Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database

Br Med Bull. 2015;116(1):115-38. doi: 10.1093/bmb/ldv047. Epub 2015 Nov 18.


Background: Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.

Sources of data: This systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed).

Areas of agreement: ESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate.

Areas of controversy: The distinction between radial ESWT as 'low-energy ESWT' and focused ESWT as 'high-energy ESWT' is not correct and should be abandoned.

Growing points: There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome.

Areas timely for developing research: Future randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.

Keywords: ESWT; PEDRo; RSWT; musculoskeletal system.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Databases, Factual
  • High-Energy Shock Waves / adverse effects
  • High-Energy Shock Waves / therapeutic use*
  • Humans
  • Musculoskeletal Diseases / therapy*
  • Randomized Controlled Trials as Topic / methods
  • Tendinopathy / therapy