Radial vs Focused Shockwave

Radial shockwave therapy (also called radial pressure wave or RSWT/RPW) and focused shockwave therapy (FSWT or focused ESWT) are two primary types of extracorporeal shockwave therapy (ESWT) used primarily for musculoskeletal conditions like tendinopathies (e.g., tennis elbow, plantar fasciitis, Achilles tendonitis), calcifications, non-unions, and sometimes erectile dysfunction (ED). Both promote healing by stimulating blood flow, reducing inflammation, breaking down scar tissue, and activating growth factors, but they differ fundamentally in physics, delivery, and applications.

Key Differences

Aspect	Radial Shockwave (RSWT/RPW)	Focused Shockwave (FSWT/ESWT)
Generation	Ballistic: Pneumatic projectile hits applicator tip, creating a pressure wave that spreads outward from skin surface.	Acoustic: Electromagnetic, piezoelectric, or electrohydraulic; waves converge at a focal point via lens/reflector.
Energy Profile	Max energy at skin surface (0.1-1 MPa); dissipates rapidly; lower peak pressure (100x less than focused).	High peak pressure (10-100 MPa) at focal point; true “shockwave” with sharp rise/fall.
Penetration Depth	Superficial (3-6 cm max); energy weakens with depth.	Deeper (up to 12 cm); precise targeting.
Treatment Area	Broad/diffuse (covers larger superficial areas like muscle chains).	Focal/precise (small, targeted zone).
Pain/Comfort	Often more painful (may need numbing); feels like a “massage gun.”	Generally more comfortable, especially for acute cases.
Cost/Accessibility	Cheaper devices; common in clinics.	More expensive; often requires specialist equipment.
Sessions	Typically 3-6; 2000 pulses/session.	Similar, but adjustable for depth/energy.

Applications and Effectiveness

• Radial: Best for superficial issues (e.g., myofascial pain, trigger points, tennis elbow, carpal tunnel, early plantar fasciitis). Effective for broad areas; good short-term pain relief. Some studies show comparable results to focused for superficial tendinopathies (e.g., tennis elbow at 12 weeks).
• Focused: Superior for deep/chronic conditions (e.g., calcific tendinopathy, bone non-unions, rotator cuff tears, hip/hamstring issues, deep ED). Better long-term outcomes (e.g., 24-48 weeks for rotator cuff). Meta-analyses favor it for recalcitrant plantar fasciitis.

Head-to-Head Evidence (from RCTs/meta-analyses):

Condition	Winner/Notes
Plantar Fasciitis	Focused often superior long-term; radial better short-term in some metas.
Rotator Cuff Tendinopathy	Focused superior at 24-48 weeks.
Tennis Elbow	Comparable short-term; focused may edge long-term.
Knee OA	Both effective; no clear winner.
ED	Focused preferred (deeper penetration); radial unproven/less effective.

Combination Therapy: Many experts recommend radial for superficial tissues + focused for deep targets; yields “outstanding results.”

Safety and Considerations

Both are non-invasive, low-risk (mild redness/swelling possible), with no downtime. Avoid in pregnancy, cancer near site, or active infection. Consult a provider for device quality (e.g., Storz Medical). Evidence is stronger for focused in deep/chronic cases, but radial is more accessible.

Choose based on condition depth: superficial → radial; deep/chronic → focused (or combo). Always pair with rehab (e.g., eccentrics). RCTs ongoing; results vary by protocol/energy.