Radial Shockwave Therapy

What This Is Not — A Relaxing Modality

Shockwave is not massage. It is not Tecar warmth or PEMF quiet. The pulse train is sharp and percussive — most patients rate it 6 to 8 out of 10 in the moment. The intensity is the therapy. We are deliberately overriding tissue that has tuned itself out, and you will feel that we are doing it.

What This Is — Mechanotransduction Therapy

A precisely tuned mechanical input that the cell interprets as a fresh injury signal — triggering the angiogenic, anti-inflammatory, and collagen-remodeling cascades that chronic tissue has stopped producing on its own.

Step 01

Pneumatic Pulse Delivered to Skin

A burst of compressed air drives the projectile. The transmitter delivers the resulting pressure wave directly into the tissue at frequencies of 8 to 15 Hz — roughly eight to fifteen pulses per second — for two to three thousand pulses per treated region.

Step 02

Mechanotransduction — Cells Read the Signal

Cells in the treatment field convert the mechanical energy into biochemical signaling. Mechanoreceptors, integrins at the cell membrane, and cytoskeletal tension sensors translate the pulse into the language of growth factors and inflammatory mediators.

Step 03

Healing Cascade Initiated

VEGF and eNOS are released — driving the growth of new microvasculature into chronically under-perfused tissue. TGF-β1, BMP-2, and IGF-1 are upregulated — driving fibroblast and tenocyte proliferation, new collagen synthesis, and remodeling of disorganized scar.

Step 04

Pain Signaling Depleted

Substance P — the neuropeptide that sensory nerve endings use to signal pain — is depleted at the treated tissue. The nerve does not stop working. It runs out of its pain-signaling supply, and the tissue gets quiet while the regenerative cascade does its work underneath.

Days 1–3 · Inflammatory Reawakening

A controlled, mild inflammatory response. Mild soreness at the treated area for 24 to 48 hours is expected and is part of the mechanism. The tissue is signaling that it has noticed the input.

Weeks 1–3 · Neovascularization

VEGF-driven growth of new microvasculature into chronically under-perfused tendon and fascia. Tissue that has been starved of blood flow for months — a defining feature of chronic tendinopathy — finally gets oxygen and nutrients delivered to it.

Weeks 3–8 · Collagen Remodeling

Fibroblasts and tenocytes proliferate and lay down new collagen. Disorganized scar is replaced by more organized fiber architecture. This is the phase where the tissue is genuinely being rebuilt rather than simply soothed.

Weeks 6–12 · Symptom Resolution

Pain relief continues to deepen as the structural work matures. Most patients are at their best clinical result six to twelve weeks after the final session — well after the appointments themselves have ended.

During the Pulse Train

Most patients rate the sensation 6 to 8 out of 10. It is sharp and percussive — patients describe it as a snapping, drilling, or pneumatic-hammer quality. The intensity is highest over bony entheses — the heel for plantar fasciitis, the lateral epicondyle for tennis elbow — and softens noticeably over muscle bellies. Your provider titrates the energy and frequency in real time based on your feedback.

Immediately After

The percussive discomfort resolves within minutes of the device coming off the skin. Many patients report a paradoxical short-term reduction in their baseline pain — a substance-P depletion effect — for several hours after the session.

The 24–48 Hour Window

Expect mild residual soreness in the treated area for one to two days, similar to the soreness after a hard workout. This is the inflammatory reawakening phase and it is supposed to happen. Gentle movement is fine. Ice is generally avoided because it dampens the response we just initiated.

Session Two and Onward

Tolerability improves noticeably session to session. By the third or fourth session most patients describe the same pulse intensity as significantly less aversive — partly because the tissue is less inflamed, partly because the nervous system stops bracing against an input it now recognizes.

Strongest Evidence — Level 1 Indications

Plantar fasciitis  ·  Lateral epicondylitis (tennis elbow)  ·  Greater trochanteric pain syndrome / gluteal tendinopathy  ·  Mid-portion Achilles tendinopathy  ·  Non-calcific rotator cuff tendinopathy

Strong Clinical Use — Common Tendinopathies

Patellar tendinopathy (jumper’s knee)  ·  Medial epicondylitis (golfer’s elbow)  ·  Insertional Achilles tendinopathy  ·  Proximal hamstring tendinopathy  ·  Adductor tendinopathy  ·  Iliotibial band syndrome

Fascial & Myofascial

Chronic myofascial trigger points  ·  Plantar fascia adhesions  ·  Post-surgical fascial restriction  ·  Shin splints (medial tibial stress syndrome)  ·  Stubborn fascial pain in hypermobile patients

When We Refer Out

Radial does not effectively fragment calcific tendinopathy deposits — focused shockwave is the right tool for that. Radial also attenuates past three centimeters of depth, so deep targets in heavier patients or deep nerve and bone pathology are not its strength. If your imaging or exam suggests a calcific deposit or a deep target, we will say so and refer you to a focused shockwave provider rather than under-treat with the wrong tool.

Swiss Engineering, Consistent Energy

Cheaper radial units lose calibration as the frequency rises — the energy delivered per pulse drifts. The Masterpuls maintains its rated bar output across the full frequency range, which means the dose your provider sets is the dose your tissue actually receives, pulse after pulse, session after session.

A Full Transmitter Library

Different tissues need different applicators. The Masterpuls library includes the R15 standard transmitter for general musculoskeletal work, the D20 Deep Impact head for deeper soft-tissue effect, ceramic and small-joint heads for trigger points and finer anatomy, and the D-Actor and V-Actor vibration heads for myofascial preparation. The right head for your tissue, not a one-size-fits-all approach.

FDA-Cleared, CE-Marked

The Masterpuls is FDA 510(k) cleared in the United States and CE-marked in Europe as a Class IIa medical device. It is a regulated medical device, not a wellness gadget, and it is used at FIT Los Angeles within a clinical care framework under physician oversight.

Typical Series · 3 to 6 Sessions

Most evidence-based protocols call for three to six sessions, spaced approximately one week apart. Acute and moderate conditions resolve toward the lower end of that range. Longstanding chronic tendinopathies — pain you have had for a year or more — typically need the full six.

Session Length · 10 to 15 Minutes Per Region

Two to three thousand impulses are delivered per treated region. The active treatment time is short. Allow a full appointment for evaluation, positioning, and the post-treatment check-in.

Energy & Frequency · Titrated to Your Tissue

Energy starts at 1.5 to 2.0 bar and is titrated up through the session as you tolerate. Frequency typically runs 8 to 15 Hz. Patient feedback is the dosing guide — no anesthesia is used because we need you to tell us in real time what your tissue is registering.

When to Expect Results

Some patients feel a meaningful reduction in pain after the first or second session. Most see steady improvement through the series. The strongest results emerge six to twelve weeks after the final session as the collagen remodeling matures. We re-evaluate at that point — and most patients do not need a repeat series.