ESWT is a non-invasive medical procedure. Treating both acute and chronic musculoskeletal conditions. Technology developed from extracorporeal shockwave lithotripsy procedures. This was where acoustic shockwaves were used to break up kidney stones.
ESWT has established itself in the management of many musculoskeletal conditions. Particularly those stubborn to recover, as an alternative to injections and surgery.
Radial pressure wave is the most common type of shockwave therapy. It is also used in most MSK Physiotherapy clinics. Yet, Focused is growing in popularity, due to the increased treatment options. Also treatment depth, treatment precision, and patient comfort in more acute cases.
Clinical Director and Shockwave Therapy expert John McMenemy discusses the differences between the two types of Shockwave Therapy ESWT. Radial Pressure Wave and Focused Shockwaves.


So what is the difference? Focused Shockwave versus Radial Shockwave.

When comparing radial and focused shock wave therapy, the main considerations are penetration depth and localisation of the treatment. As you’d imagine, the greater the depth penetration of the waves, the easier it is to treat deep-lying issues. Primarily in the tendons, muscles, or bones. Similarly, depending on the problem area, the type of therapy needed will typically change.


Focused shock wave therapy – sometimes known as Focused Shockwaves.  It is able to provide more depth penetration for deeper tissue than radial waves. Thus focusing its output into more localised, deeper areas.
Waves are generated through the use of a coil. Creating magnetic fields when a current is applied. This generates a pressure wave that can move through the medium without any loss of energy in a focused zone.

Focused Shockwave

The site of actual wave generation experiences a minimal impact.  Limiting the damage to surface skin and underlying soft tissues.
While radial waves are applied all over a local area, FSWT is only applied at defined points within the body.  Also, it can be adapted depending on the depth that is required.
This makes focused therapy much better for treating any issues that affect tissues deeper within the body.  Including tissues close to the bone or any denser build-up that may have accrued.




Radial Shockwaves are pressured waves.  They differ considerably from focused shockwaves. The energy also spreads radially in contact with tissues.  Also, the density of energy dissipates through the skin reducing penetration depth.
This makes Radial systems unsuitable for targeted deeper areas associated with ESWT applications.

Focused shockwave

Focused v Radial Shockwave



How does Focused Extracorporeal Shockwave Therapy work?

The PiezoWave focused shockwaves reach their peak pressure on the target tissue.  This can promote cell growth, protein synthesis, and the release of growth factors.  Also stimulation of stem cells, and lubricin production.
This can also exert an anti-inflammatory and also antibacterial effect too. Promoting microcirculation and metabolic activity. One of the few technologies used to treat pain syndromes of the musculoskeletal system.

Ultrasound-Guided Shockwave Therapy?

Treatment commences with a diagnostic ultrasound scan.  From this, we can identify the area of concern, including target size and depth.
Following this, we can mark the area to be treated and set appropriate depth.  This ensures the focused shockwaves arrive at the desired point for the most benefit. Diagnostic ultrasound also allows us to image any change in tissues. This also helps track healing processes.
This method ensures precision is achieved in identifying areas of injury. Allowing accurate implementation of the treatment modality. Generally, the gold standard of shockwave therapy and also care.

Conditions treated?

Back Pain
Plantar Fasciitis
Medial Tibial Stress Syndrome
Knee Meniscal Tears
Knee Osteo-Arthritis
Stress Fractures and Non-Unions
Tendon Pathologies (Achilles / Patella / Gluteal / Hamstring / Adductor)
Rotator Cuff Calcific Tendonitis
Golf & Tennis Elbow
Carpal Tunnel Syndrome
Myofascial Pain Syndrome


Contact the Core Physio team today to discuss your focused or radial shockwave treatment plan.