Why I Choose Radial Shockwave

When it comes to regenerative therapies, there is a LOT of marketing noise. Every year there's a new machine or pill promising to be faster, better, and more revolutionary than everything that came before it.

But, really, time and research tells us what’s up. And shockwave is proving to be pretty useful: decades of clinical use and a growing body of evidence supporting its effectiveness for stubborn tendon pain, plantar fasciitis, calcific tendinopathy, and other musculoskeletal conditions.

(Honestly, as I’m aging, I’ve become more interested in ways to be able to hike with Ed & the dogs long-term, so I started doing the research, and here is my summary:)

Radial Shockwave Therapy (RSWT)

This is the shiny new machine at the Bear.

Radial shockwave uses compressed air to accelerate a projectile, creating a pressure wave that spreads through tissue. The energy is delivered over a broader area, making it particularly useful for many of the tendon and fascia problems we see every day.

Great for:

• Achilles tendinopathy

• Plantar fasciitis

• Tennis elbow

• Patellar tendinopathy

• Chronic muscle tightness and trigger points

Research suggests shockwave therapy stimulates blood vessel formation, cellular signaling, and tissue remodeling while also helping reduce pain.

I choose a unit made by Chattanooga, a company that has been producing shockwave technology for decades. We chose it because it's reliable, well-established, and backed by a substantial body of clinical research. You can read more about it here.

Focused Shockwave Therapy (FSWT)

Focused shockwave delivers energy deeper and concentrates it at a specific target.

This can be helpful for certain conditions, particularly deeper tissues or highly calcified structures.

For most everyday running, hiking, lifting, and recreational athlete injuries, radial shockwave works extremely well. But when a case requires focused treatment, I’m happy to point patients toward trusted providers who offer it.

What About SoftWave?

SoftWave uses an electrohydraulic method to generate shockwaves. It's a different way of creating and delivering acoustic energy than traditional radial systems.

You'll often see it marketed as a breakthrough in regenerative medicine. The reality is that it's one of several shockwave technologies available today. While early research is promising, there is currently limited evidence showing that SoftWave consistently outperforms established radial or focused shockwave protocols for common musculoskeletal injuries. It’s a great therapy, we just haven't seen convincing evidence that the higher cost necessarily translates into better outcomes.

What matters the most:

Honestly, no matter what machine, the research on tendon rehabilitation consistently shows that recovery depends on the combination of:

• Appropriate loading

• Activity modification

• Progressive exercise

• Time

• Patient consistency

Shockwave can be a powerful tool, but it works best when paired with a smart rehab plan. The goal is to help tissues tolerate more load. Shockwave stimulates biological responses involved in healing and remodeling, while exercise provides the mechanical stimulus needed to build stronger, more resilient tissue.

References

1. Schmitz C, et al. "European Society for Musculoskeletal Shockwave Therapy consensus statement." Journal of Clinical Medicine. 2024.

2. Lou J, Wang S, Liu S, Xing G. "Effectiveness of extracorporeal shock wave therapy without local anesthesia in chronic plantar fasciitis." American Journal of Sports Medicine. 2017.

3. Speed C. "A systematic review of shockwave therapies in soft tissue conditions." Rheumatology. 2014.

4. Ioppolo F, et al. "Clinical application of shock wave therapy in musculoskeletal disorders." European Journal of Physical and Rehabilitation Medicine. 2014.