Which Shockwave Therapy Is Best for Knee Pain?

If you’re looking into shockwave therapy for knee pain or osteoarthritis, there is one important thing to understand: not all shockwave therapy is the same. There are several different technologies, including radial, electromagnetic, piezoelectric, and electrohydraulic shockwave, and they all deliver energy into the body differently. At Square One Health, we prefer SoftWave® electrohydraulic shockwave for knee osteoarthritis, and clinically, we have seen some patients respond extremely well to SoftWave even after other forms of shockwave therapy did not give them the results they were looking for.

Radial Shockwave: More Superficial

One of the most common types is radial pressure wave therapy. A projectile is accelerated inside the treatment head and strikes an applicator, creating pressure waves that travel into the body. The energy is strongest at the skin and gradually decreases as it travels deeper, which is why researchers often describe radial therapy as a pressure wave rather than a true shockwave.¹ Radial therapy can still be useful, especially for more superficial muscles and tendons, but the knee joint and many of the structures involved in osteoarthritis sit deeper.

Focused Shockwave: Deep but Concentrated

The next category is focused shockwave, which typically includes electromagnetic and piezoelectric systems. These machines are designed to concentrate energy into a small focal point inside the body. Think of it like using a magnifying glass to focus sunlight onto one small spot. That precision can be useful when treating a very specific tendon, calcification, or localized structure, but it also means that the mechanical stress and cavitation are concentrated into a smaller area.² That is not necessarily a bad thing, but more concentrated stress does not automatically mean better healing, especially when the problem involves a larger area like an arthritic knee.

SoftWave: Broad and Deep

SoftWave works differently. It uses electrohydraulic shockwave technology, where an electrical spark inside the applicator creates an acoustic shockwave that is directed into the body using a parabolic reflector. Instead of concentrating most of the energy into one tiny focal point, SoftWave is designed to spread that energy across a broader and deeper treatment area.

A simple way to remember it is:

• Radial: wider, but more superficial
• Focused shockwave: deeper, but concentrated
• SoftWave: broad and deep

That difference is one of the reasons we like SoftWave so much for knee osteoarthritis. Arthritis usually is not a problem involving one tiny spot. The joint capsule, subchondral bone, tendons, ligaments, muscles, and other surrounding tissues may all be contributing to the pain. Being able to treat a larger area makes sense clinically when you are dealing with a condition that affects the whole joint environment.

Does Shockwave Actually Damage Tissue?

There is a common idea that shockwave therapy works by damaging tissue so the body is forced to heal it. The reality is more complicated. Shockwaves do create mechanical stress, and higher-energy focused systems can create cavitation and concentrated forces inside tissue, but research increasingly points toward mechanotransduction as a major part of the therapeutic effect.³

Mechanotransduction means that mechanical energy can influence how cells behave, affecting cellular signaling, blood flow, inflammatory pathways, and tissue-repair processes. So the goal is not simply to beat up injured tissue. The goal is to deliver an appropriate mechanical stimulus that encourages a beneficial biological response.

What Does the Research Say About Knee Osteoarthritis?

The research on shockwave therapy for knee osteoarthritis is encouraging. Multiple systematic reviews and meta-analyses have found improvements in both pain and function in patients with knee OA following extracorporeal shockwave therapy.⁴⁻⁶

Why We Prefer SoftWave for Knee Pain

In our office, we have seen patients who previously tried other forms of shockwave therapy with little or no improvement and then had a much better response with SoftWave. That does not mean SoftWave will work for every patient, but it is one of the reasons it has become our preferred shockwave technology for knee osteoarthritis and chronic knee pain.

So if you have already tried “shockwave therapy” and it did not work, do not assume that all shockwave therapy is the same. The better question is: what type of shockwave did you actually receive?

Could SoftWave Help Your Knee Pain?

If you’ve been wondering whether SoftWave could help your knee pain, come into Square One Health for a consultation and mapping session. We’ll identify the areas of your knee that are most sensitive, determine whether you’re a good candidate for treatment, and let you experience how your knee responds.

One of the things patients are often surprised by is how quickly they can notice a change. Many of our patients walk out with less pain than they came in with after just one treatment. While every patient responds differently and results cannot be guaranteed, that immediate response can give us valuable information about whether SoftWave may be a good fit for your condition.

Schedule your SoftWave mapping session with Square One Health and find out whether this treatment could be the missing piece in your knee pain recovery.

About Dr. Tim Cowan, DC

Dr. Tim Cowan, DC is a Doctor of Chiropractic at Square One Health and has written and reviewed this article. He earned his Doctorate of Chiropractic from the University of Western States after completing a Bachelor of Science in Exercise Science from Northern Arizona University. Dr. Cowan has advanced training in scoliosis rehabilitation, Chiropractic BioPhysics (CBP), and postural correction techniques. He focuses on helping patients improve posture, movement, and spinal function through individualized treatment approaches designed to address musculoskeletal conditions and movement-related dysfunction.

References

1. van der Worp H, et al. Arch Orthop Trauma Surg. 2013;133:507-514.
2. Wang CJ. J Orthop Surg Res. 2012;7:11.
3. d’Agostino MC, et al. J Biol Regul Homeost Agents. 2015;29:741-745.
4. Wang YC, et al. Extracorporeal shockwave therapy for knee osteoarthritis: systematic review and meta-analysis. Pain Med. 2020.
5. Liao CD, et al. Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskelet Disord. 2023.
6. Recent systematic reviews and umbrella analyses continue to report improvements in pain and WOMAC functional outcomes following ESWT for knee osteoarthritis.