Shockwave Therapy
Extracorporeal Shockwave Therapy (ESWT) uses acoustic waves to stimulate healing in chronically injured tendons, ligaments, and soft tissue.
Focused vs. Radial: What's the Difference?
Not all shockwave devices are the same. Focused and radial shockwave devices differ in their physics, their depth of penetration, and the conditions they are best suited to treat.
Focused shockwave therapy, delivered using a device like the PiezoWave2 used in Dr. Bhandari's practice, is a true shockwave therapy. It delivers a single high-energy pulse that has greater control over the depth of penetration. This type of shockwave device allows for the concentration of energy to be focused at a specific target with precision, without losing its effect as the tissue depth increases. Though it can target more superficial structures less than 1 cm deep, the true power of this device is delivering a highly effective dose of shockwave therapy to deeper structures such as tendons, bones, joint capsules, and even cartilage.
Radial shockwave therapy is more precisely described as a pressure wave rather than a true shockwave. This technology produces divergent acoustic waves of energy that are most concentrated at the surface of the skin. Radial shockwave therapy can penetrate to a depth of 3–4 cm, however the treatment area over which the energy is delivered is not concentrated like it would be with a focused shockwave therapy device. This type of shockwave therapy can also be very effective for treating tendons, bone spurs and calcifications, and ligament injuries.
It is important to differentiate what type of shockwave therapy you are receiving, as the indications for treatment, the number of treatments, the intensity of the treatments, and the overall effectiveness of the therapy will vary based on the device used. Dr. Bhandari chooses the device following his initial assessment of what is most needed by the specific case at hand.
How Does Shockwave Therapy Work?
When acoustic wave energy is delivered to damaged tissue, it creates a cascade of cellular responses that re-initiate the healing process in chronically damaged tissue. These mechanisms occur to varying degrees with both focused and radial shockwave therapies, though focused shockwave is more effective for tissue pathology of greater depths.
Energy waves create a series of compression and shear forces on the tissue surface, generating mechanical forces that cause microscopic gas bubbles to form and collapse within the tissue — these are referred to as cavitations. This mechanical stress can break down pathological calcifications or stimulate bone and fracture healing. Beyond the mechanical effects, shockwave therapy stimulates increased local blood flow, upregulates signaling proteins which promote collagen synthesis, cell proliferation, and structural tissue remodeling. This is a similar effect to what regenerative injection therapies can stimulate, though at a lower intensity. There is also some evidence of stem cell activation, waking up local stem cells to further support tissue healing. Shockwave therapy can also directly modulate pain by desensitizing local pain receptors. This effect contributes to the sometimes almost-immediate pain relieving effect of shockwave therapy.
Depending on the type of injury or pathology, depth of tissue, and severity of tissue damage, it can take anywhere from 4–6 or more treatment sessions, though patients will usually notice a change within the first 3 treatments.
Understanding Shockwave Therapy
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Evidence supports meaningful benefit across a range of musculoskeletal conditions — particularly those characterized by chronic degeneration, calcification, or poor blood supply. The following represent conditions most frequently addressed in Dr. Bhandari's practice.
Not sure if your condition qualifies? Dr. Bhandari evaluates each patient's case individually. A summary of your history and a thorough physical exam can often be enough to determine whether extracorporeal shockwave therapy may be the right treatment for you. Contact us to discuss your specific situation.
Frequently Asked Questions
Extracorporeal shockwave therapy has strong clinical evidence for chronic tendinopathies, including Achilles tendinopathy, rotator cuff tendinopathy, patellar tendinopathy, and lateral epicondylitis, as well as for plantar fasciitis and other fascial conditions. It also has applications in calcific tendinitis, myofascial trigger points, and certain bone and joint conditions. The clinical evidence is strongest for chronic cases where tissue has been unable to progress through normal healing or has not responded to conservative treatment. Whether shockwave is appropriate for your specific condition is determined during assessment.
Most treatment plans involve a series of sessions spaced 4-7 days apart. The total number depends on the structure treated, the chronicity and severity of the condition, and the individual response. Some patients notice improvement after the initial session, while the full therapeutic effect typically develops over a few weeks following the treatment course. Dr. Bhandari will discuss the expected treatment plan for your case at the consultation.
Shockwave treatment involves the delivery of acoustic wave energy to deeper tissue, which can produce a transient aching or pressure sensation during treatment. This is generally well-tolerated. Dr. Bhandari uses devices for both focused and radial shockwave technology, allowing treatment to be calibrated to the appropriate depth and intensity for each structure and individual. Any specific concerns about sensitivity are best addressed at the consultation.
Yes, shockwave therapy is frequently combined with orthobiologic injections, particularly Platelet-Rich Plasma (PRP) and prolotherapy, to enhance outcomes in tendon and ligament conditions. The acoustic wave energy creates a local biological environment that is receptive to the growth factors delivered through orthobiologic treatment. The combination allows the structural healing response to be amplified beyond what either approach achieves independently. Whether a combined approach is appropriate depends on the specific condition and the clinical findings.
Shockwave therapy does not require general anesthesia or a formal recovery period. Some temporary soreness in the treated area in the days following treatment is common and expected as part of the tissue response. Specific activity guidance depends on the structure being treated and is addressed individually. Dr. Bhandari will provide guidance for your case at the consultation.
Ready to Explore Shockwave Therapy?
If you're looking for a conservative measure to explore for an acute or chronic pain complaint, shockwave therapy may offer just that. Schedule a consultation with Dr. Bhandari to determine whether shockwave is appropriate for your specific condition and how he would approach your case.