Shock waves, as applied in urology and gastroenterology, were introduced in the middle of the last decade in Germany to treat different pathologies of the musculoskeletal system, including epicondylitis of the elbow, plantar fasciitis, and calcifying and noncalcifying tendinitis of the rotator cuff. With the noninvasive nature of these waves and their seemingly low complication rate, extracorporeal shock wave therapy (ESWT) seemed a promising alternative to the established conservative and surgical options in the treatment of patients with chronically painful conditions. However, the apparent advantages of the method led to a rapid diffusion and even inflationary use of ESWT; prospective, randomized studies on the mechanisms and effects of shock waves on musculoskeletal tissues were urgently needed to define more accurate indications and optimize therapeutic outcome. This review covers recent international research in the field and presents actual indications and results in therapy of musculoskeletal conditions with ESWT.