Shockwave therapy
What is shockwave therapy?
Understanding the technology behind EMS DolorClast® Radial Shock Waves — how it works, what it does in the tissue, and what to expect in the room.
The basics
Acoustic pressure waves, delivered through the skin
Radial shockwave therapy uses high-energy acoustic pressure waves to transfer energy into a targeted area of tissue. Nothing is injected and nothing is cut — the waves are delivered from the outside, through the skin, using a hand-held applicator and a layer of coupling gel.
The waves are produced mechanically inside the handpiece and pass into the body at the point of contact. From there they spread outwards — radially — rather than converging on a single deep point. Energy is at its highest at the tip of the applicator, where EMS specifies a maximum output of 0.28 mJ/mm², and the system is designed to treat structures lying within roughly 4 cm of the surface.
In practice, that means the tendons, fascia, muscle and enthesis (the point where a tendon anchors into bone) that produce most everyday overload pain: heels, Achilles, shins, knees, elbows, hips and shoulders.
EMS names four ideal applications for the radial system: superficial tendinopathies, fasciopathies, myofascial pain syndromes and large muscular areas. In plain terms, the problems that have been there a while and haven’t settled with rest, tablets or a stretch routine.
Acoustic, not electrical
A shockwave is a pressure wave — a mechanical event travelling through tissue. It isn’t an electrical current and it isn’t heat.
Non-invasive
No needles, no incision, no anaesthetic and no recovery period. You walk in, have the treatment and walk out.
Targeted by hand
The applicator is worked over the painful area and around it, so the treatment follows your anatomy rather than a fixed template.
Inside the handpiece
How does EMS DolorClast® work?
It is a pneumatic-ballistic system — a phrase that sounds complicated and describes something fairly simple: compressed air fires a small projectile, and the impact becomes a wave.
Compressed air builds
Two integrated compressors and an optimised air-management system supply constant pressure to the handpiece.
A projectile accelerates
That air fires a small projectile down the barrel of the handpiece at high speed — EMS quotes up to around 90 km/h.
It strikes the applicator
The projectile hits a fixed applicator head. Its kinetic energy is converted, at that instant, into an acoustic shock wave.
The wave enters the tissue
The wave passes through the gel and skin and spreads radially into the treatment area beneath the applicator.
THE SYSTEM WE USE
EMS Swiss DolorClast® Radial Shock Waves
Ballistic technology. Compressed air drives a projectile into a fixed applicator, and the wave spreads outwards from the point of contact on the skin into the tissue beneath.
- Built for problems within about 4 cm of the surface — which is where most stubborn tendon, fascia and muscle pain lives
- A range of applicators for different areas, from small bony points to large muscle groups
- Adjustable pressure and frequency, set to you rather than to a preset
- Several modes of action, including a setting designed for sensitive areas
EMS list it as ideal for: superficial tendinopathies, fasciopathies, myofascial pain syndromes, large muscular areas and spasticity.
One impulse, start to finish
How the energy reaches you
Mechanism
What happens in the tissue?
A shockwave is not a single push. It has a shape — and each part of that shape does something different once it’s inside you.
PHASE 01
Compression & shear stress
The wave begins with a compression phase. Its peak pressure creates shear stress within the tissue it passes through — a direct mechanical stimulus applied to structures that have become painful and unresponsive.
PHASE 02
Tensile phase & cavitation
A negative pressure phase follows, releasing the energy and generating cavitation bubbles. EMS is direct about the importance of this: cavitation is key to the success of shockwave therapy, and without it some biological responses simply do not occur in the treated tissue. The greater the energy delivered, the greater the level of cavitation.
RESPONSE 03
Metabolic & vascular response
EMS cites published research describing improved angiogenesis and blood circulation, activation of repair in damaged muscle fibres, and stimulation of tendon remodelling. These are the processes a stalled tendon or fascia has stopped mounting on its own.
RESPONSE 04
Effect on pain
EMS describes the analgesic mechanism as an overwhelming of the C nerve fibres, inhibiting the release of Substance P — which is responsible for amplifying pain signals — and a suppression of pain signalling to the central nervous system. Reducing Substance P also inhibits neurogenic inflammation. Response is individual and not everyone experiences the same change.
What to expect
The questions everybody asks
Straight answers, including the ones that aren’t particularly flattering to the treatment.
We won’t tell you it’s painless, because it often isn’t. Most people describe a strong tapping or hammering sensation, and the treated area is usually tender while the waves are being applied — particularly over bony points such as the heel or the elbow.
How much you feel depends on the area, how irritable it is and your own sensitivity. Intensity is adjusted directly on the handpiece, mid-treatment. The system also carries an analgesic mode, which EMS designed with high-frequency settings specifically to build tolerance in sensitive patients, and a ramp-up mode that increases energy gradually to maximum output. Tell us during the session and we change the settings — that is a normal part of treatment, not a failure.
Some tenderness or aching in the area afterwards is common and usually settles. We’ll tell you what to expect before you leave.
Treatment time varies with the area being treated, the number of areas and the individual. The shockwave application itself is not a long procedure; your first appointment takes longer than the ones that follow, because it includes the assessment and a discussion of what we’re doing and why.
As a guide, allow about 20 minutes for a treatment appointment. Your first visit takes a little longer because it includes the assessment.
It depends on four things: the condition itself, how long it has been present, the area being treated, and how you respond. Shockwave therapy is normally given as a short course of sessions spaced out over a few weeks rather than as a single treatment — for plantar fasciopathy, for example, EMS suggests a course commonly falls in the region of three to five sessions.
We will not sell you a fixed block of sessions up front, and we won’t promise a number before we’ve seen how the area responds. If it isn’t working, we’ll say so and talk about what else might suit you better.
There’s no downtime — you can drive home and get on with your day. We’ll give you specific advice for your area at the end of the session, which usually covers what to avoid in the first day or two and how to load the tissue sensibly between appointments.
Shockwave therapy tends to work best alongside appropriate loading and rehabilitation rather than instead of it. If you’re already working with a physiotherapist or coach, keep going.
No. No treatment for tendon and fascia pain works for everybody, and anybody offering you a guarantee is telling you something they cannot know. Radial shockwave therapy has been studied in randomised controlled trials across a number of musculoskeletal conditions, and it is an established option — but individual response varies.
What we can commit to is an honest assessment beforehand, an honest review afterwards, and telling you plainly if we don’t think this is the right treatment for your problem.
In the room
What actually happens in a session
Nobody tells you this part, so here it is start to finish.
Handpiece, coupling gel, and the machine beside the couch
We find the spot
We talk through the history, then press around the area until we find what reproduces your pain. That map is what gets treated — not a guess.
Gel, then contact
Coupling gel goes on so the waves pass into the skin properly. The applicator is picked to suit the area — small heads for a focal point, larger ones for a muscle belly.
The waves start
Loud, rhythmic tapping you can hear as well as feel. We begin low and build. At 25 Hz the device delivers 1,500 shocks a minute, so ground gets covered quickly.
You set the ceiling
Say the word and the intensity comes down. Energy is adjusted on the handpiece mid-treatment, and there’s an analgesic mode EMS built specifically for sensitive areas.
Then it’s done
Gel wiped off, you stand up and walk out. Many people notice a difference in the area immediately; some feel it a day or two later, and some don’t.
Afterwards
Some tenderness in the area for a day or so is common. No downtime — you can drive home. We’ll give you loading advice for the gap before the next session.
Where it came from
It started with a man touching a metal plate.
Shockwave therapy isn’t new and it isn’t alternative. It came out of German aerospace research, went on to transform the treatment of kidney stones, and reached tendons almost by accident. Here’s the short version.
Somebody feels a shock that isn’t electrical
At the German aerospace company Dornier, an employee happened to be touching a metal plate at the instant a high-velocity projectile struck it. He felt something pass through his body like an electric shock. When it was measured, no electricity was involved — the shock wave had travelled from the plate, through his hand, and into him. That a pressure wave could pass through a human body without breaking the skin was the observation everything else grew from.
Germany funds the question properly
A defence-funded programme studied how shock waves interact with living tissue. The finding that mattered: high-energy shock waves produce effects inside the body at a distance from where they enter it.
A kidney stone is broken without being touched
Haeusler and Kiefer reported breaking up a kidney stone in the laboratory using shock waves alone, with nothing making contact with it. The possibility of treating something inside a person from outside them was now real.
Munich, February 1980
The first human being was treated for a kidney stone using a Dornier prototype. Within a few years the technique had spread worldwide and largely replaced open surgery for stones. It is still the only non-invasive treatment for them. The first commercial machine was installed in 1983, and American regulatory approval followed in 1984.
Somebody notices the bones
While treating kidney stones, clinicians observed that bone near the path of the shock waves appeared to be getting denser. Nobody had been trying to do that. It prompted the obvious question — if shock waves do something to bone, what else might they do? By 1986 animal studies were showing that shock waves could stimulate bone formation, and orthopaedic use followed from there.
Shockwave becomes practical for tendons
EMS in Switzerland patented the first radial shockwave device. Instead of concentrating energy deep inside the body, it delivered it at the skin and let it spread outwards — which suited the tendon, fascia and muscle problems that sit close to the surface. It is the principle every radial machine still works on, and the system we use.
An established treatment, still being studied
Shockwave therapy has been through many randomised controlled trials across plantar fasciitis, Achilles and patellar tendinopathy, tennis elbow and more. It is used in hospitals, sports medicine and private clinics worldwide. It is not a miracle and it does not work for everybody — but it is a serious, well-researched option for problems that have stopped improving on their own.
Safety & suitability
Is shockwave therapy safe?
Radial shockwave therapy is a non-invasive treatment with a long clinical track record, but it is not appropriate for everybody, and it is not appropriate for every painful area. That’s why we screen before we treat.
Please tell us about your general health and any medication before your appointment. Some circumstances mean shockwave therapy should not be used, or should only be used after you’ve spoken to your doctor. These commonly include pregnancy, blood-clotting disorders or anticoagulant medication, active infection or a tumour in the area to be treated, and treatment directly over certain sensitive structures.
This list isn’t exhaustive and it isn’t a self-assessment tool. Tell us what’s relevant and we’ll work it out together — if there’s any doubt, we’ll ask you to check with your GP first.
Please tell us before treatment if you
- Are pregnant, or think you might be
- Take blood-thinning medication or have a clotting disorder
- Have a pacemaker or other implanted device
- Have an infection, open wound or skin condition in the area
- Have a known tumour or are under oncology care
- Have had a steroid injection into the area recently
- Are under 18 years of age
EMS DolorClast®
The technology behind your treatment
Treatment at EMS Shockwave is delivered on the EMS Swiss DolorClast® radial system from EMS Electro Medical Systems SA in Nyon, Switzerland — the company that patented the first radial shockwave device in 1997.
Where the technology came from
EMS didn’t adopt radial shockwave therapy — it started it. In 1997 the company patented the first radial shockwave device, the Swiss DolorClast®, built on the ballistic principle: compressed air accelerates a projectile that strikes a fixed applicator, and that kinetic energy becomes a shock wave delivered into the tissue through the skin.
Nearly three decades on, that same principle is what every radial device in the field is doing. The difference is in the engineering around it.
Why it’s a trust point, not a sales point
Plenty of clinics list “shockwave therapy” without ever telling you what’s in the room. We name ours because the equipment is a real part of what you’re paying for: a Swiss-engineered system built by the company that invented the category, designed to hold its energy output across its frequency range.
EMS describes DolorClast® as the most researched radial technology, citing 34 randomised controlled trials.
Sources
Where the technical information on this page comes from
- EMS Electro Medical Systems SA — DolorClast® Radial Shock Waves product information, device specifications, modes of action and applicators. ems-dolorclast.com
- EMS Electro Medical Systems SA — Guided DolorClast® Therapy: Evidence-Based High-Energy Therapies, brochure FA-1011 EN rev. B (2024): radial indication depth 0–4 cm, maximum output 0.28 mJ/mm² at the applicator tip, ballistic technology, treatment modes, and the role of energy and cavitation.
- EMS Electro Medical Systems SA — DolorClast® Radial indications for superficial sub-acute and chronic musculoskeletal conditions, and patient information on radial shockwave therapy for plantar fasciopathy.
- EMS Swiss DolorClast® Physician’s Labeling (US FDA) — radial propagation of shock waves and maximum energy at the coupling point on the skin surface.
- Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis. Am J Sports Med 2008;36(11):2100–2109.
EMS DolorClast® and the EMS name are trademarks of EMS Electro Medical Systems SA. EMS Shockwave is an independent provider using EMS equipment and is not affiliated with, endorsed by, or acting on behalf of the manufacturer.
Next step
Think it might suit your problem?
Send us a message describing where the pain is and how long it’s been there. We’ll tell you honestly whether radial shockwave therapy is worth considering.