Radial vs Focused Shockwave Therapy for Tendinopathy: What the Latest Research Says

Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.

Radial vs Focused Shockwave Therapy for Tendinopathy: What the Latest Research Says

Tendon pain can be frustrating, persistent, and difficult to fully resolve — especially when it starts interfering with work, sport, gym training, or everyday movement.

Whether you are dealing with tennis elbow from repetitive lifting, shoulder pain from tradie work, Achilles pain from running around Sunbury, or knee tendon pain from local sports competition across Melbourne, chronic tendinopathy can significantly impact your quality of life.

At Health Wise Chiropractic, one of the most common questions we hear is:

“What’s the difference between radial and focused shockwave therapy — and which one works better?”

A major 2025 systematic review and meta-analysis examined exactly that question, comparing Radial Shockwave Therapy (RSWT) and Focused Shockwave Therapy (FSWT) across multiple tendon conditions.

Here’s what the latest evidence means for patients looking for shockwave therapy treatment in Sunbury and surrounding Melbourne suburbs.

What Is Tendinopathy?

Tendinopathy refers to chronic tendon pain and dysfunction caused by repeated mechanical overload.

Common examples include:

• Tennis elbow

• Golfer’s elbow

• Rotator cuff tendinopathy

• Achilles tendinopathy

• Patellar tendinopathy (jumper’s knee)

• Gluteal tendinopathy

• Shoulder calcification injuries

• 
  

Research shows tendinopathy commonly affects:

• Athletes

• Gym-goers

• Tradespeople

• Office workers

• Runners

• Active adults

• People performing repetitive lifting or gripping tasks

Without proper treatment, tendon pain can become chronic and harder to resolve.

What Is Shockwave Therapy?

Shockwave therapy is a non-invasive treatment that uses acoustic pressure waves to stimulate healing within injured tissue.

There are two primary types:

Radial Shockwave Therapy (RSWT)

Radial shockwave therapy disperses energy over a broader area and works more superficially within tissues.

It is commonly used for:

• Tennis elbow

• Plantar fasciitis

• Achilles tendinopathy

• General muscular tightness

• Broad tendon irritation

Focused Shockwave Therapy (FSWT)

Focused shockwave therapy concentrates energy at a precise depth and focal point.

This allows treatment of deeper tissue structures and more targeted tendon pathology.

Focused shockwave is often used for:

• Deep tendon injuries

• Calcific shoulder tendinopathy

• Persistent chronic tendon pain

• More localised tissue degeneration

Which Shockwave Therapy Worked Better?

Focused Shockwave Therapy Showed Better Pain Reduction

The pooled analysis found that Focused Shockwave Therapy (FSWT) demonstrated statistically superior pain reduction compared with radial shockwave therapy when used alone.

Researchers reported:

• Statistically significant pain reduction favouring FSWT

• Stronger mid-term improvement beyond 12 weeks

• Better long-term outcomes in some shoulder tendinopathy studies

One study involving non-calcific rotator cuff tendinopathy found:

• Both RSWT and FSWT improved symptoms

• However, FSWT showed superior long-term outcomes beyond 24 weeks

Another study on tennis elbow found:

• Both treatments improved pain and function

• FSWT produced more sustained benefits over time

• 
  

Radial Shockwave Therapy May Improve Strength More Effectively

Interestingly, the research also found that RSWT may provide greater improvements in wrist extensor strength, particularly in tennis elbow cases.

The pooled analysis showed:

• A statistically significant improvement in wrist extensor strength favouring RSWT

• Benefits observed in both short-term and mid-term follow-up periods

Researchers believe this may occur because radial shockwave treats a broader treatment area, including surrounding forearm muscles and tendon structures.

This may make RSWT particularly useful for:

• Tennis elbow

• Forearm overuse injuries

• Grip-related dysfunction

• Occupational repetitive strain injuries

• 
  

Both Treatments Were Found to Be Safe

Reported side effects included:

• Mild skin redness

• Temporary bruising

• Minor swelling

• Temporary discomfort during treatment

Researchers noted that local anaesthetic was generally not required for low-energy shockwave therapy.

Shockwave Therapy May Work Best Alongside Rehabilitation

The review highlighted that shockwave therapy is often combined with:

• Strengthening exercises

• Eccentric loading programs

• Chiropractic care

• Manual therapy

• Mobility rehabilitation

• Sports rehabilitation

• 
  

At Health Wise Chiropractic, we commonly combine shockwave therapy with evidence-based rehabilitation approaches to improve long-term tendon recovery.

This is particularly important because tendinopathy is no longer viewed as simply “inflammation.”

Modern research shows tendon pain also involves:

• Collagen degeneration

• Reduced tendon healing capacity

• Altered pain processing

• Nervous system sensitisation

• Reduced tendon load tolerance

• 
  

Why Tendon Pain Can Become Chronic

The review explained that chronic tendinopathy involves complex biological changes within the tendon.

Shockwave therapy may help stimulate:

• New blood vessel formation

• Tendon regeneration

• Collagen production

• Fibroblast activity

• Tissue remodelling

• Cellular repair mechanisms

Researchers also noted that chronic tendon pain may involve central sensitisation, where the nervous system becomes increasingly sensitive to pain signals over time.

This helps explain why some tendon injuries persist for months — even when scans do not appear severely damaged.

Which Shockwave Therapy Is Better Overall?

The honest answer from the research is:

There is currently no clear overall winner.

The review concluded:

• FSWT may provide superior pain reduction in some tendon conditions

• RSWT may improve muscle strength more effectively in tennis elbow

• Both therapies appear safe and clinically useful

• More high-quality studies are still needed

Researchers also noted that treatment protocols varied significantly between studies, including:

• Number of shocks

• Energy settings

• Session frequency

• Treatment duration

• Exercise integration

This makes direct comparisons challenging.

Who May Benefit From Shockwave Therapy?

Shockwave therapy may help people suffering from:

• Tennis elbow

• Shoulder tendinopathy

• Achilles tendinopathy

• Jumper’s knee

• Rotator cuff pain

• Chronic tendon irritation

• Persistent sports injuries

• Repetitive strain injuries

It may be particularly useful for patients who have:

• Ongoing tendon pain lasting longer than 3 months

• Failed to improve with rest alone

• Plateaued with standard physiotherapy

• Recurring flare-ups

• Difficulty exercising due to pain

Shockwave Therapy in Sunbury & Melbourne

At Health Wise Chiropractic, we provide shockwave therapy as part of an integrated treatment approach for chronic tendon and musculoskeletal injuries.

We regularly help patients from:

• Sunbury

• Melton

• Craigieburn

• Gisborne

• Keilor

• Melbourne

Whether your tendon pain is coming from sport, gym training, work demands, or everyday wear and tear, an accurate assessment is the first step toward recovery.

Book a Shockwave Therapy Assessment

If you are dealing with persistent tendon pain, our team can help determine whether radial or focused shockwave therapy may be appropriate for your condition.

How Chiropractic Care May Help

At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.

Treatment may include:

• Chiropractic adjustments

• Postural assessment

• Soft tissue therapy

• Corrective exercises

• Ergonomic advice

• Laser therapy

• Shockwave therapy

• Spinal decompression therapy

We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.

About the Author

Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.

He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.

His treatment focus includes:

• Chiropractic adjustments

• Sports chiropractic

• Massage therapy

• Shockwave therapy

• Laser therapy

• Non-surgical spinal decompression

Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.

Reference

Stania M, Pawłowski M, Benduch M, Dudon A, Hirjaková Z, Bzdúšková D, Kimijanová J. Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis. Sci Rep. 2026 Feb 6;16(1):7632. doi: 10.1038/s41598-026-37160-3. PMID: 41651897; PMCID: PMC12936064.