Focused or radial: how is the choice made?

Start with the question to be dealt with

Those looking for shockwave soon encounter a comparison of devices. For a patient, the most important comparison begins earlier: are both proposals about the same symptom and the same probable cause? A treatment for fasciopathy plantar cannot be compared one by one with a proposal for nerve pain under the foot.

Ask first which diagnosis is used and what findings support it. If there is still important doubt, it should remain visible. A technically precise treatment does not solve diagnostic uncertainty by itself.

The treatment goal also helps. Do you want to tolerate a particular activity better, break a recurring pattern or weigh another treatment option? The more specific the question, the easier it becomes to assess whether a technique fits.

What's different in physics?

Focused shock waves are beaming energy into a target area. Radial pressure waves are spreading from the point of contact. The ISMST appoints both as different techniques. This includes differences in the generation and description of the institutions.

A number on one device cannot be compared to a number on the other. The words high and low also get meaning within the technique and application used. For the treatment choice is relevant why a certain distribution of energy would be needed.

A table can organize the conversation without identifying a winner:

What does research say about the choice?

Studies differ in participants, treatment institutions and additional care. A study in which people also do exercises answers a question other than a study in which only a device treatment is given. So watch the whole treatment program.

In heel pain by fasciopathy plantaris calls the Dutch guideline of 2026 both techniques within a defined additional approach. That supports a conversation about choice. It does not prove general superiority of one technique for all symptoms.

A careful centre can therefore sometimes say that the security is limited. That is useful information: you can then consider costs, load and personal preferences without assuming a guarantee. Hiding uncertainty behind device names makes a decision less clear.

Opinions shall not be unanimous: Thuisarts doesn't recommend shockwave with long heel spur. Discuss this difference with your clinician; an additional option is not a self-evident standard treatment.

Three examples of thinking to recognize differences

Let's say two proposals for heel pain use the same diagnosis. One clinician first advises a more elaborate practice program, the other directly shockwave. Then the first discussion is not focused on radial, but on whether the basic approach has already been sufficiently implemented.

Then suppose you have shoulder pain and a scan of calcification. Then it has to be explained whether that finding fits your symptom and what evidence is part of this diagnosis. An investigation of symptoms from the tendons in the shoulder without calcification does not automatically answer the same question.

A third example is a combination proposal. Focused, radial and an additional technique are offered together. Then ask for each part what separate purpose it has. More parts make a proposal more comprehensive, but the added value still needs to be argued.

In case of symptoms of tendons in the shoulder without calcification, the JOSPT guideline from 2025 Shockwave off. An indication per diagnosis should therefore also be substantiated.

How do you weigh your own preference?

You can attach importance to travel distance, tolerability, time or cost reduction. Those preferences are legitimate, as long as you understand what they mean for the choice. The technically most comprehensive treatment is not automatically the best connection to your goal.

Put three priorities on paper for a conversation. For example: you want to continue to be able to do your job, you don't want to go through endless loose treatments and you want to understand what you can do for yourself. This gives a personal framework to the assessment.

Also ask what happens if you don't choose a shockwave for the time being. A good conversation contains an understandable alternative and a moment to revisit the choice. You can agree to that on the basis of content, without the feeling that there is only one chance of recovery.

When is a proposal sufficiently clear?

You should be able to explain in your own words after the conversation which structure is probably involved, why a technique has been chosen and to which improvement is measured. If that is not possible, additional questions will make sense.

Check whether the evaluation can also result in discontinuation or adaptation. Treatment does not automatically become more appropriate because it has already been invested in time and money. The original goal remains the starting point.

Keep the explanation, any research results and your own questions. It helps to coordinate with other operators. It also prevents a subsequent choice from revolve around a device, while the most important conversation is about your symptoms, functioning and capabilities.