Clarifying misconceptions in the medical use of shock waves and radial pressure waves: Insights into common errors and the physical principles behind them

The clinical use of shock waves has evolved surprisingly since their introduction for kidney stone fragmentation in 1980, expanding into diverse fields including orthopedics, cardiology, dermatology, and erectile dysfunction. Emerging applications, such as Alzheimer’s disease therapy, appear promising. Despite this broad acceptance, the physical and biological mechanisms behind their therapeutic effects are not yet fully understood, particularly regarding the relevance of specific physical parameters. The introduction of devices that generate radial pressure waves has broadened the use of extracorporeal pressure wave therapy. However, it has also caused confusion about the distinction between shock waves and radial pressure waves. This has led to inconsistencies in protocol design, and outcome interpretation, ultimately hindering clinical progress. This article presents a physics-based overview of shock waves and radial pressure waves, focusing on their propagation through biological tissues and the associated secondary effects. Key parameters, such as energy flux density, focal zones, and impulse, are defined and contextualized to support accurate reporting. Emphasis is placed on the correct use of terminology, adherence to international standards, and the importance of proper training for healthcare providers using these technologies. Several common errors are analyzed, including issues related to pressure wave coupling, patient positioning, parameter selection, and improper device operation. By clarifying some physical principles and addressing common misunderstandings, this article aims to enhance the safe and effective use of extracorporeal pressure wave therapies. It advocates for a more rigorous approach to terminology, parameter reporting, and clinical implementation, with the goal of enhancing treatment outcomes.