SoftWave vs. Radial Shockwave: What the Difference Means for Your Recovery

Ask a patient who’s had shockwave therapy at a lot of clinics what the machine did for them. The response is often “it worked, but it was painful” or perhaps “it didn’t do much and it hurt.” There’s a reason for either answer: the vast majority of what you’ll find on the market under the label “shockwave” isn’t a true shockwave in any sense of the word. They’re radial pressure wave devices. The marketing may be indistinguishable from the real thing, but the physics isn’t.

So: what’s actually different, and why does it matter for what you’re paying for?

Two ways to make a wave

A radial device is pneumatically driven. Compressed air propels a projectile within the handpiece to hit an applicator tip and radiate a pressure wave from that spot. It’s a common piece of equipment because of its mechanical simplicity, yet the wave dissipates fast and the effect is largely superficial. That concentration of energy near the skin is what accounts for the bruising and discomfort one might expect from that kind of treatment.

We use SoftWave, which is of a different order. It produces a true electrohydraulic shockwave. An electrode in the water-filled head of the applicator discharges to form an expanding gas bubble (the very same principle applied in breaking up kidney stones), yielding an acoustic shockwave that travels through tissue at many times the speed of sound in air. With its patented parabolic reflector, the SoftWave applicator is able to unfocus that energy over a broad, deep zone. In this way it can reach where a radial device’s more shallow wave can’t, be it the plantar fascia, a rotator cuff tendon, or a deep hip bursa.

Why some shockwave hurts, and this typically doesn’t

Older focused shockwave devices work on a fairly blunt principle: they concentrate the wave on one painful spot with enough force to induce controlled microtrauma, operating under the premise that a new injury response will put an end to the chronic problem. The approach can be effective, but it’s uncomfortable enough that many clinics will numb the area before they begin.

SoftWave is another matter entirely. Its mechanism is what tends to surprise patients. Rather than damaging tissue in order to elicit healing, the unfocused wave compresses and expands cell membranes as it moves through them. We call this mechanotransduction: a means of turning on the body’s repair signals without harming healthy tissue in the process. You’ll feel pressure and vibration from SoftWave, not the kind of sharp, localized pain a radial or focused device inflicts by putting all its energy in one place. Consequently there’s no need for us to apply any numbing agent first, and most patients are able to sit through a complete session in comfort, even over a genuinely tender area.

As for the evidence, I’ll be straightforward: extracorporeal shockwave therapy has a well-earned reputation for chronic tendinopathies that haven’t responded to rest or more conservative measures. Plantar fasciitis, Achilles tendinopathy, calcific rotator cuff issues, and tennis or golfer’s elbow are where the track record is best. Then there’s knee osteoarthritis, IT band syndrome, and recalcitrant ligament sprains, which we also see it used for in practice. The research isn’t as thick for those, though what’s there is positive, and the biology makes sense: you’re stimulating collagen turnover and blood flow in tissue that’s otherwise stalled. If you’re unsure whether shockwave is the answer for your particular case, we’d prefer you come discuss it with us directly instead of making assumptions based on a label.

What to actually ask if you’re comparing providers

There’s a case for some shockwave-shopping, and given how differently these devices perform, you should ask the questions that actually distinguish the machines:

• Is it electrohydraulic, or pneumatic/radial? By the strict laws of physics, only the former qualifies as a true shockwave.
• Focused or unfocused? An unfocused device disperses its energy over a wider and deeper field, whereas a focused one puts all the intensity at a point, which is more localized and may call for numbing.
• Does it require a numbing agent? If a numbing agent is called for, you’re likely looking at an aggressive, microtrauma-based focused unit rather than something working on mechanotransduction principles.

That’s not to say radial devices have no merit; they still have a place for superficial, localized problems. But should you have had an unsatisfactory experience with “shockwave” in the past, find out what kind you were given before you write off the treatment altogether.

At our West Linn clinic we use the SoftWave OrthoGold 100. A session runs $150 to $300 depending on the area being treated, though we can offer package rates and financing for those requiring multiple visits. Patients from Lake Oswego or Tualatin will find local scheduling information on the shockwave pages we have for those communities, or you can read more on our main SoftWave therapy page.

Ultimately, the category of the device isn’t what matters. Come in for an initial visit and lay out your particular injury and any concerns you have. That conversation will be the true measure of whether this is the right approach.