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Focused shockwave therapy versus radial pressure waves
Focused shockwaves concentrate energy at depth; radial pressure waves are strongest at the skin. How they differ and why it matters for treatment.
Awaiting clinical review
No clinician has reviewed this page yet. It is written from the sources listed below and will carry the reviewer's name once a clinician has checked it.
In short: focused shockwaves concentrate their energy at a chosen depth inside the body; radial pressure waves are strongest at the skin and weaken as they spread. Both are called shockwave therapy, but they suit different problems, and the ISMST recommends focused devices for some of them.
| Focused shockwaves (fESWT) | Radial pressure waves (rESWT, RPW) | |
|---|---|---|
| How they are made | Electrically, in water: by a spark (electrohydraulic), a vibrating membrane (electromagnetic) or piezo crystals (piezoelectric) | Mechanically: a projectile driven by compressed air or a magnet strikes the applicator |
| Where the energy goes | Concentrated in a focal zone that can lie deep in the tissue | Highest at the skin, spreading out and weakening with depth |
| Physically | True shock waves: a very steep pressure rise | Slower pressure waves; not shock waves in the physical sense |
| Typical use | Deeper targets, calcium deposits, bone | Larger, superficial areas of soft tissue |
Why it matters for you
The ISMST recommends focused, high-energy devices to treat calcium deposits and, with precise positioning, for treating bone. For conditions near the surface, devices with or without focusing may be used, with attention to how deep the target lies. Because radial devices are cheaper and simpler, they are widely available, and some practices offer only one type.
Studies comparing the two directly are fewer than studies of each on its own, and results depend on the condition. For calcific shoulder tendinopathy and knee osteoarthritis, for example, trials have compared focused, radial and combined treatment with differing results. That is why the choice should follow the diagnosis, not the device a practice happens to own.
Questions to ask
- Which type do you use, focused, radial or both?
- Why is that type suitable for my condition and for how deep the problem lies?
- Is the treatment positioned by examination alone, or with ultrasound or X-ray?
In the directory you can filter by therapy type when you search. Some practitioners list both.
This page is general information. It does not replace a consultation with a qualified healthcare professional, who can assess your situation.
Sources
- ISMST. Physical principles of ESWT, accessed November 4, 2026
- ISMST. Indications (approved standard, empirically tested, expert and experimental indications; prerequisites), accessed November 4, 2026
- Abo Al-Khair MA, El Khouly RM, Khodair SA, et al. Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy. Phys Sportsmed. 2021;49(4):480-7 (2021)
- Ko NY, Chang CN, Cheng CH, et al. Comparative effectiveness of focused extracorporeal versus radial extracorporeal shockwave therapy for knee osteoarthritis: randomized controlled study. Int J Environ Res Public Health. 2022;19(15):9001 (2022)
Last updated November 4, 2026