Radial shockwave energy delivery is dependent on the following:
• The volume of shocks provided. Most studies, and Enovis TM , recommend 2000 pulses per location when treating tendon dysfunction. Trigger points may require fewer shocks. Patient feedback will dictate length and intensity of treatment over an area. • The rate at which the shocks are provided (Hz). Some patients will subjectively prefer higher frequency treatments. Treating at higher rates will also shorten treatment times. • The bar pressure of the machine which dictates the intensity of the radial pressure wave. Deeper tissue dysfunction requires higher bar settings in most cases.
• The applicator used. Softer materials transmit less energy and are useful for superficial tissues/ sensitive areas. Harder metals (steel and titanium) are used to treat deeper tissues as they transmit more energy into the tissue. Examples of different applicators are listed below:
F15 White soft transmitter 15mm for superficial pain regions, muscles of mastication, cervical spine Penetration depth 0-30mm Intensity level: Very Low Ro40 15mm Energy beam transmitter with concave coupling surface, best for pain zones near the skin surface Penetration depth 0-35mm Intensity level: Medium DI15 Golden Depth 15mm Deep Impact ® transmitter for deep target areas, chronic disorder, local trigger points Penetration depth 0-60mm Intensity level: High
D20-S Standard Oscillator, 20mm transmitter for muscle and connective tissue Penetration depth 0-50mm Intensity level: Medium
C15 CERAma-x ® Ceramic Energy 15mm transmitter for any type of tendinopathy Penetration depth 0-35mm Intensity level: High
Atlas Soft flexible tipped transmitter 15mm for highly sensitive regions and trigger points in the cervical spine
The divergent wave of the RSW makes it easier to locate painful tissue when scanning for painful areas. This is a key factor in why RSW has been shown to be statistically more effective in 88.5% of studies that compared RSW to either placebo or alternative treatment modalities when treating different types of tendinopathies. 37
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