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Effects of frequency on shockwave treatment

A lot of attention is spent on the energy delivered to the tissues, but more recently, people are asking, what is the impact of the changes in frequency.

shockwave treatment

With other technologies like TENS, therapeutic and diagnostic ultrasound, and electrotherapy in general, we know the frequency has an impact on shockwave treatment.

Surely this is the same with shockwave therapy? You are not wrong, but the jury is out on the exact impact.

The frequency of shockwave is measured in Hertz (Hz), which is shocks per second, e.g. 5Hz equals five shocks per second.

For focused shockwave, changing the frequency should not affect treatment depth or energy distribution. Changing the frequency for radial shockwave does affect those aspects.

For radial shockwave therapy:

  • Low frequency
    o Deeper energy penetration
    o Higher perceived intensity
  • High frequency
    o Superficial energy penetration
    o More tolerable.

Shockwave therapy is a MECHANICAL energy, and the body absorbs and responds to mechanical loads differently, so we cannot be 100% sure how the frequency affects the treatment outcome.

Why change the frequency?

shockwave treatment

Below are the five main reasons you would change frequency.

1) Pain sensation
Patients tolerate shockwave therapy differently, and to avoid changing the energy input, alter the frequency to help make treatment more tolerable.

Generally, higher frequencies are tolerated more than low frequency – but play around people are different!

2) Depth of penetration
For radial shockwave, the frequency can affect the depth of the energy penetration.

This is not the case for focused shockwave therapy, as the depth is controlled by a spacer.

3) Distribution of energy
Again, for radial shockwave, how the energy disperses within the tissues can be affected.

It is understood that a higher frequency delivers energy over a smaller area, whereas lower frequencies can spread wider.

And the biggest one…

4) Tissue response
Different tissues respond differently to different frequencies, but also the cells and physiological responses may differ too.

For example, tendon tissue may respond better to higher frequencies (8-12Hz), whereas bone may respond better to frequencies of 2-5Hz.

Physiologically, regenerative cells may respond better to frequencies of 5-Hz, but pain receptors may respond to higher frequencies that create a barrage effect.

Differences in delivery

Depending on the machine, whether radial or focused, you can have access to different frequencies.

Typically, most shockwave machines can offer between 1-12Hz with some going up to 20Hz and up.

The BIGGEST thing for you to consider is if the shockwave therapy device has any limitations between combining the energy delivery and changing the frequency.

I.e. does increasing the energy level affect the frequency of the shocks?

With most radial shockwave systems, these are often not limited, meaning you can max. Out the energy level and frequency, no issue.

The same cannot be said for focused shockwave systems. Most do have a limitation which can impact the treatment outcome.

For example, if you set the frequency at 10Hz, as you increase the energy output, the frequency starts to drop automatically. So by the time you are at a maximum energy output,
the frequency can be down to as low as 2Hz.

Little plug for the Piezowave2 focused shockwave as this is not the case for this range. Not only is it the most powerful system on the market, delivering energy levels up to 0.8mJ/mm2, the system can deliver this energy at its maximum of 8Hz, more than any other system.

This gives you the most treatment combinations and option on the market. Period.

The Longest Powershocker can deliver an impressive 4 bar of energy at a maximum of 17hz, with no impact on the energy output, again giving you ultimate control of your shockwave therapy treatment.

To find out more about which shockwave may be best for you, contact us to speak to a specialist. You can also find lots of informative videos about shockwave treatment at Our Academy.

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