The objectives of this study were to determine the ability of several commercial shockwave devices to achieve a desired thrust profile in a benchtop setting, determine the thrust profile in a clinical analog, and determine the influence of operator experience level on device performance.


We conducted two different types of testing: (1) bench testing to evaluate the devices themselves, and (2) clinical equivalent testing to determine the influence of the operator.


The results indicated a significant dependence of thrust output on the compliance of the test media. The Activator V-E device matched the ideal half-sine thrust profile to 94%, followed by the Impulse device (84%), the Activator IV/FS (74%), and the Activator II (48%). While most devices deviated from the ideal profile on the return path, the Impulse device exhibited a secondary peak. Moreover, the Activator V-E device provided evidence that the device performs consistently despite operator experience level.This has been a major concern in manual spinal manipulation. Based on our results, a hyper-flexible spine would receive a lower peak thrust force than a hypo-flexible spine at the same power setting. Furthermore, a hand-held operation further reduced the peak thrust force as it increased the system compliance. However, that influence was dissimilar for the different devices. Although controlled clinical trials are needed to determine the correlation between thrust profile and clinical outcome, already ongoing clinical studies indicate an improved patient satisfaction due to reduced treatment pain when devices are used with a thrust characteristic closer to an ideal sine wave.

Annals of Biomedical Engineering, Vol. 42, No. 12, December 2014 ( 2014) pp. 2524–2536 DOI: 10.1007/s10439-014-1115-4

Author information: Liebschner, Michael A. K.; Chun, Kwonsoo; Kim, Namhoon; and Ehni, Bruce

Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA;  Exponent Failure Analysis, Houston, TX, USA;  Department of Pediatrics Cardiology, Baylor College of Medicine, Houston, TX, USA; and Neurosurgery Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA

In Vitro Biomechanical Evaluation of Single Impulse and Repetitive