Detailed knowledge concerning the action of extracorporeal shock waves on the locomotor system as well as concerning possible side effects of extracorporeal shock wave therapy (ESWT) are crucial to optimize the clinical use of ESWT for the treatment of illnesses such as calcific tendinitis of the shoulder, tennis elbow, plantar fasciitis, aseptic pseudarthrosis, and aseptic hip necrosis. This study presents the current knowledge gained from animal experiments, which have yielded important findings, in particular concerning possible side effects of ESWT. Very recent studies have also provided valuable insights into the molecular actions of extracorporeal shock waves on the locomotor system. Further intensified experimental animal research will greatly improve the scientific basis for the clinical use of ESWT in the near future.