Shockwave Therapy Types, Uses and Benefits

Your body’s tissues are equipped with their own innate healing mechanisms, perfectly designed to self-repair and regenerate. But multiple factors can slow or prevent the healing process, prolonging your pain and physical dysfunction. Extracorporeal shockwave therapy (ESWT) uses acoustic pressure waves to stimulate and accelerate tissue healing and repair.

Learn about the various types of shockwave therapy, the conditions each treats, and shockwave’s benefits over conventional treatment options.

What Exactly is Shockwave Therapy?

Shockwave therapy is a non-invasive regenerative technology that harnesses sound waves to stimulate the body’s own reparative mechanisms. Shockwaves are delivered to the skin’s surface via a transducer, with a topical gel as a medium. It is completely non-invasive and does not require anesthesia.


Shock wave therapy creates tiny ruptures in the capillaries that feed injured tissues, prompting the production of new blood vessels and increasing the flow of oxygen and nutrients. By disrupting cells and the interstitial spaces between cells, shockwaves trigger the release of biomolecules and increase cell membrane permeability to promote healing.

Shockwave therapy sets a high bar as the gold standard for regenerative technologies, especially when performed by an experienced clinician under ultrasound guidance.

The Evolution of Shockwave Therapy

Shockwaves were originally used in the 1980s to break up kidney and gall stones in a procedure called lithotripsy. At the time, doctors were concerned that shockwaves could potentially harm the hip bones of patients receiving the treatment.

Those concerns led to research on the impact of shock waves on bony tissue, where it was discovered that shockwaves have an osteogenic effect that stimulates and accelerates the healing of bone fractures. Before long, it became clear that shockwave therapy also has a regenerative effect on muscles, tendons, fascia, cartilage, nerves and blood vessels.

Decades later, further research and advancements in technology have broadened the range of possibilities for shockwave therapy. Options are now available to alter the intensity of shockwaves, vary the depth and width of penetration, zoom in to focus on specific tissues, and zoom out to cover larger areas.

Shockwave Types and Their Applications

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT technology produces high frequency sound waves to treat damaged tendons, muscles, fascia and bones. Focused shock waves are used to target smaller focal areas. Focused ESWT is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Focused shock waves are most commonly used for:

  • Acute athletic injuries
  • Bone fractures
  • Shin splints
  • Groin pain
  • Achilles tendon pain
  • Medial and posterior tibial pain
  • Ankle sprains
  • Wound healing

Radial Pressure Waves

Also known as Extracorporeal Pulse Activation Technology (EPAT), radial pressure waves are the type of shockwave therapy used in most therapy clinics. EPAT is used for larger treatment areas at a more superficial level. Radial shock waves emit their greatest energy at the skin’s surface, and lose power as their energy penetrates deeper tissues.

Radial shock waves are most often used for:

  • Superficial tendinopathy
  • Superficial trigger points
  • Myofascial pain
  • Plantar Fasciitis
  • Greater trochanter (hip) pain
  • Spasticity management in stroke, cerebral palsy, multiple sclerosis, dystonia and writer’s cramp

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new form of shockwave therapy that allows for deeper penetration of tissues, making it superior for larger myofascial zones. The waves are softer and more dispersed, offering better results for arthritic soft tissues and small nerves.

MyACT is highly effective for:

  • Overuse injuries.
  • Plantar fasciitis (heel pain)
  • Runner’s knee
  • Achilles tendonitis

MyACT is the best option for deep trigger points, and its deep penetration makes MyACT a good choice for larger people with hip joint conditions.

Actions Achieved with Shockwave Therapy

Most injuries involve multiple types of tissues at varying depths, covering varying amounts of area. The majority of clinics that offer shockwave therapy as a service only offer radial EPAT therapy, which is only effective for limited types of conditions.

Shockwave therapy is often used to prepare damaged tissues prior to physical therapy. To get the most effective injury treatment, you should look for a clinic that offers a spectrum of shockwave types, along with other regenerative technologies that support and enhance the effects of shockwave therapy, helping to accelerate healing.

In addition to treating injured musculoskeletal tissues, shockwave therapy is effective in treating urinary incontinence, chronic male prostatitis and chronic pelvic pain syndrome. Promising research on the use of shockwave therapy to treat additional pelvic organ conditions such as endometriosis and erectile dysfunction is ongoing.

Different types of shockwaves can be combined to accomplish multiple goals in a single session:

  • Neovasculogenesis
  • Autologous stem cell proliferation
  • Nitric oxide release
  • Collagen remodeling
  • Bone regeneration
  • Pain neuromodulation
  • Tendon regeneration
  • Restoration of hyaluronic acid
  • Scar softening
  • Nerve regeneration
  • Breakup of soft tissue calcifications
  • Release of growth factors

Benefits of Shockwave Therapy vs Conventional Injury Treatment

Whether injuries have an acute onset or develop over time, conventional medical treatment often falls short of restoring tissue integrity. In many cases, drugs used to manage pain and inflammation can cause tissues to degenerate further, and surgical solutions often have no better outcomes than conservative care.

There exists a large body of research that supports the advantages of shockwave therapy for various use cases over mainstream medical treatment and conventional physical therapy.

Following are just a few of the endless dozens of recent research findings about the effectiveness of shockwave therapy for various conditions:

  • Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic low back pain.” — Kızıltaş, Ömer, et al. (2022)
  • Compared to corticosteroid injections and conventional physical therapy in the treatment of chronic lateral epicondylitis (tennis elbow), “ESWT had a higher effect decreasing pain and improving functional disability in daily life activity at short and long term follow-up.” — Ismael et al. (2020)
  • For treatment of calcifying shoulder tendonitis, “high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.” — Rompe et al. (2001)
  • “ESWT improves pain and functional outcomes in patients with Achilles tendinopathy” — Fan et al. (2020)
  • “ESWT is more effective than traditional physical therapy methods on pain, quality of life, sleep, fatigue, depression, and disability in patients with myofascial pain syndrome.” — Gezgİnaslan and GÜmÜŞ Atalay (2020)
  • “Low intensity shockwave therapy is an effective treatment modality for the improvement of pain and quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome… it should be recommended as a part of individualized treatment strategies in such patients.” – Mykoniatis et al. (2021)
  • “8 weeks of low intensity shockwave therapy attenuated stress urinary incontinence symptoms on physical activity, reduced bladder leaks and overactive bladder… brought significant improvement in the quality of life.” – Long et al. (2020)
  • “Low intensity ESWT may transiently improve…quality of life, pain scores, and urinary symptom scores of patients with chronic pelvic pain syndrome.” – Li and Man (2021)

Overall, we can conclude that, when faced with the option of conventional care versus a combination of shockwave therapy, regenerative therapies and physical therapy, patients stand a better chance of repairing injured tissues and restoring functional mobility with ESWT.

Get Comprehensive Shockwave Therapy in NYC

Many clinics advertise shockwave therapy, but they only offer EPAT. While EPAT alone can effectively treat certain conditions, it falls short of treating a broad range of tissue types. Since injuries often involve more than one type of tissue, a combination of different shockwaves can be highly effective in restoring healthy bones, muscles, tendons, nerves and fascia.

If you are suffering from a slow-to-heal injury contact NYDNRehab today

Request an appointment » map Our location: 11 West 25th Street 5th floor, New York, NY 10010

At NYDNRehab, our advanced technologies equip us to use a variety of shockwave types to treat a broad range of conditions. Our shockwave procedures are performed with high-resolution ultrasound guidance, ensuring that the waves hit their targeted tissues with precision. If you are suffering from a slow-to-heal injury, contact NYDNRehab today, and speed up the healing process to restore pain-free mobility.


  • Fan, Yifei, et al. “Efficacy of extracorporeal shock wave therapy for achilles tendinopathy: a meta-analysis.” Orthopaedic Journal of Sports Medicine 8.2 (2020): 2325967120903430.
  • Gezgİnaslan, Ömer, and Sevgi GÜmÜŞ Atalay. “High-energy flux density extracorporeal shock wave therapy versus traditional physical therapy modalities in myofascial pain syndrome: A randomized-controlled, single-blind trial.” Archives of Rheumatology 35.1 (2020): 78.
  • Gezgİnaslan, Ömer, and Sevgi GÜmÜŞ Atalay. “High-energy flux density extracorporeal shock wave therapy versus traditional physical therapy modalities in myofascial pain syndrome: A randomized-controlled, single-blind trial.” Archives of Rheumatology 35.1 (2020): 78.
  • Ismael, Mona Mohamed Mohamed, et al. “Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis.” Egyptian Rheumatology and Rehabilitation 47 (2020): 1-6.
  • Kızıltaş, Ömer, et al. “Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain.” Turkish Journal of Physical Medicine and Rehabilitation 68.3 (2022): 399.
  • Li, Guizhong, and Libo Man. “Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis.” Translational Andrology and Urology 10.3 (2021): 1202.
  • Long, Cheng-Yu, et al. “Therapeutic effects of Low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence.” Scientific reports 10.1 (2020): 5818.
  • Mykoniatis, Ioannis, et al. “Low‐intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta‐analysis.” BJU international 128.2 (2021): 144-152.
  • Rompe, Jan D., Jan Zoellner, and Bernhard Nafe. “Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.” Clinical Orthopaedics and Related Research (1976-2007) 387 (2001): 72-82.

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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