Written by: Michael Strøm

Radial pressure wave is a important part of the shockwave family. When the first treatments of epicondylitis and heel spur were performed in the 1990’s with focused shockwave, the research for more mobile and more cost-efficient machines began. The result of this research led to the development of the radial pressure wave or radial shockwave machine in the mid 1990’s with the first machine in place for the 1996 Olympic games in Atlanta, GA.

Radial pressure wave is a pressure wave that is generated from air pressure driving a small metal bullet back and forth in a tube. When the metal bullet connects with the transmitter tip attached to the hand piece, it transmits the kinetic energy into the tissue in the form of a pressure wave.

The effect and depth of penetration is dependent on the specific shape and type of transmitter attached to the device. With RSW, the main energy is delivered to the surface of the skin and then spreads into the tissue. The general assumption is that it is possible to treat up to 5 cm into the body when using the more dense and powerful transmitters with radial shockwave devices. 1

Many of the indications that indicate the positive use of radial pressure waves with successful therapeutic results achieved will can be very similar to the effects associated with Focused Shockwave Therapy such as tendinopathies and most musculoskeletal conditions. 

RSW generates oscillations in the tissue which will lead to improved microcirculation and increased metabolic activity, so faster healing will be possible. This is also the reason that radial shockwave is a very good solution for working with elite athletes experiencing myofascial conditions – both in regular indications or in conjunction with enhancing recovery. 2

radial pressure wave

The effect from radial shockwave is undeniably seen in the tissue and thousands of patients are being treated every hour worldwide; however, the main focus of the research is still with the focused shockwave devices.

When we look at some of the effects seen in radial shockwave, it can be listed as follows:

  • Release of trigger points
  • Stimulation of circulation
  • Treatment of myofascial indications
  • Tensile strength
  • Lymphatic activity
  • Tissue mobilization

What about mechanotransduction as we see in focused shockwave?
The theory of RSW is based on the principles of mechanotransduction, with the concept of the biological effect (mentioned i FSW post, insert link) through a mechanical pressure effect. 3

So far, no conclusive evidence has been gathered showing whether SWT and RSWT are using the same mechano-biological signaling pathways, but so far the hypothesis is we can achieve it with both technologies when we take penetration depth and the specific tissue type into consideration. When it comes to myofascial trigger points, the theoretical explanation of the effect of RSW is that it reduces or even ideally reverses the believed energy crisis in the muscles. That theory is made by Janet Travell and David G. Simons. Mechanical stress to the skeletal muscle will activate the production of different proteins and increase the recovery of the muscles, in the combination of the increased circulation in the system. 4 

In general the RSWT makes it possible to efficiently treat a large variety of indications that affect people on a daily basis. These include epicondylitis, plantar fasciitis, calcification in the shoulder, DOMS and general trigger-points, just to mention a few. 

The technology is easy to use and with a few hours of training, you will have the foundation to work with basic indications in a safe way. It will make a great addition to the rehabilitation process, where it can reduce tension in muscles, reduce pain and increase range of motion. That will give a high amount of compliance and satisfaction for your patients. Working with shockwave is a skill, and you will experience a steep learning curve that will take you from basic to very advanced indications with a high confidence. Just remember following these small “hacks” 

– Know your anatomy.
– Know your pathology.
– Know the physics
– Know the desired target depth.
– Use the most optimal transmitter ( we will cover that in a future blog) 

– Define what you want to achieve with the application.
– Client education about effect and perception of intensity

1 Cleveland, R. O. et al.: Acoustic field of a ballistic shock wave therapy device. Ultrasound in medicine and biology, 33(8), 1327 – 1335, 2007.
2 Grecco, M. V. et al.: One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy. Clinics, 68(8),1089 –1095, 2013.

3 Bloch. W., Suhr, F :mechanotransduction: mechanical stimulation of biological processes. How shock and pressure waves initiate the healing process. Multidisciplinary medical applications. Level10buchverlag, heilbronn, 2014: p. 50-69
4 Ulrich Dreisilker: ENTHESOPATHIES KNOWLEDGE UPDATE: Pressurewaves: mechanism of actions p. 42-44