Shockwave therapy is the medical use of acoustic pressure waves, delivered through the skin, to stimulate healing in tendons, bone, and other soft tissue. What most explanations leave out is that two different technologies are marketed under that single name. Focused electromagnetic shockwave produces a true acoustic shockwave with a defined focal point reaching several centimeters deep. Radial pressure wave produces a slower, superficial pressure pulse with no focal point. The professional societies that define shockwave classify them as separate technologies, and most of the published evidence for deep conditions is built on the focused kind.
Search “what is shockwave therapy” and most answers describe one general category: a device that sends pressure waves into tissue to reduce pain and speed healing. That is true as far as it goes, and it is also incomplete in a way that matters if you are deciding whether to book a session. The word “shockwave” is not a regulated medical term, so it covers two genuinely different pieces of equipment with different physics, different depth of reach, and a different evidence base behind them.
This page defines the category properly: what shockwave therapy is, where it came from, the two technologies that share the name, what it is cleared and studied for, and how a session actually works. For the deep, side-by-side comparison of focused versus radial devices, see our focused versus radial breakdown. This page is the definition; that page is the detailed comparison.
What shockwave therapy actually is
Extracorporeal shockwave therapy, ESWT, delivers acoustic pressure waves through the skin to a target tissue, without surgery or injection. The technology originated in lithotripsy, using focused shockwaves to break up kidney stones, developed in the 1980s. Researchers observed that the same acoustic energy affected soft tissue and bone healing, and orthopedic applications followed starting in the 1990s. The proposed mechanism is mechanotransduction: the mechanical energy of the wave stimulates a cellular repair response, including new blood vessel formation, and in the case of calcific deposits, can help stimulate their breakdown. It is not ultrasound, which uses continuous sound waves primarily for imaging or lower-intensity therapeutic heating, and it is not a laser or electrical stimulation device, despite occasionally being confused with both.
Two technologies share the name; only one produces a true shockwave
This is the distinction most definitional explainers skip, and it is why this page exists. A true acoustic shockwave has a pulse rise time measured in nanoseconds and a sharp, high-pressure peak. Focused electromagnetic ESWT produces exactly that: an electromagnetic generator creates a shockwave with a defined focal point, so the clinician can direct concentrated energy to a specific depth, up to several centimeters into tissue. Radial pressure wave produces a different physical event: a pneumatic ballistic mechanism fires a projectile that strikes an applicator, generating a pressure pulse with a rise time in milliseconds, a much lower peak pressure, and no focal point, so the energy disperses across the surface rather than concentrating at depth.
The International Society for Medical Shockwave Treatment (ISMST) and the American Society for Medical Shockwave Therapy (ASMST), the professional bodies that define shockwave classification, both treat these as separate technologies per their published classifications. Because “shockwave” is not a regulated marketing term, a clinic that owns only a radial pressure wave unit can still legally advertise “shockwave therapy.” When published research describes ESWT for deep tendinopathy, calcific tendinitis, or bone stress injury, it is almost always referring to the focused technology.
| Property | Focused Electromagnetic ESWT | Radial Pressure Wave |
|---|---|---|
| Generator | Electromagnetic coil | Pneumatic ballistic projectile |
| Pulse rise time | Nanoseconds | Milliseconds |
| Focal point | Defined, depth-selectable | None; disperses at the surface |
| Typical depth | Several centimeters | About 1 to 3 cm, superficial |
What shockwave therapy is FDA-cleared and studied for
The U.S. Food and Drug Administration cleared extracorporeal shockwave devices for chronic proximal plantar fasciitis in 2000 and for lateral epicondylitis, tennis elbow, in 2002, through the 510(k) pathway, which requires demonstrating the device is substantially equivalent to a legally marketed predicate. Individual devices carry their own specific clearances beyond those two conditions. Published systematic reviews, including a 2015 review in the British Medical Bulletin and a 2014 review in the British Journal of Sports Medicine, describe evidence supporting shockwave therapy across a range of tendon and bone conditions, with the strongest results for deep or calcific targets tied specifically to focused delivery. Radial pressure wave has its own, generally narrower, evidence base focused on superficial myofascial and soft-tissue applications.
How a shockwave session actually works
A session is performed in-office, without anesthesia, and typically takes only a few minutes per treatment area. The clinician applies a coupling gel and positions the applicator over the target, using palpation, ultrasound, or imaging to locate the correct depth and focal point for focused devices. Energy level is adjusted for patient tolerance and the tissue being treated. Most patients describe a deep, momentary discomfort at the treatment site rather than sharp pain, and resume normal activity the same day. A course of care is typically a series of sessions spaced about a week apart, not a single visit, with the number determined by the condition being treated.
Why the distinction changes what you should ask before booking
If you arrived at this question while weighing shockwave for a specific condition, the practical takeaway is this: ask what type of device the clinic actually owns before you book, not after. A clinic can accurately call either technology “shockwave” while offering very different physics and a different evidence base behind the result. Our focused versus radial comparison covers the five verification questions in detail, and our technique page covers why the clinician’s training matters as much as the device itself.
Frequently asked questions
What is shockwave therapy?
Shockwave therapy, or extracorporeal shockwave therapy (ESWT), is the medical use of acoustic pressure waves, delivered through the skin without surgery or injection, to stimulate a healing response in tendons, bone, and other soft tissue. The technology originated in lithotripsy for breaking up kidney stones in the 1980s and was adapted for orthopedic and musculoskeletal use starting in the 1990s. The proposed mechanism, called mechanotransduction, is that the mechanical energy of the wave stimulates cellular repair processes and new blood vessel formation. Two different technologies are marketed under the single name shockwave: focused electromagnetic devices, which produce a true acoustic shockwave with a defined focal point, and radial pressure wave devices, which produce a different, more superficial pressure pulse.
Is radial pressure wave the same thing as shockwave therapy?
Not by the physics definition, though it is commonly marketed under the same word. A true acoustic shockwave has a pulse rise time measured in nanoseconds and a defined focal point; focused electromagnetic devices produce that. Radial pressure wave uses a pneumatic ballistic mechanism that produces a much slower pulse, measured in milliseconds, with no focal point and energy that disperses across the surface. The International Society for Medical Shockwave Treatment and the American Society for Medical Shockwave Therapy classify them as separate technologies. Because the word shockwave is not a regulated marketing term, a clinic can legally call either device shockwave therapy, so asking which type a clinic owns is the only way to know which one you are getting.
What is shockwave therapy used for?
Common uses include chronic plantar fasciitis, Achilles and patellar tendinopathy, tennis and golfer’s elbow, calcific tendinitis of the shoulder, and bone stress injuries, primarily using focused electromagnetic devices for the deeper or calcific targets. Radial pressure wave is more often used for superficial myofascial conditioning, muscle tightness, and trigger points, or as an adjunct alongside focused treatment. The specific condition and its depth are what determine which technology, or combination, is actually appropriate, rather than shockwave being a single interchangeable treatment for any painful area. At Dynamic Athlete, the modality, or combination of modalities, is selected at evaluation based on the specific tissue and depth involved, rather than a single default protocol.
Is shockwave therapy FDA-cleared?
Yes, for specific indications. The FDA cleared extracorporeal shockwave devices for chronic proximal plantar fasciitis in 2000 and for lateral epicondylitis in 2002, through the 510(k) premarket notification pathway. Individual devices carry their own specific clearances that can extend beyond those two conditions, so the exact cleared use depends on the specific device and manufacturer. Clearance reflects a determination that the device is substantially equivalent to an already legally marketed device for that indication, and it is one reason why the type of device a clinic owns is a meaningful question, not a technicality.
Does shockwave therapy hurt?
Most patients describe it as uncomfortable rather than painful, with the sensation concentrated at the treatment site and, for focused devices, at the specific depth being targeted. No anesthesia is required, sessions typically take only a few minutes per area, and most patients resume normal activity the same day. Radial pressure wave tends to produce a milder, more superficial tapping sensation. Discomfort is generally more noticeable at higher energy settings, and the energy level is adjusted during the session for patient tolerance and the tissue involved. Soreness at the treatment site can continue for a day or two afterward, which is an expected part of the tissue response rather than a sign of a problem.
How is shockwave therapy different from ultrasound therapy?
They are different technologies despite sometimes being confused. Ultrasound therapy uses continuous, high-frequency sound waves (typically 1 to 3 MHz), primarily for diagnostic imaging or for lower-intensity therapeutic heating of tissue. Shockwave therapy uses discrete, high-pressure acoustic pulses delivered to stimulate a cellular repair response, a mechanically different process at much higher peak pressure for focused devices. Ultrasound is also commonly used alongside shockwave and injection therapies for imaging guidance, to confirm a diagnosis or localize a target, which is a separate role from shockwave’s own therapeutic mechanism. This distinction matters because a patient researching shockwave therapy can find ultrasound-related results and assume they describe the same treatment, when the underlying technology and evidence base are not interchangeable.
Where did shockwave therapy come from?
The underlying technology originated in lithotripsy, developed in the 1980s to break up kidney stones using focused acoustic shockwaves generated outside the body. Researchers subsequently observed that the same acoustic energy, at different settings, affected soft tissue and bone healing, and orthopedic and musculoskeletal applications of shockwave therapy followed starting in the 1990s. Radial pressure wave technology developed somewhat separately, using a simpler pneumatic mechanism, and became associated with the same shockwave marketing language even though its underlying physics differ from the focused, lithotripsy-derived technology. That shared origin is also why the deepest, most established evidence for shockwave therapy traces back to focused, depth-targeted delivery rather than the simpler radial technology that followed it to market.
Who performs shockwave therapy at Dynamic Athlete?
Focused electromagnetic ESWT, radial pressure wave, and EMTT are all performed by Aneesh Garg, DO, CAQ, who founded the American Shockwave Training Institute (ASTI) and trains other clinicians nationally on modality classification and technique. The type of device and, for focused delivery, the focal depth are selected for the specific condition being treated, localized by palpation, ultrasound, or imaging, rather than a single default protocol applied to every patient. Every case begins with an evaluation to confirm the diagnosis and appropriate modality before a device is used, consistent with the training standard ASTI teaches nationally. Full detail on the focused-versus-radial distinction is on our comparison page.
Medically reviewed by Aneesh Garg, DO, CAQ, double board-certified in Sports Medicine and Internal Medicine, Founder and Medical Director of the American Shockwave Training Institute. Rated 4.9 out of 5 across 179 Google reviews. This article is educational and does not replace an individualized medical evaluation.
If you are deciding whether shockwave therapy fits your condition and want the distinction explained plainly before you book anywhere, request a consultation or call (303) 997-1733.