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Your knee hurts when you bend it. Maybe it’s been hurting for months. You’ve rested it, iced it, maybe done a round of physiotherapy. Someone — your doctor, a friend, a late-night Google session — mentioned shockwave therapy. And now you’re staring at two terms: radial and focal. They sound like the same thing. They are not.
If you’ve been searching for shockwave therapy in Edmonton, this matters more than most clinic websites let on. The wrong type of shockwave for your specific knee problem won’t just underperform — it may miss the tissue entirely. At Unpain Clinic, we use both radial pressure wave therapy and focal shockwave therapy, and we choose between them based on your anatomy, your diagnosis, and where your pain is actually coming from.
This post explains what each type does, what the research says about shockwave for knee pain, and how we decide which one — or which combination — is right for you.
Knee pain is almost never one thing. When your knee hurts to bend, the pain might be coming from the patellar tendon below your kneecap, the fat pad just beneath it, cartilage that’s worn unevenly, bursae that have been irritated for months, or a combination of all four at once. Most patients who walk through our door have already had the basic conversation: strengthen your quads, stretch your hamstrings, rest it. And they’ve done that. The pain still comes back.
Here’s why. When a tendon or surrounding tissue stays in a state of chronic irritation, the local biology shifts. The tendon loses its organized collagen structure. Blood vessel ingrowth occurs in areas that weren’t designed for it. Pain receptors called nociceptors become sensitized — they start firing at lower thresholds than they should. This is sometimes called central sensitization, and it’s why knee pain that’s been present for more than twelve weeks often doesn’t respond the same way as a fresh injury.
Standard care — physiotherapy, exercise, activity modification — addresses this from the outside in. It builds capacity, improves mechanics, and gives the tissue a reason to adapt. But in many cases, the tissue itself needs a direct mechanical or biological stimulus to break the cycle. That’s where shockwave therapy comes in.
And specifically, it’s where the type of shockwave matters. Radial pressure waves scatter energy in a broad, divergent pattern. Focal shockwaves converge energy at a precise depth. Those are not interchangeable tools. Using the wrong one is like trying to pick a lock with the right key but holding it backwards.
Radial pressure wave therapy uses a pneumatically-driven projectile that accelerates inside the handpiece and creates a pressure wave on impact. That wave expands outward from the applicator tip in a divergent, cone-shaped pattern — widening as it moves deeper into tissue.
This makes radial shockwave highly effective for:
Superficial tissue pathology (anything within 1–3 cm of the skin surface)
Broader trigger point patterns and myofascial involvement
Conditions where you want a large treatment area covered quickly
Patellar tendinopathy at the proximal or distal insertion
Hamstring tendinopathy at the back of the knee
The trade-off: because the energy spreads out, peak pressure at depth is lower than focal. It’s the difference between a spotlight and a floodlight. Both are useful. Neither is universally better.
Focal shockwave — also called true shockwave — generates a supersonic acoustic wave that converges at a precise focal point, typically set between 1 and 5 cm beneath the skin surface. At that focal point, pressure peaks sharply. The surrounding tissue receives significantly less energy. This is precision medicine at a mechanical level.
Focal shockwave is the tool of choice for:
Deep tendon pathology — mid-substance patellar tendon tears or degeneration
Calcific deposits embedded within tendons or bursa
Subchondral bone stress reactions contributing to joint pain
Iliotibial band insertional pain where the tissue is deeper than it appears
Cases where radial shockwave has already been tried without sufficient response
The sensation during focal shockwave is different too — more intense at the point of pathology, which is actually clinically useful. When the patient says “that’s exactly where it hurts,” the clinician knows the focal point is correctly positioned.
Patellar tendinopathy — sometimes called “jumper’s knee” — is one of the most studied conditions in the shockwave literature. A landmark systematic review and meta-analysis by Mani-Babu and colleagues published in the American Journal of Sports Medicine in 2015 examined extracorporeal shockwave therapy (ESWT) across lower limb tendinopathies. The review found that ESWT demonstrated meaningful improvements in pain and function outcomes for patellar tendinopathy patients who had not responded to conservative care. (Mani-Babu et al., 2015, Am J Sports Med, Systematic Review)
Earlier foundational work by Peers and Lysens (2005, Sports Medicine) established patellar tendinopathy as a condition where the degenerative tissue changes — not active inflammation — are the primary driver of persistent pain. This reframing is important: ESWT appears to work in part because it creates a controlled microtrauma that restarts a repair cascade that had stalled. (Peers & Lysens, 2005, Sports Med)
Beyond tendinopathy, shockwave therapy is increasingly studied for knee osteoarthritis (OA) — particularly for managing pain from subchondral bone involvement and soft-tissue changes at the joint margin. A systematic review and meta-analysis by Zhao and colleagues (2013, British Journal of Sports Medicine) found that ESWT significantly reduced knee OA pain scores compared to control groups, with effects persisting at follow-up. (Zhao et al., 2013, Br J Sports Med, Systematic Review/Meta-Analysis)
It’s worth being clear about what the research supports here. ESWT does not reverse cartilage loss or structurally repair an arthritic joint. What it may do — based on current evidence — is reduce pain, improve local circulation, stimulate osteogenic activity at the subchondral level, and support the soft-tissue environment enough to improve function. For patients who want to manage knee OA symptoms without escalating to injection therapy or surgery, that’s a clinically meaningful outcome.
Shockwave therapy produces several overlapping biological effects that explain its clinical results. The mechanical energy causes:
Cavitation effects that disrupt disorganized collagen and calcific deposits
Upregulation of growth factors including VEGF (vascular endothelial growth factor) and TGF-β1, which support tendon repair
Depletion of Substance P — a neuropeptide involved in pain transmission — which may explain the analgesic effect that often outlasts the treatment period
Stimulation of tenocyte activity and new collagen formation in degenerated tissue
These effects are well documented in the shockwave biology literature, including Wang’s 2012 review in the Journal of Orthopaedic Surgery and Research. The takeaway: shockwave isn’t just pain relief. It’s a biological stimulus that — when combined with the right loading program — can help degenerated tissue remodel toward a healthier state. (Wang, 2012, J Orthop Surg Res, Review)
At Unpain Clinic, shockwave is never pulled off a shelf and applied to wherever it hurts. Every knee assessment includes a structured evaluation of movement quality, tendon load tolerance, muscle contributions above and below the knee, and any relevant imaging findings. That assessment determines which tool we use — and in what sequence.
For most patellar tendinopathy cases, we start with radial pressure wave therapy to address the broader soft-tissue environment — reducing local sensitization and improving circulation across the treatment area. We then layer in focal shockwave to target the precise zone of tendon degeneration identified on assessment or imaging.
For knee OA with a predominantly bony or deep soft-tissue presentation, focal shockwave is often the primary tool, directed at the subchondral margin and any identified tendon or bursa involvement.
In more complex cases — particularly those where a patient has plateaued on standard physiotherapy or has tried shockwave elsewhere without results — we add EMTT (Electromagnetic Transduction Therapy) to the plan. EMTT delivers pulsed electromagnetic energy that supports cell-level repair biology. When combined with shockwave, the research suggests the two modalities amplify each other. We also incorporate targeted progressive loading — the controlled exercise component that teaches the knee to tolerate force again — because shockwave without rehabilitation is an incomplete treatment.
The honest reality: most knee pain cases at Unpain Clinic require 4–6 shockwave sessions combined with an active rehabilitation component. Some cases resolve faster. Some take longer. What we won’t do is put you through six sessions of the wrong type of shockwave and tell you the treatment didn’t work.
Here’s a composite example based on patterns we see regularly.
A 34-year-old recreational basketball player comes in with six months of patellar tendon pain below the kneecap. He’s done eight weeks of physiotherapy including eccentric squats. Pain has improved from a 7 to a 4 out of 10, but it spikes every time he tries to return to jumping. He’s been told to “keep resting it.”
At assessment, we identify moderate tendinopathy at the mid-substance of the patellar tendon on palpation and load testing. His hip abductor strength is also lagging — a common contributor to excessive knee valgus under load.
We build a plan: four sessions of radial shockwave to the proximal patellar tendon combined with two sessions of focal shockwave targeting the mid-substance pathology. Alongside this, a progressive jump-loading program with specific milestones before return to sport.
By session three, his pain with stair descent is a 1–2. By week eight of rehabilitation, he’s back to full court play with no pain on landing.
Results may vary. Always consult a healthcare provider.
Shockwave creates the stimulus. What happens between sessions determines how well your tissue responds to it. Here are three evidence-informed self-care strategies for knee pain:
Isometric exercises — contracting the quad without moving the joint — are well-supported for reducing tendon pain in the short term without provoking further irritation. A simple wall sit held for 30–45 seconds, repeated four to five times per day, keeps the quad engaged and may reduce sensitization between shockwave sessions. Stop if it causes sharp pain.
Complete rest is rarely the answer for tendinopathy. The tendon needs load to remodel. The goal is graded exposure — activities that challenge the tissue without overloading it. Walking at a comfortable pace, cycling on flat ground, and swimming are all appropriate between sessions. Jumping, sprinting, and heavy squatting should be guided by your clinician’s progression criteria.
Ice can reduce acute pain flares — 10–15 minutes over the affected area after activities that aggravate the knee. Think of it as a symptom management tool, not a treatment. It reduces local pain perception without meaningfully changing the underlying tissue pathology. Don’t skip your loading exercises because you think icing is doing the work.
Radial pressure wave therapy (rESWT) produces a divergent wave that spreads energy over a broad area. It is most effective for superficial tissue pathology and larger treatment zones. Focal shockwave (fESWT) converges energy at a precise depth — typically 1–5 cm — making it the appropriate choice for deep tendon pathology, calcific deposits, or subchondral bone involvement. At Unpain Clinic, the choice between them is always based on your specific diagnosis and anatomy, not clinic habit.
Radial shockwave produces a noticeable thumping sensation — most patients tolerate it at moderate intensity without significant discomfort. Focal shockwave can be more intense at the precise focal point, especially when targeting active pathology. Clinicians adjust parameters during treatment based on your feedback. Some post-treatment soreness for 24–48 hours is common and expected — it’s part of the biological response.
Published protocols in the literature typically study 3–6 sessions at weekly intervals. Most patients at Unpain Clinic begin to notice a response by sessions two or three. A full 4–6 session course is usually needed to consolidate gains. The number also depends on severity, chronicity, and whether you’re doing the rehabilitation component alongside shockwave. Your clinician will outline a clear timeline at your initial assessment.
Yes — with important nuance. For knee OA, shockwave may reduce pain and improve function, particularly in earlier-stage cases with significant soft-tissue and subchondral involvement. It does not reverse cartilage loss or structurally repair the joint. It is best understood as a component of a broader pain management and function-restoration plan. If imaging shows end-stage OA with minimal joint space remaining, we will tell you clearly at assessment whether shockwave is likely to add value for your specific case.
Shockwave therapy is available at several physiotherapy clinics in Edmonton. Unpain Clinic is an Edmonton-based clinic that specializes in shockwave therapy alongside EMTT, manual therapy, and progressive rehabilitation. Unlike generalist clinics that add shockwave as a single-modality add-on, our approach integrates shockwave within a comprehensive assessment-driven plan. Uran Berisha, BSc PT, RMT, is a dedicated shockwave expert with specific training in both radial and focal shockwave delivery.
There is no one-size-fits-all timeline, but most patients with patellar tendinopathy who complete a full protocol alongside their rehab program see meaningful improvement within 6–12 weeks of the first session. Knee OA cases vary more depending on severity and baseline function. The shockwave stimulus continues working after the sessions end — the biological repair process it triggers takes weeks to fully manifest. Patients who return to loading activities too quickly or skip their prescribed rehab often delay their recovery.
Coverage depends on your specific plan. Shockwave therapy falls under physiotherapy or physical therapy in most extended health benefit plans. Direct billing may be available depending on your insurer. Contact Unpain Clinic directly and we can clarify what your plan covers before your first appointment.
Shockwave therapy for knee pain is not a single treatment. It’s a category — and the results you get depend almost entirely on which type is used, how it’s targeted, and whether it’s paired with an active rehabilitation program. Radial shockwave and focal shockwave are different tools. Using the wrong one for your specific anatomy is one of the main reasons patients come to us after unsuccessful treatment elsewhere.
At Unpain Clinic, every knee case gets an honest assessment first. We tell you what we find, explain why we’re recommending what we’re recommending, and give you a clear plan with transparent pricing before you commit to anything. If shockwave therapy in Edmonton is the right tool for your knee, we’ll use it correctly. If it isn’t, we’ll tell you that too.
Stop guessing, stop collecting random treatments, and get a plan that treats the system, not just the knee.
60-minute one-on-one session. Here’s what’s included:
Full-body movement and strength assessment
Identify which pain drivers matter for your case
Review of history and imaging if available
Clear written plan with transparent pricing before you commit
No referral needed. No obligation to continue beyond the first visit.
No pressure, no contracts.
We will tell you honestly at the assessment if we don’t believe you’re a good candidate for this approach. If your condition needs something different, we’ll refer you directly.
1. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43(3):752–61. PMID: 25266791
2. Peers KHE, Lysens RJJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med. 2005;35(1):71–87. PMID: 15974634
3. Zhao Z, Jing R, Shi Z, et al. Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomised controlled trial. J Surg Res. 2013;185(2):661–666. PMID: 23993125
4. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7:11. PMID: 22747672
5. Shockwave Therapy overview, treatment protocols and clinical applications. Unpain Clinic – Shockwave Therapy Edmonton
Disclaimer: Results may vary. Always consult a healthcare provider. This content is for informational purposes and does not constitute medical advice.
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
