Dr. Tammara Moore
DPT, OCS, CSCS
I have been using focused and radial shockwave therapy for more than four years in the treatment of acute and chronic musculoskeletal conditions.
As an experienced orthopedic and sports physical therapist, I have seen how valuable these technologies can be—particularly when they are integrated with a thorough evaluation, hands-on care, progressive strengthening, and functional movement training.
How I work — select a card
01What it is
What is shockwave therapy?
Extracorporeal shockwave therapy uses precisely delivered acoustic pressure waves to stimulate a biological response in injured or painful tissue. The treatment is noninvasive and does not involve an injection or incision.
Shockwave does not replace exercise or restore strength by itself. Its greatest value is often in helping create a more favorable environment in which movement, loading, and rehabilitation can become more effective.
- 01 Local circulation and vascular signaling
- 02 Cellular mechanotransduction—the conversion of mechanical energy into biological activity
- 03 Tendon and connective-tissue remodeling
- 04 Pain modulation
- 05 Resolution of persistent tissue sensitivity
- 06 Breakdown and resorption of certain calcific deposits
- 07 Improved tolerance for rehabilitation and progressive loading
02Focused vs radial
Focused versus radial shockwave
Although the terms are sometimes used interchangeably, focused and radial shockwave are physically different technologies. Drag the depth line to see where each delivers its energy.
Two technologies, two depth profiles.
01Deeper, targeted
Focused shockwave
Focused shockwave concentrates acoustic energy within a defined treatment zone beneath the skin. It can reach deeper structures and allows the clinician to select a specific treatment depth and energy level.
02Broader, superficial
Radial pressure-wave therapy
Radial therapy produces ballistic pressure waves that spread outward from the applicator. The greatest pressure is generated near the surface and disperses with depth.
03Used together
Why use them together?
Focused and radial technologies are not necessarily competing treatments. They can serve different purposes within the same clinical plan.
Radial therapy may be used to address a broader region, including surrounding muscle and fascial tissues. Focused shockwave can then be directed toward a more specific or deeper structure. The choice depends on the diagnosis, tissue depth, irritability, treatment goals, and the individual's response.
Not every patient needs both forms of treatment. The technology and dosage should be selected from the clinical examination rather than applied as a standardized protocol.
The equipment
Chattanooga Intelect F-SW
Focused shockwave in the clinic is delivered with the Chattanooga Intelect F-SW, an electromagnetic focused shockwave system with a handheld applicator.
04Conditions treated
Conditions commonly treated
Shockwave therapy has been studied most extensively for persistent tendon and tendon-related disorders. Depending on the examination findings and medical history, it may be considered for conditions such as:
Heel and foot
Plantar fasciopathy or persistent heel pain, and other persistent foot and ankle tendinopathies.
Achilles and knee
Achilles tendinopathy, patellar tendinopathy, and selected presentations of knee osteoarthritis.
Hip and hamstring
Proximal hamstring tendinopathy, gluteal tendinopathy and greater trochanteric pain syndrome.
Shoulder
Rotator-cuff tendinopathy and calcific tendinopathy of the shoulder.
Elbow
Lateral elbow tendinopathy, commonly called tennis elbow, and selected medial elbow tendinopathies.
Muscle and myofascial
Selected myofascial pain and trigger-point presentations, and certain muscle injuries after appropriate evaluation.
Clinical evidence is not equally strong for every condition. Research is most established for several chronic tendinopathies, plantar fasciopathy, and calcific shoulder tendinopathy. Evidence for acute injuries, osteoarthritis, myofascial pain, and other applications is still developing. Treatment recommendations are therefore based on the diagnosis, current evidence, safety considerations, and each patient's individual presentation.
05The science
What does the science tell us?
Shockwave therapy produces mechanical stimulation within tissue. Cells can respond to this stimulation through mechanotransduction—a series of signaling processes that may influence circulation, pain sensitivity, extracellular-matrix turnover, and tissue remodeling.
Laboratory and clinical research has investigated effects involving nitric-oxide signaling, growth-factor activity, vascular responses, collagen organization, inflammatory signaling, and sensory-nerve modulation. These proposed mechanisms help explain why improvement may continue over time rather than occurring only during the treatment session.
The biological response is dose-dependent. More energy is not automatically better. Treatment depth, energy, frequency, number of impulses, tissue type, chronicity, and patient tolerance all matter.
Clinical studies support shockwave therapy for a number of musculoskeletal conditions, but results vary. It should therefore be presented as a clinically useful treatment option—not as a guaranteed cure or a replacement for a complete rehabilitation program.
Pain reduction is valuable, but lasting improvement usually requires the tissue to regain the ability to tolerate force. That is why I pair shockwave, when appropriate, with a carefully progressed loading program.
The timing and dosage of exercise matter. Loading too aggressively can increase irritability, while avoiding load for too long can reduce tissue capacity. Treatment is continually adjusted according to symptoms, functional testing, and the individual's response.
07Beyond the painful area
More than treating the painful area
One of the most important principles in my practice is that the location of pain is not always the source of dysfunction.
Persistent knee pain may be influenced by limitations at the hip, ankle, or foot. Shoulder symptoms may relate to thoracic mobility, scapular mechanics, strength, or sport-specific workload.
During treatment, shockwave may help identify clinically sensitive areas by reproducing recognizable symptoms. This provides useful feedback, but it is not a stand-alone diagnostic scan.
My evaluation draws on extensive orthopedic and sports-performance experience, including training in the Selective Functional Movement Assessment, or SFMA.
08An integrated approach
An integrated approach
Depending on the individual, treatment may combine:
These modalities are not automatically appropriate for every patient, and evidence differs among technologies and conditions. Each is selected only when it contributes to a clear clinical objective.
Technology can be a powerful part of that process.
At this stage of my career, I most enjoy helping people connect the pieces: symptoms, tissue health, movement, strength, workload, recovery, and the activities that matter most to them.
Many patients need more than a passive treatment. They need an experienced clinician who can assess the injury, guide the rehabilitation process, and serve as a movement coach as they return to exercise, sport, and everyday life.
Technology can be a powerful part of that process. The real value comes from knowing when to use it, how to dose it, what to combine it with, and how to progress the person—not simply the painful body part.
Shockwave is not appropriate for every condition or every individual. A complete evaluation is necessary to confirm the diagnosis, screen for contraindications, and determine whether focused shockwave, radial pressure-wave therapy, another treatment, or a medical referral is the best next step.
Individual responses vary, and no specific outcome can be guaranteed.
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Dr. Tammara Moore
DPT, OCS, CSCS · Performance, Running Physio
Clinic — Marin Spine and Wellness, Physio Services & Shockwave
Private gym — Corte Madera, strength training & running services