Radial pressure wave therapy
A clinic device that delivers rapid mechanical pressure pulses through the skin, commonly used for stubborn tendon pain.
Radial pressure wave therapy uses a handheld device to deliver rapid mechanical pressure pulses into tissue through the skin. It is offered in physiotherapy and sports clinics, most often for stubborn tendon problems such as plantar heel pain, Achilles and patellar tendinopathy and tennis elbow.
It is often marketed under the shockwave label, and the distinction is worth knowing. Focused shockwave devices generate a true acoustic shockwave that can be concentrated at depth; radial devices produce a pressure wave that disperses from the applicator and is strongest near the surface. They are different technologies with different evidence bases and different prices.
The proposed mechanisms include stimulating local blood flow, provoking a controlled healing response in tissue that has stalled, and altering pain signalling. Which of these does the work, if any, is not settled.
The evidence is genuinely mixed. Some randomised trials and reviews report benefit for specific tendinopathies, particularly plantar heel pain, while others find effects that are small or indistinguishable from placebo, and blinding these trials is difficult because the treatment is noticeable.
What is clearer is where it sits in the sequence. Progressive loading is the treatment with the strongest evidence for tendinopathy, and adjuncts like this belong alongside a loading programme for people who have stalled, rather than instead of one.
It is usually delivered as a short course of weekly sessions, it can be uncomfortable, and it is often paid for privately.
In practice, if a clinician offers it as part of a rehabilitation plan that also includes progressive loading, that is a reasonable use; if it is offered as a substitute for the loading, that is the part to question.