Shockwave therapy is a groundbreaking, non-invasive treatment designed to address pain and injuries by stimulating the body’s natural healing processes. It’s widely used for musculoskeletal conditions, offering an excellent alternative to surgery or prolonged medication use.
There are two main types: radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT). This article explores their differences and applications, essential for determining the best treatment options for your clinic.
What is Radial Shock Wave Therapy (RSWT)?
Radial shock wave therapy (RSWT) is a form of Electrocorporeal Shockwave Therapy (ESWT). ESWT is a non-invasive procedure that offers an ideal alternative to painkillers or surgery. It uses shockwaves to provide fast pain relief and speed up recovery times for various injuries and chronic conditions in the musculoskeletal system, including bones, joints, muscles, tendons, and other soft tissues.
RSWT is one of the two primary ESWT modalities that has shown excellent results in treating superficial conditions spread over relatively large areas of the body.
How Does RSWT Work?
RSWT uses ultrasonic pulses, audio-acoustic pulses, and relatively slow shear waves applied to the skin's surface using a gun-like applicator. Compressed air accelerates a projectile within the applicator at high speeds toward the applicator tip, colliding with it and generating an energy pulse.
The kinetic energy is the greatest at the tip of the applicator in contact with the skin and weakens as it travels away from the tip as a radial wave. This makes it a useful treatment for patients with superficial conditions, with an effective treatment depth of about 3-4cm, but it becomes ineffective below 4cm.
Applications:
- Carpal tunnel responds well since it is close to the skin's surface.
- Tennis elbow patients can experience decreased pain, functional impairment, and increased grip strength.
- Achilles tendonitis patients experience reduced pain, improved blood flow, and tissue regeneration. Patients respond exceptionally well when combined with physical therapy.
- Muscle chains can be treated successfully because the waves break up adhesions and trigger points, relieving pain over a wide area.
- Plantar fasciitis can be successfully treated with pain relief and functional improvement, as seen in many patients.
What is Focused Shock Wave Therapy (FSWT)?
Focused shockwave therapy (FSWT) is a different type of ESWT that uses focused shockwaves to penetrate deeper tissues than radial waves can. They are also much more precisely targeted to a specific area. It makes it more useful for deeper, localized injuries or chronic conditions.
How Does FSWT Work?
FSWT also uses a gun-like applicator. However, focused waves are made when an electromagnetic current is applied through a cone of crystals that focus the energy field, creating a pressure wave that travels through the skin without losing power over a narrow focal point.
The skin experiences minimal impact with no superficial damage to the skin and underlying soft tissues. The pressure wave travels deep into bones, tendons, and other tissues, making it great for hip and leg conditions.
It stimulates the nervous system and interrupts pain signals, providing pain relief. Plus, the energy output can be adjusted to reach varying depths within the body, optimally up to 12cm.
Applications:
- Hip pain responds well because of the depth of treatment.
- Hamstring injuries mid to deep within the tissues can be successfully treated.
- Knee and joint arthritis respond well since FSWT improves blood flow and reduces inflammation and pain signals.
- Bone and stress fractures respond best to this more targeted form of ESWT, stimulating healing.
- Medial Tibial Stress Syndrome requires more targeted, deeper penetration next to the bone where shin splints typically occur.
- Delayed unions and non-unions also require a deeper, more targeted treatment to improve blood flow and stimulate healing.
- Rotator cuff injuries treated with this have reduced pain, improved function, and reduced calcification size.
- Insertional Achilles Pain responds well where FSWT stimulates blood flow and promotes tissue healing within the tendon insertion site.
- Tibialis Posterior Tendon Syndrome, especially mild to moderate conditions that have not responded well to physical therapy and orthotics, may benefit from this.
- Urological indications, male impotence, or mild to moderate erectile dysfunction, especially those with vascular-related causes, respond well to FSWT.
- Patients who can’t tolerate RSWT for acute injuries often benefit from a more shallow-focused form of FSWT.
What Are the Differences Between Radial and Focused Shockwave Therapy?
While both are forms of ESWT, there are significant differences in how they’re used and their effects on the body.
Energy Density and Distribution
RSWT uses lower energy density divergent waves that are strongest at the source and spread over a larger area than FSWT, which uses higher energy densities with a much smaller focal point. Since FSWT effectively skips the skin without stimulating the sensory network, it can use higher energy densities with little discomfort, but its effects have a much smaller focal point.
Treatment Area and Penetration Depth
RSWT is best for larger, more superficial areas up to 3-4cm deep since its effect is shallow and spreads more widely but diminishes rapidly beyond 4cm depth. On the other hand, FSWT is best for more precisely targeted areas up to 12cm deep. It is also much more adjustable, allowing tissues at depths between 2 and 30cm to be targeted.
Wave Speed
The energy wave of FSWT travels at 1,500 m/s, faster than the speed of sound. On the other hand, RSWT waves travel at only 10 m/s.
Shock Wave Generation
RSWT uses pneumatic principles, accelerating a projectile using compressed air to produce a radial wave, which technically doesn’t travel fast enough to be a shockwave. FSWT uses an electroacoustic principle, using electromagnetic currents focused through crystals to break the sound barrier and create a shockwave.
Biological Effects
Both modalities stimulate healing at the cellular level by increasing cell wall permeability. They act as potent vasodilators, stimulating the microcirculation of blood and lymphatic fluids. Additionally, they stimulate the release of neurotransmitters to reduce pain.
Focused shockwaves also stimulate growth factors and cause the cavitation release of nitric oxide, which enhances cellular metabolism, stimulates blood vessel formation, and has an anti-inflammatory effect.
Pain
While both modalities are used to treat pain, RSWT can be painful during treatment because of how it is applied to the skin. FSWT is considered much less painful and can be used in acute conditions where people cannot tolerate RSWT.
Combining Radial and Focused Shockwave Therapy for Better Results
There are numerous benefits of shockwave therapy. When you combine radial and focused therapies, you can get even better results. This is because you can use RSWT to treat the superficial structures and then use focused methods to target the deeper source of the injury. The two methods are often combined with great success, especially in runners, athletes, and sports injuries.
Frequently Asked Questions
What Are the Two Types of Shock Wave Therapy?
The two primary types of shock wave therapy are radial shock wave therapy (RSWT), which uses lower-intensity waves to target shallower tissues, and focused shock wave therapy (FSWT), which uses higher-intensity waves to target deeper tissues.
Final Thoughts
Radial and focused shockwave therapies offer unique benefits for treating numerous musculoskeletal system conditions. RSWT is ideal for larger, shallow areas, while FSWT precisely targets deeper, more localized issues. Combining both modalities can enhance outcomes, especially for athletes and sports injuries.
If you’re interested in learning more about shockwave therapy or treatments, consider Maven Imaging for Shockwave Therapy Equipment tailored to your clinic’s needs.
