The shockwave & EMTT knowledge library.

This systematic review and network meta-analysis examined 14 randomized controlled trials involving 738 patientsand compared ESWT, conventional physical therapy, sham treatment, and the combination of shockwave with physical therapy. ESWT significantly reduced pain compared with sham treatment, while the combination of ESWT plus conventional physical therapy produced greater pain reduction and functional improvement than physical therapy alone. These findings support a practical approach to shockwave integration: it does not have to replace the way clinicians already assess, treat, and rehabilitate patients. Instead, shockwave can become another tool within an existing treatment plan, working alongside rehabilitation to potentially improve outcomes.

This systematic review evaluated 53 studies involving 1,835 adult patients across bone conditions including delayed and nonunion fractures, osteonecrosis, bone stress injury, medial tibial stress syndrome, and bone marrow edema. Seven studies provided Level I evidence, with findings showing ESWT could achieve outcomes comparable to established interventions in select bone pathologies, including long-bone nonunion and early-stage femoral head osteonecrosis. Across studies reporting safety, no significant adverse events were identified. The review highlights the growing role of shockwave beyond traditional tendon applications, particularly focused shockwave, as clinicians explore noninvasive strategies for influencing bone healing and managing challenging orthopedic conditions.

This large systematic review and network meta-analysis evaluated 65 publications representing 3,921 patients across common tendinopathies, including lateral epicondylitis, Achilles tendinopathy, rotator cuff tendinopathy, greater trochanteric pain syndrome, and patellar tendinopathy. ESWT demonstrated significant pain improvements over placebo for several major conditions, with particularly favorable evidence for lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy. The results reinforce an important clinical point: shockwave is not simply a treatment for “tendon pain.” Its value is greatest when the technology and treatment strategy are matched appropriately to the pathology, supporting a more targeted, evidence-driven approach to MSK care.