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Radial Shockwave Therapy Indications and Protocols

Posted by Vitality Team on 2019 Aug 14th

Radial Shockwave therapy is an effective treatment used to treat many orthopaedic conditions. It is one of the few modalities that offers an efficacious solution to chronic conditions that often do not respond well to other modalities. 


Indications include but are not limited to the following:

  • Plantar fasciitis
  • Heel spurs
  • Patellar tendinitis (jumper’s knee)
  • Lateral epicondylitis (tennis elbow)
  • Medial epicondylitis (golfer’s elbow)
  • Thumb basal joint Arthritis
  • Tendinitis
  • Chronic Inflammation
  • Bursitis
  • Shin splints
  • Morton' s Neuroma
  • Stress Fractures
  • Osteoarthritis
  • Insertion Tendonopathy
  • Epicondylopathy radialis /Ulnaris
  • Myofascial Pain Syndromes
  • Impingement Syndrome
  • Tendon calcifications
  • Patellofemoral Syndrome /Achillodynia
  • Tibialis anterior Syndrome
  • And more recently it has been found to have excellent results for common forms of Erectile Dysfunction.


There are not many contraindications for Radial Shockwave Therapy (RSWT). It is a safe, effective therapy for many conditions and does not have any serious side effects. However, it is not indicated under the following conditions:

  • Lung tissue should be avoided
  • The epiphysis has been considered and whilst some experiments demonstrate a detrimental outcome, others do not.
  • Patients who are haemophiliac or who are on anticoagulant therapy
  • Malignancy remains on the contraindication list, though some experimental work is ongoing whereby shockwave therapies are being employed to try and minimise the growth and spread of malignant tissue.
  • Metal implants seem okay for bone-based treatments, but implanted cardiac stents and implanted heart valves have not been fully evaluated.
  • Infection in the local area should be treated with strong caution given the as yet unknown effect of the therapy in this field.
  • Joint replacements - Cemented implants should be avoided. On the other hand, several researchers have actually used shockwave as a means to stimulate bone growth around an already lose prosthesis (osseous ingrowth).


Protocols may vary depending on the Shockwave unit and applicator head surface area. The following are sample protocols from the Zimmer enPuls Radial Shockwave devices. These units are electromagnetic radial shockwave units measuring force in mJ and frequency in Hz.

Chronic Calcific tendinitis of the shoulder

Frequency: 10-16 Hz

Power level: 120 mJ

Shocks per treatment: 2000-2500

Number of treatments: Up to 9

Frequency of treatment: 3 - 5 days

Recommended applicator head: 15 mm, moving to 6mm after familiarisation

Application method: Semi-static and dynamic

Initially treat trigger and pain points statically with up to 600 shocks per point and per treatment and then work slowly and directly over the entire area using the dynamic approach.

Acute Myofascial trigger point treatment e.g. on the back, in the case of muscular back pain

Frequency: Burst or 5–10

Pulse energy 60 mJ

Pulses (on average, overall per treatment) 1500–2000

No. of treatments (average) 1-4

Interval between treatments 7 days

Recommended applicator 15 mm, after familiarisation 6 mm

Application method: Static and Semi-static

Determine trigger points and myofascial tone and set priorities. Initially treat trigger and pain points statically with up to 600 shocks per point and per treatment. Start with the point with the highest priority. Work through dynamically at the end.

Acute Painful muscle spasms of the upper margin of the trapezius muscle

Frequency 5–10

Pulse energy 60–90 mJ

Pulses (on average, overall per treatment) 2000

No. of treatments (average) 3–4

Interval between treatments 5–7 days

Recommended applicator 15 mm punctual 6 mm

Application method: Static and Dynamic

Use the dynamic method at the upper margin of the trapezius muscle, working towards the clavicle and against the free hand, and adopt a short-term static procedure (for 100–200 pulses) for local hardening. Do not work directly in the direction of the shoulder blade. If myogelosis is palpable, use the 6 mm applicator and carefully treat the hardness directly using the static method.

Chronic Radial Epicondylitis

Frequency 10–16

Pulse energy 120 mJ

Pulses (on average, overall per treatment) 2000

No. of treatments (average) 4–8

Interval between treatments 3–5 days

Recommended applicator 15 mm / 25 mm

Application method: Dynamic

Differential diagnosis: Use another protocol if trigger points are palpable. Otherwise, accurately determine the painful area or structure. Then apply the dynamic method directing the shock across the tendon and muscle fibre.

For more sample protocols download the Treatment Manual from the Zimmer enPuls product page