Shockwave Therapy in Integrative Chiropractic Explained

Shockwave Therapy in Integrative Chiropractic Care: Why Device Type Matters

Many people hear the words shockwave therapy and assume every machine does the same thing. That is not true.

There is a big difference between true extracorporeal shockwave therapy (ESWT)—especially focused shockwave therapy (FSW/fESWT)—and lower-energy devices that primarily act like surface-pressure or massage tools. Mayo Clinic explains that only focused shockwaves create a true shockwave, while radial devices produce a different waveform (radial pressure waves) and should be labeled accordingly (Romero, 2025).

This differentiation matters because the physics, depth, dose, and healing effects can vary significantly.

In simple terms:

• Focused shockwave (FSW/fESWT) = deeper, targeted energy with a real focal point

• Radial pressure wave (RPW) = more surface-level energy that spreads out

• Massage/percussion devices are helpful for some soreness, but they are not the same as ESWT

If you are trying to treat chronic tendon pain, scar tissue, slow-healing injuries, or some bone-related conditions, the type of device matters a lot (Mayo Clinic, 2025; Crevenna & Mickel, 2020; Moya, 2024).

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What “Real” Shockwave Therapy Means

Genuine shockwave therapy is usually called Extracorporeal Shockwave Therapy (ESWT). It is a non-surgical treatment that sends acoustic energy into tissue to stimulate healing. It has been used in medicine for years, first in urology (for kidney stones) and later for musculoskeletal problems such as plantar fasciitis, tendon injuries, and some bone-healing issues (Mayo Clinic, 2025; UCHealth, 2023).

Key features of true focused ESWT

Focused ESWT differs because it is designed to deliver energy to a specific depth and a small focal area. A Springer review explains that focused ESWT is delivered into focal areas around 2–8 mm and uses a measurable dose called energy flux density, reported in mJ/mm² (Crevenna & Mickel, 2020).

That dose language matters because it shows the treatment is not just “vibration” or “pressure.” It is a dosed medical energy treatment.

The same review also explains that focused shockwave devices can produce converging pressure at a selected depth, while so-called “radial shockwaves” are not true shockwaves and have a pressure field that is strongest at the source and spreads outward (Crevenna & Mickel, 2020).

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Focused Shockwave vs. Radial Pressure Waves

This is one of the most important points for patients and clinics.

Mayo Clinic clearly states that only focused shockwave generates a true shockwave, and radial devices should be called radial pressure wave (RPW) devices (Romero, 2025). Mayo also notes that focused shockwave can generate maximal force at a specific depth, while radial devices have their highest energy near the applicator tip and lose energy as they spread through tissue.

Why this difference matters clinically

A device that concentrates energy at depth may be better suited for conditions that need:

• Precise targeting

• Deeper tissue penetration

• Higher-energy dosing

• Bone-related healing stimulation

By contrast, radial pressure wave devices can still be useful, especially for some soft tissue problems, but they are not identical to focused ESWT (Romero, 2025; Moya, 2024).

The Argentine Orthopaedic and Traumatology review (Moya, 2024) also supports this distinction, explaining that focused waves are used for higher-energy applications (such as calcifications and bone lesions) and can reach greater depths than radial waves. It also notes that radial waves tend to have a more superficial effect and cover broader treatment areas.

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How Shockwave Therapy Helps Tissue Heal

Many people think shockwave therapy is just “breaking up scar tissue.” That can be part of it, but the healing effect is broader.

The healing process (easy explanation)

Shockwave therapy creates controlled stress in tissue—sometimes described as microtrauma or a healing stimulus. That stimulus can help “wake up” tissue that has stalled in a chronic pain or poor-healing cycle. UCHealth describes this procedure as helping restart the body’s reparative process by delivering high-energy acoustic waves and stimulating a local healing response (Piantanida interview via UCHealth, 2023).

The Mayo Clinic and the Springer review describe the deeper science as mechanotransduction. This means the acoustic wave changes how cells behave, which can influence:

• Cell signaling

• Cell migration and proliferation

• Blood vessel growth (neovascularization)

• Pain pathway changes

• Tissue remodeling and healing (Romero, 2025; Crevenna & Mickel, 2020)

What this can do in practice

These biologic effects may support:

• Tendon healing

• Reduced chronic pain

• Improved function and movement

• Better blood flow

• Remodeling of damaged tissue

• In some cases, support for bone healing (Mayo Clinic, 2025; Moya, 2024)

This is why true ESWT is often discussed in sports medicine, orthopedics, PM&R, and integrative musculoskeletal care—not just wellness marketing.

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Depth and Dosing: Why “Energy” Matters

One of the biggest differences between a real medical shockwave device and a weaker surface-level device is how energy is delivered.

Depth

UCHealth’s sports medicine summary gives a clear example:

• Focused shockwave can send pulses deeper, up to about 13–14 cm

• Radial shockwave (radial pressure wave) reaches about 3–6 cm (UCHealth, 2023)

This means treatment choice should depend on the tissue being treated. A shallow device may not be enough for some deep structures.

Dosing (mJ/mm²)

Focused ESWT uses a measurable dosing system called energy flux density (mJ/mm²), which is a core treatment parameter. The Springer review describes this as an essential dosage factor in focused ESWT and gives examples of lower and higher energy ranges for different clinical uses (Crevenna & Mickel, 2020).

This is a major point: true focused shockwave treatment is not just “turning up intensity.” It is about controlled, documented energy delivery to a target area.

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FDA and Device Quality: Why Regulation Matters

The user’s point about regulation is important, but it needs one clear note: FDA status depends on the device and the indication.

Mayo Clinic notes that shockwave devices are FDA-approved for certain uses, such as plantar fasciopathy, while not all indications are covered by insurance (Romero, 2025).

A Urology Times report on shockwave controversies in the ED also highlights an important issue: some lower-level devices are marketed broadly, while higher-end devices are more tightly regulated. In that article, Mayo urologist Dr. Tobias Kohler distinguishes shallow, low-impact class 1 devices from more regulated class 2 machines that deliver “real” shocks (Kohler quoted in Urology Times, 2019).

Even though that article is about ED, the broader lesson applies to musculoskeletal care too:

• Not every machine marketed as “shockwave” is equivalent

• Device class and clinical evidence matter

• Provider training matters

• Patients should ask what type of wave and what device is being used

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Conditions That May Benefit from ESWT

Shockwave therapy is not magic, but it can be very helpful in the right case.

Mayo Clinic and UCHealth both describe common musculoskeletal uses, and the orthopedic review by Moya (2024) summarizes evidence levels for focused and radial treatments. Together, these sources support ESWT for many chronic or stubborn conditions, especially when standard care has not fully worked.

Common musculoskeletal uses

• Plantar fasciitis

• Achilles tendinopathy

• Tennis elbow / epicondylopathy

• Patellar tendinopathy

• Greater trochanter pain syndrome

• Calcific shoulder tendinopathy

• Some chronic soft tissue injuries

• Some delayed bone healing/nonunion cases (selected patients)

Moya (2024) also notes that the strength of the evidence varies by condition. For example, focused shockwave therapy has strong support for some calcific tendon problems, and both focused and radial approaches have strong support for plantar fasciitis.

That is a crucial point for patients: the best device may depend on the diagnosis.

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Why Integrative Chiropractic Clinics Are Using Shockwave Therapy

An integrative chiropractic clinic can be a good setting for shockwave therapy when it uses a thorough diagnostic process and combines ESWT with a comprehensive rehab plan.

Why the combination can work well

Chronic pain is often not just one problem. A patient may have:

• Joint restriction or alignment issues

• Tendon overload

• Scar tissue

• Weakness or movement compensation

• Inflammation and pain sensitivity

Shockwave therapy can support soft tissue healing and pain reduction, while chiropractic and rehab strategies can address:

• Joint motion

• Biomechanics

• Posture

• Gait

• Return-to-activity planning

Mayo Clinic also notes that shockwave therapy may be used in combination with other treatments and that, as evidence accumulates, combined care approaches may expand (Romero, 2025).

Some clinics and industry sources also discuss using shockwave alongside other gentle treatments (such as exercise rehab, hands-on care, or laser therapy) to achieve better results in complex muscle and joint cases, but these sources are primarily promotional and should be viewed with caution.

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Clinical Observations in Integrative Practice: Dr. Alexander Jimenez

Dr. Alexander Jimenez’s public clinical site describes a model that combines family nurse practitioner care, chiropractic care, and integrative/functional medicine in El Paso. His site also emphasizes chronic pain care, personal injury rehabilitation, sports injuries, and neuromusculoskeletal conditions, along with multi-modal, personalized treatment plans (Jimenez, n.d.).

Based on the way his clinic describes its approach, shockwave therapy fits well into that kind of practice model because it can support the same goals he frequently discusses:

• Non-surgical treatment options

• Musculoskeletal rehabilitation

• Personalized care plans

• Functional recovery

• Integrative, whole-person care (Jimenez, n.d.)

In practical terms, a clinician with both chiropractic and nurse practitioner training can help patients by combining:

• A medical screening mindset (to rule out red flags)

• A movement and structural assessment

• Conservative treatment planning

• Ongoing functional follow-up

That combination is especially useful when a patient has chronic pain that affects daily activity, sleep, mobility, or return to work/sport.

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Safety, Contraindications, and Smart Use

Shockwave therapy is non-invasive, but it is still a real medical treatment and should be used correctly.

Mayo Clinic and the Springer review list common side effects and contraindications. Side effects are usually mild (redness, bruising, soreness), but proper screening is important (Romero, 2025; Crevenna & Mickel, 2020).

Common reasons to avoid or delay treatment (depending on type and location)

• Pregnancy (treatment area concerns)

• Malignant tumor in the treatment area

• Severe bleeding/coagulation disorders

• Lung, brain, or spine in the treatment zone for high-energy focused waves

• Open growth plates in some cases

• Acute infection in the treatment area (Mayo Clinic, 2025; Moya, 2024; UCHealth, 2023)

This is why “real shockwave therapy” should not be treated like a spa add-on. It should be:

• Diagnosed correctly

• Applied by trained professionals

• Matched to the condition

• Dosed appropriately

• Followed by a rehab plan

Moya (2024) also stresses that poor outcomes often come from diagnostic error, not just the technology itself.

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What Patients Should Ask Before Starting Shockwave Therapy

If you are considering treatment, ask these questions:

• Is this focused shockwave (true ESWT) or radial pressure wave?

• What condition are you treating, and why is this the right option?

• What depth and energy settings are you using?

• How many sessions are typical for my condition?

• What other therapies will be combined with this (rehab, mobility work, chiropractic, etc.)?

• What are the risks or reasons I may not be a candidate?

These questions help you avoid paying for a treatment that sounds advanced but may not match your problem.

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Final Takeaway

Real shockwave therapy—especially focused ESWT—is not the same as weak radial devices or massage tools.

True focused shockwave therapy uses:

• High-energy acoustic waves

• Precise targeting at depth

• Measured energy dosing (mJ/mm²)

• Biologic healing effects through mechanotransduction

The evidence supports its use for many chronic musculoskeletal problems, especially tendon and fascia conditions, and in selected cases for bone-related healing. At the same time, not every device marketed as “shockwave” is equal, and not every patient needs the same type of treatment (Mayo Clinic, 2025; Moya, 2024; Crevenna & Mickel, 2020).

In an integrative chiropractic clinic, ESWT can be a strong non-surgical option when it is combined with proper diagnosis, structural care, rehab, and individualized follow-up—exactly the kind of whole-person model described in Dr. Alexander Jimenez’s clinical practice materials (Jimenez, n.d.).

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References

• Crevenna, R., & Mickel, M. (2020). Focused extracorporeal shockwave therapy in physical medicine and rehabilitation. Current Physical Medicine and Rehabilitation Reports. https://link.springer.com/article/10.1007/s40141-020-00306-z

• Jimenez, A. (n.d.). El Paso, TX Chiropractor Dr. Alex Jimenez DC | Personal Injury Specialist. https://dralexjimenez.com/

• Mayo Clinic. (2025, October 10). Shockwave treatment: A new wave for musculoskeletal care. https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/shockwave-treatment-a-new-wave-for-musculoskeletal-care/mac-20590258

• Medray Laser & Technology. (n.d.). Medray’s dual laser & shockwave therapy | Integrative healing system. https://medraylaser.com/class-4-therapy-lasers/dual-laser-therapy/

• Moya, D. (2024). Shock waves: Myths, truths and doubts (Rev Asoc Argent Ortop Traumatol). https://raaot.org.ar/index.php/AAOTMAG/article/download/1835/5581/

• UCHealth. (2023, November 15). Shockwave therapy can help those who have chronic injuries. https://www.uchealth.org/today/shockwave-therapy-can-help-those-who-have-chronic-injuries/

• Urology Times. (2019). Shock wave therapy: ED cure or unproven treatment? https://www.urologytimes.com/view/shock-wave-therapy-ed-cure-or-unproven-treatment

• Firgeleski Chiropractic Center. (n.d.). Combination therapy in chiropractic care. https://www.firgeleskichiropracticcenter.com/combination-therapy