Radial pressure wave therapy in chiropractic care

What is radial pressure wave therapy?

The use of extracorporeal shockwave therapy (ESWT) has rapidly expanded in musculoskeletal care. DCs have embraced it as a noninvasive solution supporting recovery in tendinopathy, fascial disorders and soft tissue dysfunction.¹ Yet, amidst the proliferation of devices, confusion remains. Is radial better than focused? Which technology “goes deeper”? Does one replace the other?

These questions, though common, often miss the clinical point. The focus shouldn’t be on classifying devices but rather on applying them purposefully, according to the patient’s presentation and phase of healing.

Radial pressure wave (RPW) therapy, delivered via pneumatic or electromagnetic generators, has emerged as a strategic first-line shockwave application. It is not only accessible and cost-effective, but physiologically appropriate for addressing superficial pain, neuromechanical tension and soft tissue reactivity.² For DCs, RPW therapy offers a sensory-rich treatment that aligns well with the profession’s manual heritage while offering efficiency and scalability in practice.

How radial pressure wave therapy works: Mechanical signal, neurological response

Unlike focused shockwave, which converges acoustic energy to a precise tissue depth (often 6–12 cm), RPW propagates energy radially through mechanical percussion.³ Though often labeled “shockwave,” RPW technically functions more like a pressure wave, diffusing energy outward across a shallower target zone (typically 3–5 cm) with high frequency.

The combination of dispersive pressure and frequency engages superficial mechanoreceptors, such as Meissner’s corpuscles, Ruffini endings and Pacinian corpuscles, which are richly distributed in fascia and subcutaneous tissue.

This neuromechanical interaction leads to reduced peripheral nociception, improved blood flow and lymphatic return and sensory desensitization that increases tolerance to movement and therapy.⁴

In clinical context: When and why radial pressure wave therapy works

RPW has sometimes been referred to as an introduction or gateway into acoustic therapy, implying there is a progression to something else and ultimately abandoning this approach at a later time. RPW is not simply “entry-level” shockwave; it’s a precision tool for specific conditions and stages. Its greatest utility is found in addressing the following:

• Myofascial pain
• Tendon-bone junctions (e.g., lateral elbow, Achilles insertion)
• Fasciopathies (e.g., plantar fasciitis, iliotibial band syndrome)
• Paraspinal hypertonicity
• Upper trapezius or gluteal tension disorders
• By engaging a broad surface area with consistent stimulus, RPW improves local tissue pliability and pain response, facilitating subsequent manual work, mobilization or active rehabilitation.

It’s especially helpful in early or subacute stages, where deeper, focused energy might be uncomfortable or premature. In practices offering high-intensity laser therapy (HILT) or manual therapies, such as myofascial release, RPW adds a neurosensory primer, improving compliance and outcomes.

Respecting manual therapy

Manual soft tissue techniques remain a cornerstone of chiropractic care and for good reason. Techniques such as Active Release Technique, instrument-assisted soft tissue manipulation and pin-and-stretch provide targeted, functional input to soft tissues. However, they are also clinician-intensive, requiring sustained physical effort and advanced training.

RPW offers a supportive adjunct, not a substitute. It allows staff to contribute meaningfully to the care plan and reduces clinician strain, especially in busy practices or practices with repetitive condition types.⁵ Applied before manual therapy, RPW can reduce tissue reactivity, making manual work more effective and less taxing.

Patient experience and value perception

RPW is also uniquely aligned with patient psychology. Many patients equate treatment efficacy with sensory engagement; they want to feel the treatment working.^6,7,8

Unlike modalities that are silent or subtle, RPW is highly tactile: It thumps, vibrates and resonates through the muscle, delivering a strong message that therapy is in action. This enhances both compliance and perceived value, especially when out-of-pocket expense is involved.

It becomes a gateway modality for patients unfamiliar with out-of-pocket therapies, helping bridge the gap between traditional visits and regenerative services.

Focused and defocused shockwave: When to progress⁹

There are indeed cases where focused or “defocused” shockwave (with energy concentrated deeper or spread more broadly) may be preferable. For example:

• Chronic tendinopathies at greater depth (e.g., proximal hamstring, calcific shoulder tendinitis)
• Delayed fracture healing or enthesopathic changes that require more directed energy
• Greater depth of penetration for focused; defocused may not have much depth beyond RPW
• Plateauing cases that failed RPW or conservative management

In such cases, RPW can act as a first-phase strategy, improving tolerance and reducing reactivity before progressing to higher-energy focused protocols.

Putting it all together: A modern strategy

In daily practice, RPW shines in its ability to enhance outcomes across a variety of care models, particularly in chronic low back pain, a condition with both structural and functional contributors.

Case example: Chronic low back pain with myofascial restriction

A patient presents with long-standing lower back pain, moderate mobility restriction and postural fatigue. Imaging is nonspecific, but clinical assessment reveals gluteal and lumbar paraspinal tension, thoracolumbar fascial tightness and restricted pelvic mobility.

Plan

• Initiate RPW therapy once weekly, targeting lumbar paraspinals, gluteus medius and thoracolumbar fascia.
• Duration: Three to eight treatments, once weekly.
• Lumbar decompression or flexion-distraction therapy to unload/mobilize joints.
• Chiropractic adjustments and appropriate exercise therapy for stabilization, symmetry, endurance and range of motion as progression allows.

This example highlights how RPW integrates seamlessly into multi-modal chiropractic care, offering a neurologically active primer before passive decompression, chiropractic adjustments or dynamic rehabilitation work.

Clinical efficiency in the real world

• RPW can reduce the need for additional staff time to support out-of-pocket (often referred to as cash-based) care expansion.
• Deliverable by trained staff, freeing the doctor for diagnosis, chiropractic adjustments or new patient consults.
• Patient-friendly and easy to explain, making it a great intro to modality-based care.
• Pairs well with existing standards of care.
• Ideal for once-per-week protocols, saving time while maintaining continuity of care.

Final thoughts: The case for radial pressure wave therapy as a first-line tool

Radial pressure wave therapy is not a budget alternative to focused energy. It’s a clinically strategic, neurologically responsive and patient-friendly modality that deserves its place at the front of the conservative care plan.

For DCs navigating busy schedules, physical demands and patient financial realities, RPW offers a combination of efficiency, engagement and evidence. Used with intention, it becomes a bridge between the hands-on approach and increased outcomes while providing an enhanced patient experience.

Christopher M. Proulx, DC, PHD, CSCS, is a doctor of chiropractic and sport scientist with advanced training in clinical neuroscience, exercise physiology and conservative sports medicine. He has authored peer-reviewed articles and lectures nationally on therapeutic technology integration, injury recovery models and evidence-based rehabilitation. In his current clinical practice and his experience as a former Certified Athletic Trainer, he has been involved with the management of sports injuries for more than two decades. Proulx is currently the VP of Clinical Affairs and Strategy for Medray Laser and Technology. He can be reached at chris@medraylaser.com.

References

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2. Notarnicola A, et al. Biological effects of extracorporeal shock wave therapy on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1):33–37. https://pubmed.ncbi.nlm.nih.gov/23738271/ . Accessed June 17, 2025.

3. Wang CJ. An overview of shock wave therapy in musculoskeletal disorders. Chang Gung Med J. 2003;26(4):220–232. https://pubmed.ncbi.nlm.nih.gov/12846521/ . Accessed June 17, 2025.

4. van Leeuwen MT, et al. Extracorporeal shockwave therapy for patellar tendinopathy: A review of the literature. Br J Sports Med. 2009;43(3):163–168. https://pubmed.ncbi.nlm.nih.gov/18718975/ . Accessed June 17, 2025.

5. Kasimis K, et al. Effects of manual therapy plus pain neuroscience education with integrated motivational interviewing in individuals with chronic non-specific low back pain: a randomized clinical trial study. Medicina (Kaunas). 2024;60(4):556. https://pmc.ncbi.nlm.nih.gov/articles/PMC11052486/ . Accessed June 22, 2025.

6. Cheung L, Soundy A. The impact of reassurance on musculoskeletal (MSK) pain: A qualitative review. Behav Sci (Basel). 2021;11(11):150. https://www.mdpi.com/2076-328X/11/11/150/ . Accessed June 22, 2025.

7. De la Corte-Rodríguez H, et al. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthcare (Basel). 2023;11(21):2830. https://www.mdpi.com/2227-9032/11/21/2830/ . Accessed June 22, 2025.

8. Wand BM, O’Connell NE. Chronic non-specific low back pain–sub-groups or a single mechanism? BMC Musculoskeletal Disorders. 2008;9:11. https://pubmed.ncbi.nlm.nih.gov/18221521/ . Accessed June 17, 2025.

9. Ryskalin L, et al. Molecular mechanisms underlying the pain-relieving effects of extracorporeal shock wave therapy: A focus on fascia nociceptors. Life. 2022;12(5):743. https://www.mdpi.com/2075-1729/12/5/743/ . Accessed June 22, 2025.