Radial Shockwave Therapy: What It Is, How It Works, and What the Science Says

If you’ve been struggling with chronic pain, especially in your muscles, tendons, or joints, you may have heard of Radial Shockwave Therapy (RSWT), also known as Radial Pressure Wave Therapy, and sometimes Extracorporeal Shockwave Therapy (ESWT) (typically ESWT refers to focal shockwave - see below) as a treatment option. It's becoming increasingly popular in physical therapy and sports medicine clinics — and for good reason. This non-invasive treatment is helping people recover from conditions that used to require surgery or long-term medication.

But what exactly is shockwave therapy? How does it work? And more importantly, what does the science say about its effectiveness?

Let’s break it down in simple terms.

Why Shockwave Therapy in our clinic?

Jane and Kathy from our clinical team traveled to Canada in February to learn advanced shockwave therapy techniques from an expert with 20 years of experience. The protocols they brought back are grounded in both evidence and extensive practice. We've been especially impressed with how effective shockwave has been in treating chronic soft tissue issues, particularly when other treatments have failed or progress had plateaued. 

In short, it is an effective and non-invasive way to maximize your body's ability to heal.

What is Shockwave Therapy?

Shockwave therapy is a non-surgical treatment that delivers high-energy sound (acoustic) waves to injured areas of the body. These sound waves — not electric shocks, despite the name — stimulate the body’s natural healing processes. There are two main types of shockwaves, Radial and Focal. They have similar effects in tissues, but are generated by different devices.

Radial shockwave therapy (RSWT) – waves are spread across a broader area, and fan out from the treatment head. The accoustic wave is generated though a mechanical device. The applicator has several different end attachments that allow for a more customized reach to different typed of tissue. Radial shockwave can penetrate tissues to a depth of 2 inches. This is the type of shockwave therapy we have in our clinic at this time. 

Focal shockwave therapy (FSWT) – waves penetrate deeper and are more concentrated. The applicator is similar in shape to a flashlight - the bell shape at the end helps focus the waves to a pre-determined depth. This form of shockwave has been used in medicine (surgery) for several decades. High energy focal shockwaves are used to break down kidney stones (lithotripsy). Focal shockwave also has application to musculoskeletal problems, particularly in deeper tissues. 

How Does It Work?

Shockwave therapy uses acoustic energy to create mechanical pressure and microtrauma in the targeted tissue. This controlled disturbance does a few things:

• Stimulates blood flow: More nutrients and oxygen get to the damaged area.

• Activates endogenous stem cells and encourages collagen production: Essential for repairing ligaments and tendons.

• Breaks down scar tissue and calcifications: Helps improve mobility and reduce pain.

• Disrupts pain signals: The waves may overstimulate nerve endings, reducing pain over time.

Think of it like jump-starting your body’s natural healing mechanism — only it’s guided by technology and backed by growing scientific support.

How Does Shockwave Therapy Differ From Ultrasound Therapy?

Shockwaves and therapeutic ultrasound are both mechanical waves and work in the same frequency range. A closer look, however, shows that the two technologies are fundamentally different.

Ultrasound is essentially a continuous wave with frequent and symmetrical oscillations chiefly in the megahertz range. These oscillations lose part of their energy due to absorbtion by tissue and can cause an increase in temperature.

Shockwaves have a single pressure pulse lasting about 1 microsecond, followed by a tensile wave with a relieving effect that is of lower amplitude. The asymmetrical pulse form of shockwave means that both successive momentums cannot compensate for each other, and a reciprocal effect with high pressure ("mechanical pressure") and low tension (where the "microtrauma" occurs) is generated. There is no significant heating of tissues with shockwave therapy.

What Does Treatment Look Like?

Most sessions last about 20-30 minutes, depending on the area being treated. For the most successful outcome, a minimum of 3 treatments is recommended, one per week, with a fourth follow up visit scheduled 4-6 weeks after the third session. This permits the tissue time to heal and allows your therapist to determine if an additional 1-2 sessions are needed. 

During the procedure:

• A clinician will apply a gel to the treatment area.
• A handheld device delivers shockwaves through the skin.
• You may feel some discomfort during the session — like snapping rubber bands against the skin — but it’s generally well tolerated. Areas with less padding, like elbows and feet, tend to be more sensitive. 

After the procedure:

Post treatment soreness is uncommon. We recommend no big change in usual activity so cause and effect of treatment can be more accurately determined. 

What Conditions is shockwave treatment good for?

Clinics use shockwave therapy to treat various musculoskeletal conditions, including but not limited to:

• Plantar fasciitis
• Achilles tendinopathy and tendinitis
• Tennis and golfer's elbow
• Patella tendinopathy (jumper's knee)
• Shoulder calcific tendinitis
• Chronic back and neck pain
• non-healing bone fractures
• Rotator cuff tendinosis and partial tears
• Calcific tendinitis
• Trochanteric bursitis
• Scars and abrasions
• Muscular scar tissue

What the Research Says: A Look at the Evidence

Now let’s get to the real meat of it — what peer-reviewed studies say about how well shockwave therapy works.

1. Plantar Fasciitis

This painful condition affects the thick band of tissue at the bottom of the foot. It’s one of the most commonly treated issues with shockwave therapy.

A 2017 meta-analysis published in The Journal of Orthopaedic Surgery and Research reviewed 14 randomized controlled trials (RCTs) and found that ESWT significantly improved pain and function compared to placebo in patients with chronic plantar fasciitis (Yin et al., 2017).

👉 Key finding: Shockwave therapy improved pain scores by up to 60% in chronic cases unresponsive to other treatments.

2. Achilles Tendinopathy

Achilles tendon pain can be stubborn. Traditional rest, stretching, and strengthening often aren’t enough.

A 2020 study in The American Journal of Sports Medicine by Rompe et al. found that combining eccentric loading exercises with shockwave therapy led to significantly better outcomes than exercises alone.

👉 Key finding: Pain and functional improvement were twice as good in the shockwave group after 4 months.

3. Tennis Elbow

Lateral epicondylitis, or tennis elbow, is another condition where shockwave therapy has made waves (pun intended).

A 2015 review in Cochrane Database of Systematic Reviews found mixed results — shockwave therapy wasn't significantly more effective than placebo in all cases, but may be helpful in chronic, resistant cases.

A 2020 systematic reveiw and meta-analysis published in Biomed Research International, found that ESWT can effectively relieve pain and functional impairment (loss of grip strength) caused by tennis elbow, with better overall safety than several other methods. 

👉 Key takeaway: Results depend on the chronicity and severity. Not always first-line, but can be helpful when other methods fail.

4. Calcific Shoulder Tendinitis

In this condition, calcium deposits form in the rotator cuff tendons, causing pain and limiting movement.

A 2013 study published in The Journal of the American Medical Association (JAMA) found that patients receiving focused shockwave therapy had significantly greater reductions in calcium deposits and better functional outcomes compared to placebo.

👉 Key result: Complete resolution of calcium deposits in 86% of patients receiving high-energy focused shockwave therapy.

5. Erectile Dysfunction (ED)

Shockwave therapy is also being explored as a treatment for vascular ED. The mechanism here is improved blood vessel growth in the penile tissue.

A 2017 systematic review in European Urology concluded that low-intensity shockwave therapy improved erectile function in men with mild to moderate ED.

👉 Note: This use is still considered investigational in many countries.

Is It Safe? What Are the Side Effects?

Shockwave therapy is generally considered safe and well-tolerated. Most people don’t experience any significant side effects, though temporary issues like the following can occur:

• Swelling
• Redness
• Soreness for a day or two

These side effects usually resolve quickly on their own.

That said, radial shockwave therapy isn’t suitable for everyone. It’s not recommended if you:

• Are pregnant
• Have a blood clotting disorder
• Are taking prescription blood thinners
• Have a tumor in the treatment area
• Have a pacemaker in the treatment area

Always consult a healthcare provider to make sure it’s a good fit for you.

What Are Patients Saying?

While clinical trials are crucial, real-world feedback also matters. Many patients report substantial improvements after just a few sessions. Here is a testimonial from one of our early patients here at Taylor & Thornburg Physical Therapy:

"I suffered with plantar fasciitis for several months, trying physical therapy exercises, and a Cortisone injection. But I still could not walk comfortably. After three novel shockwave treatments I am hiking the hills again. Thank you so much." - J.K.

...........................................

"After struggling with chronic posterior tibial tendonitis for 20+ years, and trying all conservative based treatment, the persistent pain along the inside of my ankle and foot continued. Within just a few sessions of radial shockwave therapy, I started to notice a reduction in pain and inflammation along the tendon. But the biggest improvement was noted several weeks after the treatment was completed. It has been several months now and I can honestly say my pain has not returned. 

Radial shockwave therapy gave me results that no other treatment had. I highly recommend it to anyone dealing with chronic posterior tibial tendonitis who hasn't found relief through conventional methods." - H.D.

Who Performs Shockwave Therapy?

You’ll typically find shockwave therapy offered at medical offices of some kind. This could be:

• Physical therapy clinics
• Sports medicine centers
• Orthopedic practices
• Podiatry practices
• Chiropractic and regenerative medicine clinics

How Much Does It Cost?

Prices vary based on location and provider.  A web search on prices per treatment session in the USA indicates $200-$500 per session. Please see our SHOCKWAVE therapy page on our website for our prices. Shockwave therapy is generally not covered by insurance. If you have a Healthcare Spending Account (HSA), it is possible you could be reimbursed for shockwave treatment. 

That said, compared to surgery, injectibles, or long-term medication, many patients find it a cost-effective alternative with minimal / no post treatment recovery time.

Final Thoughts: Is Shockwave Therapy Worth It?

Shockwave therapy is not a magic bullet, but it’s a powerful option for certain types of chronic pain and injury. The research supports its use in conditions like plantar fasciitis, Achilles tendinopathy, and calcific shoulder tendinitis — especially when conservative treatments haven’t worked. 

✅ Pros:

• Non-invasive
• Avoids injectibles, but can be a a good compliment to concurrent regenerative injectible therapies, such as PRP
• Minimal downtime
• Backed by clinical studies
• Can prevent or delay surgery

❌ Cons:

• Doesn’t work for everyone
• Usually requires multiple (3-5) sessions
• Not covered by insurance

If you’re considering shockwave therapy, talk to your healthcare provider about whether it’s the right option for your condition. When used appropriately and administered by skilled hands, it can be a game-changer in your recovery journey.

References

1. Yin, M.C. et al. (2017). “Efficacy of extracorporeal shock wave therapy for plantar fasciitis: a meta-analysis of randomized controlled trials.” Journal of Orthopaedic Surgery and Research, 12(1), 113. Link
2. Rompe, J.D. et al. (2020). “Shock wave therapy combined with eccentric loading compared with eccentric loading alone for chronic insertional Achilles tendinopathy.” AJSM, 48(3), 718–726.
3. Buchbinder, R. et al. (2015). “Shock wave therapy for lateral elbow pain.” Cochrane Database of Systematic Reviews, Issue 10.
4. Gerdesmeyer, L. et al. (2003). “Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis.” American Journal of Sports Medicine, 36(11), 2100–2109.
5. D’Agostino, M.C. et al. (2013). “Focused extracorporeal shock wave therapy for calcific tendinitis of the shoulder: a randomized controlled trial.” JAMA, 309(2), 218–223.
6. Gruenwald, I. et al. (2017). “Shockwave therapy for erectile dysfunction: a systematic review and meta-analysis.” European Urology, 72(4), 593–600.

Author: Kathryn Thornburg, DPT, OCS, FAAOMPT