Understanding the Key Differences Between Radial Pressure Wave Therapy (EPAT) and Focused Shock wave Therapy (ESWT)

Two prominent therapies that have generated a lot of interest in recent years are Radial Pressure Wave Therapy (EPAT) and Focused Shock Wave Therapy (ESWT). Both therapies are often referred to as shock wave therapy and while they both utilize wave technology to achieve their results, the two technologies differ significantly.

We have noted that this has created a lot of confusion. Using Shock Wave as a catch all term is probably not the best strategy, and the information below hopefully will help explain the differences and similarities and should help you choose the right treatment type for the right patient:

Radial Pressure Wave Therapy (EPAT)

Radial Pressure Wave Therapy, or Acoustic Wave Therapy, employs a handheld device that emits low-energy acoustic waves using a ballistic system.

These waves spread out radially from a central point, targeting a broader tissue area. The key characteristics of Radial Pressure Wave Therapy include:

Mechanism of Action

EPAT generates kinetic energy transmitted through the skin into the tissues. This energy promotes increased blood circulation, stimulates cellular metabolism and facilitates the dissolution of calcifications or fibrosis.

Treatment Area

EPAT is particularly effective for treating larger, more superficial areas of tissue, such as muscles and tendons. It is commonly used for conditions like muscle strains, tendinopathies (e.g., Achilles tendonitis) and trigger points.

Patient Experience

Radial Pressure Wave Therapy typically involves a series of sessions spaced over several weeks. The treatment is generally well-tolerated, causing mild discomfort at most, and does not require anesthesia or downtime.

Focused Shock Wave Therapy (ESWT)

Focused Shock Wave Therapy (ESWT or Extracorporeal Shock Wave Therapy), in contrast, uses a device that emits shock waves focused on a precise point within the body. These high-energy sound waves travel faster than the speed of sound and can penetrate deeper into tissues. The distinguishing features of Focused Shock Wave Therapy include:

Mechanism of Action

ESWT delivers shock waves directly to a targeted area, such as a specific tendon insertion or chronic injury site. This focused energy induces controlled microtrauma, stimulating healing processes, promoting tissue regeneration, and reducing inflammation.

Treatment Area

ESWT is particularly suited for treating localized musculoskeletal issues requiring precise targeting, such as plantar fasciitis, tennis elbow (lateral epicondylitis), and calcific shoulder tendinitis.

Patient Experience

ESWT sessions are typically shorter in duration compared to EPAT, and fewer sessions may be required overall. The therapy may cause mild discomfort during treatment, and some patients might experience temporary soreness afterward. Similar to EPAT, ESWT does not require anesthesia or downtime.

Conclusion

Whilst Radial and Focused are often both called Shock Wave, that is not particularly helpful. The amount of energy and the method used to generate that energy differ tremendously. The following graph shows very clearly that these two treatments are not the same and therefore outcomes and expectations are going to differ significantly as the literature very clearly demonstrates.

 
 

Radial Pressure Wave is generally used to:

  • Release trigger points

  • Stimulate circulation

  • Treat myofascial indications

  • Enhance tensile strength

  • Increase lymphatic activity

  • Mobilize tissue

Focused Shock Wave is generally used to:

  • Increase cell permeability

  • Activate stem cells

  • Reduce non-myelinated nerve fibers

  • Enhance antibacterial effects

  • Stimulate microcirculation

  • Release growth hormones

  • Energize neurons

A Combination of the two?

Combining EPAT and ESWT technologies can provide a comprehensive solution, enhancing each other's effects and minimizing limitations in treating various indications. Combination towers include both Radial and Focused machines allowing you to ensure the correct treatment is given for the patient sitting in front of you.

When deciding on the suitable wave technology for your clinical setup, consider your current and future treatment goals. Consult with our clinical experts for personalized guidance on incorporating pressure wave and/or shock wave therapy into your practice.

Citations

Cleveland, R. O. et al.: Acoustic field of a ballistic shock wave therapy device. Ultrasound in medicine and biology, 33(8), 1327 – 1335, 2007.

Grecco, M. V. et al.: One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy. Clinics, 68(8), 1089 – 1095, 2013.

Bloch, W., Suhr, F.: Mechanotransduction: mechanical stimulation of biological processes. How shock and pressure waves initiate the healing process. Multidisciplinary medical applications. Level10buchverlag, heilbronn, 2014.

Wess, O. et al.: Working group technical developments – consensus report. In: Chaussy, C. et al. (eds.): High Energy Shock Waves in Medicine. Georg Thieme Verlag, Stuttgart, 1997.

Maier, M. et al.: Substance P and prostaglandin E2 release after shock wave application to the rabbit femur. Clinical Orthopaedics and Related Research, (406), 237 – 245, 2003.

Mariotto, S. et al.: Extracorporeal shock waves: From lithotripsy to anti-inflammatory action by NO production. Nitric Oxide, 12(2), 89 – 96, 2005.

Byron, C. R. et al.: Effects of radial shock waves on membrane permeability and viability of chondrocytes and structure of articular cartilage in equine cartilage explants. American Journal of Veterinary Research, 66(10), 1757 – 1763, 2005.

Schuh, C. M. et al.: In vitro extracorporeal shock wave treatment enhances stemness and preserves multipotency of rat and human adipose-derived stem cells. Cytotherapy, 16(12), 1666 – 1678, 2014.

Raabe, O. et al.: Effect of extracorporeal shock wave on proliferation and differentiation of equine adipose tissue-derived mesenchymal stem cells in vitro. American Journal of Stem Cells, 2(1), 62 – 73, 2013.

Klonschinski, T. et al.: Application of local anesthesia inhibits effects of low-energy extracorporeal shock wave treatment (ESWT) on nociceptors. Pain Medicine, 12(10), 1532 – 1537, 2011.

Church, C.: A theoretical study of cavitation generated by an extracorporeal shock wave lithotripter. The Journal of the Acoustical Society of America, 86(1), 215 – 227, 1989.

Kisch, T. et al.: Repetitive shock wave therapy improves muscular microcirculation. Journal of Surgical Research, 201(2), 440 – 445, 2016.

Goertz, O. et al.: Short-term effects of extracorporeal shock waves on microcirculation. Journal of Surgical Research, 194(1), 304 – 311, 2015.

Nishida, T. et al.: Extracorporeal cardiac shock wave therapy markedly ameliorates ischemia-induced myocardial dysfunction in pigs in vivo. Circulation, 110(19), 3055 – 3061, 2004.

Chao, Y.-H. et al.: Effects of shock waves on tenocyte proliferation and extracellular matrix metabolism. Ultrasound in medicine and biology, 34(5), 841 – 852, 2008.

Christ, Ch. et al.: Improvement in skin elasticity in the treatment of cellulite and connective tissue weakness by means of extracorporeal pulse activation therapy. Aesthetic Surgery Journal, 28(5), 538 – 544, 2008.

Gollwitzer, H. et al.: Radial extracorporeal shock wave therapy (rESWT) induces new bone formation in vivo: results of an animal study in rabbits. Ultrasound in medicine and biology, 39(1), 126 – 133, 2013.

Wess, O.: A neural model for chronic pain and pain relief by extracorporeal shock wave treatment. Urological Research, 2008; 36(6), 327 – 334, 2008.

Beisteiner, R. et al.: Transcranial Pulse Stimulation with Ultrasound in Alzheimer’s Disease – A New Navigated Focal Brain Therapy. Advanced Science, 7(3):1902583, 2019.

08/31/24