Radial vs focused shockwave: how to choose a shockwave therapy machine for your clinic

A shockwave machine is one of the larger equipment purchases a physiotherapy, sports therapy, podiatry or chiropractic clinic will make, and the decision is harder than it looks because the two technologies sold as "shockwave" are physically different, cost very different amounts and suit different caseloads. This guide is for clinic owners and practitioners rather than patients. It covers the physics of radial and focused devices, the parameters and applicators that matter, portability, service and training, how to think about return on investment, and the questions to put to a supplier. For the clinical evidence behind the main indications, see our complete guide to shockwave therapy.

Radial vs focused: the physics

Strictly, a shock wave is an acoustic pulse with an extremely steep pressure rise measured in nanoseconds. Only one of the two device families produces that.

Focused shockwave (fESWT) devices generate a true shock wave electrohydraulically (a spark gap in water), electromagnetically (a coil driving a membrane) or piezoelectrically, then use a reflector or lens to concentrate it at a focal zone that can sit several centimetres below the skin. Energy is highest at the focus and low at the surface. These machines descend from kidney stone lithotripters and are the type used in the older hospital trials and for deep or calcified targets such as calcific shoulder tendinopathy [1].

Radial pressure wave (rESWT or RPW) devices are ballistic. A projectile is fired down a barrel in the handpiece and strikes an applicator head resting on the skin, sending a pressure wave outward into the tissue. Because the wave diverges, energy is highest at the surface and falls off with depth, giving an effective treatment depth of a few centimetres. The pressure rise takes microseconds rather than nanoseconds, so purists call these "pressure wave" devices. The projectile is driven either by compressed air or by an electromagnetic accelerator that needs no compressor.

A 2015 systematic review of PEDro-listed trials argued that labelling radial as "low energy" and focused as "high energy" is misleading, since the energy measures are not comparable, and found no evidence that either type produces better outcomes for the common orthopaedic indications [1]. Direct comparisons remain scarce. For a buyer, the practical point is that radial covers most superficial musculoskeletal work, while focused is needed for depth, calcifications or reproducing specific hospital protocols.

Energy and frequency

Radial devices have two main settings. Energy determines how hard the projectile hits: pneumatic units express it in bar, typically 1 to 5, and electromagnetic units in millijoules per pulse. Manufacturers publish conversion tables, but treat them as approximate because delivered energy also depends on projectile mass, speed and the applicator fitted. Frequency is pulses per second in hertz; higher frequencies make sessions quicker and are often better tolerated at lower energy, while lower frequency with higher energy suits small precise targets. A session usually delivers 1,500 to 3,000 pulses. Burst modes that fire a short train of pulses per trigger press, and the ability to store your own protocols, are both useful extras.

Focused devices are set by energy flux density in mJ/mm². NICE's Achilles guidance notes that protocols above about 0.12 mJ/mm² can be painful enough to need local anaesthetic, which may itself worsen outcomes [2]. For plantar fasciitis, a 2019 meta-analysis found medium-energy protocols more consistently effective against placebo than high-energy ones [3], so "more powerful" is not automatically better.

Applicators

The applicator head shapes how energy enters tissue. Most radial systems ship with 6, 15 and 25 mm heads, with specialised heads sold separately:

• Small (around 6 mm): concentrates energy on a small superficial target such as a lateral epicondyle or trigger point; usually run at lower energy.
• Medium (around 15 mm): the general-purpose head for plantar fascia, Achilles and patellar tendons.
• Large (20–25 mm or more): spreads energy over muscle bellies and larger regions, and is better tolerated.
• Specialised: deep-impact, spine-shaped and soft-material heads. Ask whether they are included.

Heads and handpiece generators are consumables with a rated life in pulses, which feeds directly into running costs.

Compressed air vs electromagnetic drive

Within radial devices, pneumatic units drive the projectile with a compressor, built in or separate, which adds weight, noise and a serviceable part. Electromagnetic units use a coil instead, removing the compressor and typically making the unit lighter and quieter. Some manufacturers also tune the pulse shape: Zimmer, for example, describes a heavier projectile at lower impact speed to produce a softer-feeling pulse. Such refinements have not been tested in trials, so treat them as comfort and usability features rather than therapeutic claims.

Portability, service and support

A mobile therapist or a practitioner working across sites needs a unit that packs into a case and sets up in a minute; a single-site clinic may prefer a cart-mounted console. Check console and handpiece weight, cable length, whether a case or footswitch is included, and mains requirements.

The sticker price is only part of the cost of ownership. Establish the handpiece service life in pulses and the cost of an overhaul (a two-million-pulse generator at 2,000 pulses per session covers roughly a thousand sessions, which gives a per-session figure once you know the overhaul price), applicator life and replacement cost, warranty terms and who honours them, whether servicing is UK-based with a loan unit, and whether software updates are free.

Regulation and training

Shockwave devices are medical devices. In Great Britain the MHRA currently accepts CE-marked devices alongside UKCA-marked ones under transitional arrangements running to 2028 or 2030 depending on the device, and all devices must be registered with the MHRA before being placed on the market [4]. Ask for the certificate and registration status, and be wary of devices sold through general marketplaces without documentation.

NICE's guidance on shockwave for greater trochanteric pain syndrome specifies that only clinicians with specific training should perform it [5], a principle that applies to every indication. Good suppliers include training covering patient selection, contraindications and consent, not just operation. Confirm with your insurer that your indemnity covers shockwave before treating anyone.

Return on investment

Sales presentations often show the machine paying for itself in months. Build your own calculation instead:

1. Estimate demand from your own caseload: count last year's patients with chronic plantar fasciitis, Achilles, patellar or elbow tendinopathy, or calcific shoulder who had not improved with first-line care.
2. Be honest about the evidence. Plantar fasciitis has reasonable sham-controlled support; Achilles tendinopathy and tennis elbow do not on the best recent reviews [6], and your consent process must say so.
3. Price a course, not a session, since most patients have three to six.
4. Add running costs, training time and any insurance change.
5. Compare with alternatives for the same money, such as another treatment room or recovery compression equipment with broader appeal to an athletic clientele.

Track outcomes from day one, as NICE asks NHS clinicians to do. It tells you whether the machine is earning its place and gives you honest figures for patients.

Questions to ask a supplier

• Radial or focused, and what is the energy source?
• Energy range (bar, mJ, or mJ/mm²) and frequency range?
• Which applicator heads are included, and what do extras cost?
• Rated life of handpiece and applicators in pulses, and overhaul cost?
• Where is it serviced, how long does it take, and is a loan unit provided?
• Warranty terms, and who honours them?
• CE or UKCA certificate and MHRA registration?
• What training is included and what does it cover?
• Console weight, and is a case or cart included?

An example: the Zimmer enPuls 2.0

To make this concrete, here is how one clinic-grade radial device stocked at cupping.com maps onto the points above. The Zimmer enPuls 2.0 is a compressor-free radial pressure wave unit from Zimmer MedizinSysteme with an electromagnetic projectile drive. Its published specifications are: energy adjustable from 60 to 185 mJ, which the manufacturer equates to roughly 1 to 5 bar; frequency from 1 to 22 Hz; burst modes of 4, 8 or 12 pulses; a colour touchscreen with seven preset programmes and over 25 illustrated protocols; SD card storage for custom programmes; a multi-directional footswitch; and a 2.7 kg console excluding the handpiece. The handpiece generator carries a minimum warranty of two million pulses, applicator heads are warranted for 150,000 pulses each and swap without tools, and the standard kit includes two 15 mm heads plus one 6 mm and one 25 mm head [7, 8]. It is positioned, in other words, as a portable low-maintenance radial unit for superficial tendon, fascia and trigger-point work rather than for deep or calcified targets, which would call for a focused device. Current availability is in our shockwave therapy collection.

Making the decision

For most UK physiotherapy, podiatry and sports therapy clinics, a radial device is the sensible first purchase: it covers the common superficial indications, costs a fraction of a focused unit and is easier to learn and carry. A focused device suits a clinic with a strong shoulder or deep-tendon caseload, ultrasound for targeting and the training to match. In either case, buy on service life and support rather than peak power, build your own demand estimate, and tell patients plainly what the evidence shows. The condition-level detail is in our articles on plantar fasciitis and Achilles tendinopathy and tennis elbow, and the full overview is in the complete guide to shockwave therapy.

References

1. Schmitz C, Császár NBM, Milz S, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British Medical Bulletin. 2015;116(1):115–138. https://academic.oup.com/bmb/article/116/1/115/401264
2. National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for Achilles tendinopathy. HealthTech guidance HTG426 (formerly IPG571), December 2016. https://www.nice.org.uk/guidance/ipg571
3. Wang YC, Chen SJ, Huang PJ, et al. Efficacy of different energy levels used in focused and radial extracorporeal shockwave therapy in the treatment of plantar fasciitis: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Medicine. 2019;8(9):1497. https://www.mdpi.com/2077-0383/8/9/1497
4. Medicines and Healthcare products Regulatory Agency. Regulating medical devices in the UK. GOV.UK guidance, updated February 2026. https://www.gov.uk/guidance/regulating-medical-devices-in-the-uk
5. National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome. HealthTech guidance HTG248 (formerly IPG376), January 2011. https://www.nice.org.uk/guidance/htg248
6. Korakakis V, Kotsifaki R, Sotiralis Y, Malliaras P. Shockwave therapy for midportion and insertional Achilles tendinopathy: a nail in the coffin? A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2026;56(5):282–299. https://www.jospt.org/doi/10.2519/jospt.2026.13985
7. Zimmer MedizinSysteme GmbH. enPuls Version 2.0: product information and technical data. https://www.zimmer.de/en/products/physical-therapy/shockwave-therapy/enpuls-version-2-0/
8. Cupping.com. Zimmer enPuls 2.0 Mobile Radial Shockwave Therapy Unit: product page. /products/zimmer-enpuls-2-0-mobile-radial-shockwave-therapy-unit-portable-electromagnetic-rpw-system

This article is for general information only and is not medical advice. Always follow the instructions supplied with your equipment, and consult a qualified healthcare professional if you have a medical condition or are unsure whether a treatment is right for you.