determined at assessment.

Can radial and focused be used together?

Yes, and frequently they are. A deep target may receive focused energy while surrounding overloaded soft tissue is treated radially, alongside osteopathic treatment and a loading programme.

Is focused shockwave the same as ultrasound therapy?

No. Therapeutic ultrasound delivers continuous or pulsed sound energy at far lower intensities and is a different treatment with a different (and generally weaker) evidence base. Focused shockwave delivers discrete high-pressure acoustic pulses with a very rapid rise time.

Do I need a referral or imaging?

No referral is needed. Existing ultrasound or X-ray reports are very useful, particularly for suspected calcific or bone-related conditions bring them. Where imaging is needed, we can refer.

What does it cost?

Shockwave therapy is $130 per single-site session and $200 multi-site; combined laser and shockwave is $150 single-site. Current pricing, ACC and Southern Cross details are on our fees page.

The bottom line

“Shockwave therapy” describes two genuinely different technologies. For most superficial tendinopathies, a quality radial device delivering an adequate dose alongside a loading programme is the right and evidence-supported choice. For calcific deposits, bone stress and deep insertions, the international guidance is specific and the physics is unforgiving. If your pathology lives deep, make sure the treatment can actually reach it.

Get the right tool for your tissue

Book with Jonathan Hall → Aotearoa’s only EMS DolorClast® focused shockwave clinic. Browns Bay, Monday to Saturday.

Jonathan Hall M.Ost, BAppSci (Human Biology), PGCertHSc (Acupuncture), GradDipHeal, FIFA Diploma in Football Medicine

References

International Society for Medical Shockwave Treatment (ISMST). Indications for shockwave therapy standard, common empirically tested and expert indications.
Gerdesmeyer L, Wagenpfeil S, Haake M, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573–2580.
Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis. Am J Sports Med. 2008;36(11):2100–2109.
Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463–470.
Reinhardt N, Wegenaer J, de la Fuente M. Influence of the pulse repetition rate on the acoustic output of ballistic pressure wave devices. Sci Rep. 2022;12(1):18060.

Disclaimer: This article is general information, not individual clinical advice. Treatment recommendations require assessment.