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Shockwave therapy has become an increasingly popular modality in physiotherapy and chiropractic clinics. As of 2025, a growing body of research supports its effectiveness for various musculoskeletal conditions, from stubborn tendinopathies to chronic pain syndromes, making it an attractive addition to a clinic’s toolkit.
But with two primary types of shockwave devices (Radial vs. Focused/Electromagnetic) on the market, how do you decide which is right for your practice?
In this post, we’ll break down the differences, review current evidence for each type, and discuss practical considerations like budget, treatment pricing, and training. Our goal is to help you make an informed, evidence-based decision so you can integrate shockwave therapy confidently and profitably.
Radial Shockwave Therapy: Cost-Effective Versatility for General MSK Care
Radial shockwave devices (like the portable Storz Medical Masterpuls One pictured above) generate radial pressure waves that disperse outward into the tissue, delivering energy to superficial structures. These machines use pneumatic or ballistic technology to create low- to medium-energy acoustic pulses that stimulate healing in tendons, muscles, and fascia.
Radial shockwaves don’t penetrate as deeply as focused waves; their effects dissipate with depth, but this “wide and shallow” energy distribution is very effective for common superficial conditions such as plantar fasciitis, tennis elbow, and Achilles or patellar tendinopathies.
In fact, the FDA cleared radial shockwave for treating plantar fasciitis in 2000 and lateral epicondylitis (tennis elbow) in 2003, and it has since become a workhorse modality in sports medicine and rehab clinics.
Clinical Evidence for Radial Shockwave
From a clinical evidence standpoint, radial Extracorporeal Shockwave Therapy (rESWT) holds its own. Multiple randomized trials and reviews have shown that radial shockwave can significantly reduce pain and improve function in chronic soft-tissue injuries:
Plantar Fasciitis
Both focused and radial shockwave produce better outcomes than sham treatment for chronic plantar heel pain.
Notably, a 2023 RCT in patients with calcaneal spurs found that radial shockwave was just as effective, if not more effective, than focused shockwave at improving foot function and pain over 5–13 weeks. Patients in the radial group had superior Foot Function Index improvements compared to the focused group. This suggests a high-quality radial device is an excellent choice for heel pain and other superficial foot conditions.
Tendinopathies (Elbow, Knee, etc.)
Radial shockwave shows comparable results to focused shockwave in many tendinopathies. For example, in chronic patellar tendinitis (jumper’s knee), a head-to-head RCT found no significant difference in effectiveness between focused and radial shockwave, both groups saw similar improvements in pain and VISA score when combined with eccentric exercise.
Similarly, for lateral epicondylitis (tennis elbow), studies indicate both radial and focused treatments yield pain relief; one trial even noted radial shockwave led to greater gains in wrist extensor muscle strength compared to focused shockwave. In short, radial devices are clinically proven to alleviate many common tendon and soft-tissue pathologies.
Myofascial Pain and Trigger Points
Radial shockwaves are also well-suited for trigger point release and general muscle pain syndromes, due to the broader area of wave dispersion. Therapists often use radial applicators to treat conditions like trapezius myofascial pain or shin splints with good effect (anecdotally and in emerging studies). The radial waves’ ability to cover larger surfaces makes them ideal for extensive or diffuse pain patterns in muscle tissue.
Practical and Cost Advantages
In terms of practicality and cost, radial shockwave machines tend to be more affordable and easier to maintain than focused units. They are often the entry point for clinics on a tighter budget. For instance, Storz Medical’s radial devices (such as the Masterpuls line) are known for Swiss-built quality and durability.
Clinics can start with a compact model like the Masterpuls One, a conveniently priced, portable radial system, which provides effective energy output for everyday MSK conditions at a fraction of the cost of a high-end focused machine.
Radial devices also typically have no consumable parts beyond the transmitter heads, and modern designs (like Storz’s “SPARROW” handpiece) are built to be robust and low-maintenance. All these factors make radial ESWT a popular choice for many clinics starting out with shockwave therapy.
When to Choose Radial Shockwave
If your clinic treats a broad range of common musculoskeletal conditions, plantar fasciitis, Achilles and patellar tendinopathies, tennis/golfer’s elbow, shoulder tendonitis, etc., and you’re working with a limited budget, a radial shockwave device is likely the best fit. It’s versatile, evidence-supported, and cost-effective. You can deliver effective treatments for superficial to moderately deep issues without the higher price tag of a focused system.
Many experts consider radial ESWT the “best bang for your buck” starting point, and you can always upgrade later. In the next section, we’ll look at when and why you might consider that upgrade to a focused shockwave device.
Focused Shockwave Therapy: High-Precision Power for Deep or Difficult Cases
Focused shockwave devices generate concentrated acoustic waves that converge at a specific depth in the body, allowing targeted delivery of higher energy to deeper tissues. These machines (often electromagnetic, piezoelectric, or electrohydraulic in design) produce true shockwaves that can penetrate further and with greater focal intensity than radial waves.
What does this mean in practice? Focused ESWT is ideal for “hard-to-reach” conditions and regenerative applications, cases where the pathology is deep, localized, or particularly stubborn.
Advanced Clinical Applications
Consider a fibrotic plantar fasciitis or a calcific rotator cuff tendonitis that hasn’t responded to superficial modalities. A focused shockwave can be aimed precisely at the calcific deposit or pathological tissue to induce biological effects like cavitation, neovascularization, and microtrauma that stimulate healing.
Focused high-energy shockwaves have been shown to physically break down calcific deposits in shoulder tendons, leading to pain relief and improved range of motion.
One clinical trial in calcific shoulder tendinopathy found that shockwave therapy (all types) significantly reduced pain and improved function for all patients at 3 months, with the greatest reduction in calcium deposit size achieved by a combination of focused + radial treatment.
This highlights the powerful role focus devices can play in regenerative orthopedics; they not only relieve pain but can structurally influence tissue healing (e.g., dissolving calcifications, promoting collagen realignment).
Deep Tissue and Joint Applications
Deep tissues and joints are another domain where focused shockwave shines. The waves’ ability to reach greater depths makes them suitable for conditions like hip enthesopathies, low-back facet joint pain, or even bone-related pathologies.
For example, in knee osteoarthritis (a condition where pain originates from deep joint structures and subchondral bone), focused ESWT has outperformed radial in head-to-head comparisons. A 2022 randomized study showed that focused shockwave was superior to radial shockwave in reducing knee OA pain and improving function (WOMAC scores and walking distance).
Both types of ESWT helped patients, but the focused treatment led to greater gains in pain relief and mobility. These findings make sense, as the energy of focused waves can reach the affected subchondral bone and deeper joint tissues better than radial waves in an arthritic knee.
Focused devices are also being explored in regenerative medicine protocols, for instance, to stimulate cartilage repair in early OA or to augment biologic treatments like PRP.
Bone Healing and Regenerative Applications
Beyond joints, bone healing and “regeneration” applications often require the power of focused shockwaves. Orthopedic literature has documented that ESWT can promote bone formation in non-union or delayed-union fractures, likely by inducing local angiogenesis and growth factor release.
Many of these bone-healing protocols use high-energy focused shockwaves. There is even evidence that shockwave therapy can be a non-invasive alternative to surgery for certain fracture non-unions.
(Interestingly, radial shockwaves have shown promise in superficial bone injuries as well, but for deep or large bones, focused waves are typically necessary) In summary, if your practice (or future plans) leans toward regenerative sports medicine, ortho-biologics, or treating deeper anatomical structures, investing in a focused shockwave device will give you the capabilities you need.
Cost and Equipment Considerations
Of course, these advanced capabilities come at a cost. Focused shockwave machines are generally more expensive than radial ones, often 2–3× the price (depending on the model and energy level).
They also tend to be larger, console-based units (as shown in the image above, which features a Storz Medical Duolith SD1 Ultra, a modular system offering both focused and radial ESWT).
However, many manufacturers now offer combination devices or modular add-ons. For example, you might start with a focused unit and later attach a radial module, or vice versa. This modular approach (illustrated by the Duolith SD1’s stackable design) means you can expand your device’s functionality as your clinic grows, rather than purchasing a whole new machine.
The key point is that if your clinical focus involves conditions like non-insertional Achilles tendinosis, deep gluteal tendinopathy, chronic low back pain, or any scenario requiring that extra depth and precision, a focused shockwave device is a worthwhile investment. It allows you to offer treatments that a radial-only device might not adequately deliver.
Evidence in Low Back Pain
To highlight evidence in low back pain, a 2024 systematic review noted that focused ESWT shows promise in treating various contributors to chronic low back pain. Patients in the analyzed RCTs had significant pain and disability improvements after focused shockwave therapy, compared to standard conservative care.
The authors concluded that focused shockwave is a “modern physiotherapeutic method” capable of addressing a broad spectrum of low back pain generators, though they called for more research.
Radial vs. focused comparisons in back pain are lacking, but it’s logical that focused waves can target deeper structures (e.g., lumbar facet joints or deep muscular trigger points) that radial waves might not fully reach.
When to Choose Focused Shockwave
Choose a focused shockwave device if your clinic prioritizes advanced regenerative therapies, needs to treat deeper orthopedic conditions, or wants the cutting-edge capability to tackle complex cases.
In 2025, many clinics specializing in sports injuries, chronic pain, or rehabilitation of recalcitrant conditions have added focused shockwave specifically for those challenging scenarios.
Although the upfront cost is higher, the potential clinical outcomes and the ability to differentiate your practice can make it very rewarding (both for patients and for your business). The next section will discuss combining both technologies for maximal versatility.
Combining Radial and Focused Shockwave: The Best of Both Worlds for Complex Cases
Why choose one when you can have both? For clinics that handle a wide variety of patients, from straightforward tendinopathies to complex chronic pain cases, a combination of radial and focused shockwave therapy offers unparalleled flexibility.
In fact, many experts recommend having both types available if feasible, as they complement each other. Radial can cover larger superficial areas (great for muscle trigger points and broad referral pain), while focused can zero in on deep or focal lesions. Using them in tandem, either in the same session or across a treatment plan, can yield synergistic benefits.
Clinical Evidence for Combined Therapy
Clinical evidence is beginning to support combined therapy as possibly more effective in tough cases. Here are a couple of examples:
Chronic Achilles Tendinopathy
A retrospective study at Harvard’s Spaulding Rehab compared patients treated with radial ESWT alone versus those who received combined radial + focused ESWT for chronic Achilles tendinopathy (all patients had failed exercise therapy).
Both groups improved significantly in function, but notably, 90% of the combined-therapy group achieved a clinically important improvement (in VISA-A scores) versus 64% of the radial-only group.
The authors suggest that combined therapy may provide “more predictable functional gains” than radial alone in recalcitrant Achilles cases. In practice, a therapist might use the radial handpiece to treat the broad area othe f calf muscle and tendon junction, then apply focused shockwaves to especially degenerated spots on the tendon, attacking the problem from multiple angles.
Calcific Shoulder Tendinopathy
As mentioned earlier, a 45-patient RCT found that while focused-only and radial-only treatments both helped chronic calcific shoulder pain, the combined approach yielded the greatest reduction in calcific deposit size and the best overall improvement in pain and range of motion.
Early pain relief was achieved with all methods, but the combination excelled by the 3-month follow-up, presumably because the focused waves broke up the calcium and the radial waves promoted circulation and healing in surrounding tissues.
This kind of outcome is why a high-volume sports clinic or orthopaedic center might invest in a top-of-the-line machine that offers both focused and radial capabilities.
Lateral Epicondylitis (Tennis Elbow)
There isn’t yet a consensus that combining modalities is superior here, but a 2024 study did compare focused vs. combined (focused+radial) ESWT for lateral elbow tendinopathy. It found both approaches effective, with perhaps some early pain reduction advantage in the combined group, though more research is needed (this was a retrospective analysis).
What it signals is that clinicians are experimenting with sequencing radial and focused treatments to maximize outcomes in stubborn tendon injuries.
Treatment Customization Benefits
From a patient-care perspective, having both radial and focused tools means you can truly tailor the therapy. For example, in a single session for a patient with chronic patellar tendinosis and quadriceps muscle tightness, you might do radial shockwave over the quad and patellar tendon surface to modulate pain and improve blood flow, then do a few minutes of focused shockwave at the deep distal patellar insertion where there’s a known degeneration on imaging. This one-two punch can address both the symptom and the root pathology.
Cost Considerations
The obvious downside is cost; owning two devices or a dual-function device is a significant investment. However, many manufacturers (like Storz, etc.) offer combined systems or upgrade paths, as noted above. If you already have a radial unit, you might be able to add a focused module for less than buying a standalone focused machine.
If you’re planning long-term and have the capital, buying an integrated unit that includes both (or is upgradable) can be cost-efficient in the grand scheme.
When to Choose Combined Systems
Clinics that specialize in complex musculoskeletal cases, chronic pain, or high-performance sports injuries should strongly consider a combined radial and focused shockwave setup.
This ensures you’re equipped for anything that walks through the door. As one practitioner put it, using combination therapy allows “revolutionizing the way you approach shockwave therapy” by leveraging each technology’s strengths. It’s the maximalist approach, but if you market it well, it can also position your clinic as a referral center for advanced shockwave treatments.
Financial Considerations: ROI and Pricing Strategies for Shockwave Therapy
Integrating shockwave therapy isn’t just a clinical decision; it’s a business one. The good news is that shockwave can be a profitable addition to your practice when managed properly. Let’s talk numbers and strategies:
Treatment Pricing
Shockwave therapy is typically billed as a premium service, reflecting the specialized equipment and the value of rapid patient results. Clinics charge anywhere from around $100 up to $200+ per session, depending on geography, practice type, and whether shockwave is combined with other therapy. In Canada and the US, a common fee is about $100–$250 per treatment (often out-of-pocket, since insurance coverage for ESWT varies).
Value-Added and Marketing
Beyond direct revenue, offering shockwave can attract new patients and differentiate your clinic. By advertising this advanced service, you might pull in individuals who would otherwise be referred for injections or surgery. It can also be an add-on service for existing patients, for instance, a chiro or physio can charge a supplemental fee to include shockwave in a treatment session for stubborn cases.
Many clinics successfully market shockwave for conditions that haven’t improved with conventional therapy, positioning it as a cutting-edge solution. Being known as the clinic with the latest technology can enhance your reputation.
In fact, there’s anecdotal evidence of competitive dynamics: one chiropractor reported that after he started offering shockwave therapy, other providers in his area without shockwave began losing patients, until they, too, invested in a machine! While that’s a lighthearted story, it underscores a real trend: patients are savvy and often seek out clinics with modern offerings.
Pricing Strategy Considerations
When setting your pricing strategy, consider your local market and your costs. Some clinics bundle shockwave into longer appointments (e.g., a 40-minute physiotherapy session that includes 10 minutes of shockwave), while others bill it à la carte (e.g. $100 for a stand-alone shockwave treatment).
There’s no right or wrong approach. The important part is to communicate the value: explain to patients that this technology is evidence-based and may help them avoid more invasive procedures. Satisfied shockwave patients can become great word-of-mouth referrers, especially among athletic communities.
Don’t forget to account for consumables or maintenance in your pricing. Radial devices have minimal consumable costs (just occasional transmitter replacements), whereas focused devices might have electrodes or therapy head maintenance after a certain number of pulses.
These costs are usually low relative to revenue, but it’s wise to include a small buffer in your pricing to cover them. Maintenance on quality devices is generally very manageable. For example, Storz systems are designed for continuous use with minimal downtime and no costly overhauls needed. Still, factor in things like warranty, training, and marketing expenses when calculating ROI.
Example Pricing Model
- Initial session (evaluation + trial of shockwave): $300 (longer visit, includes assessment and first treatment).
- Follow-up shockwave sessions: $250 each, or offer a package like 3 for $650 (to encourage commitment to the full course).
- Estimated Cost per treatment: negligible (let’s say <$10, accounting for device lease and consumables).
- Patient value: resolution of chronic pain, often priceless!
Even at 10 patients per month purchasing a 3-pack, that’s $6,500 revenue. As shown earlier, scaling up to 30-50 patients/month can yield a very robust return.
Training and Support: Set Yourself Up for Success
Whether you start with radial, focused, or both, proper training is critical to maximize the benefits of shockwave therapy. The technique for applying ESWT, finding the correct treatment points, selecting appropriate energy/dosage, and coupling the device to tissue, is a learned skill. Without training, one might not get optimal results and could even cause avoidable discomfort. Fortunately, there are resources to ensure you hit the ground running:
Hands-On Training
We highly recommend seeking hands-on instruction for you and your staff. Additionally, independent organizations offer courses. For example, the Medical Shockwave Institute (available at iloveshockwave.com) provides both in-person workshops and online certification courses for radial and focused shockwave.
They cover treatment techniques for dozens of musculoskeletal conditions and emphasize safety and efficacy. Having your clinicians certified or well-trained not only improves patient outcomes but also boosts your credibility when marketing the service.
Clinical Protocols
Leverage published research and guidelines. Many device manufacturers supply treatment protocol handbooks (with suggested settings for plantar fasciitis, tennis elbow, etc.), often based on clinical trials. These can be a great starting point. As your experience grows, you’ll fine-tune protocols for your patient population.
Ongoing Support
Choose a training partner that offers ongoing support. This might include refresher webinars, new research updates, or even forums where ESWT practitioners discuss tough cases. Shockwave therapy is an evolving field; for instance, new evidence might suggest different frequencies or numbers of pulses for a condition.
Staying updated will help you remain confident that you’re providing state-of-the-art care. (Tip: Set up Google Alerts or follow journals for terms like “ESWT” or “shockwave therapy 2024” to catch the latest findings.)
Patient Education
Finally, don’t overlook patient education. Trained clinicians will know how to set patient expectations (e.g., “You might feel relief after one session, but typically a series of 3–5 treatments is required for lasting results, and it’s normal to have mild soreness for a day or two as your body heals”, all good things to communicate.) A well-informed patient is more likely to complete their plan of care and refer others.
Making the Right Choice for Your Practice
Choosing the right shockwave device comes down to aligning clinical needs with practical realities. A radial shockwave unit may be the perfect starting point if you’re a general physio or chiro clinic looking to expand services without breaking the bank.
It will cover a wide range of conditions effectively. Suppose you’re aiming to be on the cutting edge of regenerative therapy or manage complex, deep-seated injuries. In that case, a focused shockwave device offers the precision and power to target those challenges.
And suppose you aspire to be a center of excellence for shockwave therapy, treating everything from plantar fasciitis to non-union fractures. In that case, a combination of both radial and focused will equip you to handle it all.
Importantly, the investment in shockwave is not just in equipment, but in integrating a new paradigm of treatment at your clinic. When implemented well, it can elevate your patient outcomes, open new revenue streams, and distinguish your practice in a competitive healthcare landscape.
The evidence is on your side: research shows shockwave therapy can significantly relieve pain and improve function in conditions that often frustrate both patients and providers. By adding this modality, you’re not only investing in a device, you’re investing in the ability to offer hope to patients with chronic, nagging musculoskeletal issues.
As you move forward, take advantage of the resources available. Reach out to colleagues who use shockwave, engage with training programs (like the ones at iloveshockwave.com for hands-on mentoring), and stay curious about the ongoing research.
With the right device and the right know-how, shockwave therapy can become a highlight of your practice, one that brings great satisfaction in seeing patients get better faster, and yes, a boost to your practice’s bottom line as well.
How Vale Medical Helps You Choose and Succeed with Shockwave Technology
At Vale Medical, we’ve been the leading distributor of STORZ Medical shockwave devices in the United States for over 20 years, and we understand that choosing between radial, focused, or combination shockwave systems can feel overwhelming.
That’s why we offer personalized consultations to help you select the right technology for your specific practice needs, patient population, and budget, whether you’re starting with an affordable radial system like the Masterpuls One or investing in advanced focused capabilities with the Duolith SD1 Ultra.
Ready to discover which shockwave technology is right for your practice? Contact Vale Medical today for a free consultation with one of our shockwave specialists. Let us help you make the evidence-based choice that will transform your patient care and practice success, because we’re committed to helping you get your patients better, faster.
References:
- Thammajaree C. et al. (2023). Radial Shockwave vs. High-Intensity Laser for Plantar Fasciitis, RCT Results: Both therapies significantly reduced pain in chronic plantar fasciitis patients.
- Şah V. et al. (2023). Focused vs. Radial Shockwave for Heel Spurs: 13-week RCT showed both radial and focused ESWT improved plantar fasciitis outcomes vs. sham; radial ESWT led to greater improvement in foot function scores than focused ESWT.
- Van der Worp H. et al. (2014). Focused vs. Radial Shockwave in Patellar Tendinopathy: RCT found no significant difference between focused and radial ESWT outcomes, both groups improved similarly in pain and VISA-P function scores.
- Akınoğlu B. et al. (2025). Focused vs. Radial Shockwave in Tennis Elbow: RCT found f-ESWT slightly better for pain reduction, while r-ESWT improved muscle strength more; both modalities significantly reduced lateral elbow pain and disability.
- Ko N. et al. (2022). Focused vs. Radial Shockwave in Knee Osteoarthritis: RCT demonstrated both f-ESWT and r-ESWT improve knee OA pain and function, but focused ESWT produced greater pain relief and 6-minute walk distance gains than radial.
- Abo Al-Khair MA. et al. (2021). Shockwave for Calcific Shoulder Tendinopathy (Focused vs Radial vs Combined): All groups had pain, function, and ROM improvements; the combined focused+radial group achieved the largest reduction in calcification size and best overall outcomes.
- Robinson DM. et al. (2022). Combined Radial+Focused vs. Radial Alone for Achilles Tendinopathy: Retrospective study, both groups improved, but 89.7% of combined-ESWT patients met clinically important improvement vs 63.8% with radial alone, suggesting combined therapy may yield more consistent functional gains.