Radial Vs Focus Shockwave Therapy What is the Difference?

Shockwave Therapy expert and Physio Specialist Benoy Mathew discusses the differences between the two types of Shockwave Therapy ESWT - Radial (RSW) and Focus (FSW).

Radial is the most common type of shockwave, used in most MSK clinics. However, Focus is growing in popularity, due to the increased treatment options and less pain during treatment.


Focused and Radial shockwaves differ not only in regard to their physical properties and mode of generation, but also in terms of the magnitude of the standard parameters (pressure amplitude, pulse duration, impact) used and the therapeutic tissue penetration depths achieved.

Radial Shockwaves (Soft shock) – Larger treatment area of superficial indications

Radial shockwaves are generated by means of a pneumatic system. Using compressed air, a projectile is accelerated to a high-speed then suddenly decelerated by a transmitter, which is held to the area being treated. The generated kinetic energy is than transmitted to the tissue from where it propagates outwards aspherically as a radial wave into the tissue.The transmitter surface constitutes the highest pressure and highest energy density. The shockwave loses power the deeper it goes into the body.

The radial shockwave comprises three parts – Ultrasonic pulse, audio acoustic pulse and the relatively slow shear wave.

Focused Shockwaves (Hard shock) – Smaller focal point for greater accuracy and greater treatment depth. 

The focused shockwaves are generated electromagnetically through a cylindrical coil creating opposing magnetic fields when current is applied. This causes a submerged membrane to move and generate a pressure wave in the surrounding fluid medium. These propagate through the medium without any loss in energy with a small focal zone.

At the site of actual wave generation the amount of energy dispersed is minimal. This limits damage at the skin and to underlying soft tissues.

The focusing mechanism directs each shock to a defined point within the body. The location within the body is adjusted by altering the energy output of the machine or by adjusting the focusing mechanism. Diagnostic imaging is commonly used to exactly localise the point of energy concentration. The STORZ devices can be purchased with an Ultrasound diagnostic module (black/white or colour).

F-SW is used for the treatment of:

Tendinopathies and Enthesopathies
Urological indications (ED)
Delayed bone-non unions/bone healing
Wound Healing and other dermatological and aesthetic indications

Combination of focused and radial shockwave

Those clinics who are combining radial and focused shockwave are seeing fantastic results.

"I have 2 clinics that use Shockwave, one has focused and radial devices and the other only radial. Despite the clinic with only radial being a multi disciplinary clinic treating elite professional athletes, including premier league footballers and having luxurious surroundings, I feel totally insufficient there because the focused device is at my other clinic. I know I can offer better treatments when having the focused device, it's just not the same with only radial, I end up advising all the patients to go to the other clinic for better results no matter what part f the body. Focus can treat things that radial can't and combined the two modalities are even better!". Stuart Brown, Podiatrist, Chiropodist A-King Feet, Solihull and Birmingham Chiropody & Core Clinics

“As a combination therapy Focused shockwave with Radial is providing my patients with outstanding results. I already have numerous case studies from using the device after only a few months. I treat a lot of runners and thanks to our excellent success rate with focused, the focus shockwave therapy word has spread through the running community in my area. It’s not only runners I have had great success with, one chap who suffered terribly with back pain is now enjoying his passion of Golf”. Helen How, How Clinic Edinburgh.


More on Focused Shockwave from expert Paul Hobrough:

sarah campbell