Shockwave vs Laser Therapy for Musculoskeletal Disorders

Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.

Shockwave vs Laser Therapy for Musculoskeletal Disorders

A major 2025 systematic review and meta-analysis compared Extracorporeal Shockwave Therapy (ESWT) against both Low-Level Laser Therapy (LLLT / photobiomodulation) and High-Intensity Laser Therapy (HILT) across a wide range of musculoskeletal conditions.

The answer was more nuanced than expected.

Key Findings

1. Both Shockwave and Laser Therapy Work

The strongest overall finding from this review was:

Both ESWT and laser therapy significantly improve musculoskeletal pain and function.

Researchers found improvements in:

• Pain reduction

• Functional ability

• Strength

• Mobility

• Quality of life

Across most conditions studied, neither treatment was dramatically superior overall.

For More Information on what shockwave therapy is : Click Here

For More Information on what laser thearpy is : Click Here

Pain Relief Results

Shockwave vs Low-Level Laser Therapy (LLLT)

The meta-analysis found:

• No statistically significant difference in pain relief

• Both treatments produced meaningful improvement

• Results were similar across:

  • plantar fasciitis

  • tennis elbow

  • knee osteoarthritis

  • myofascial pain

  • carpal tunnel syndrome

Shockwave vs High-Intensity Laser Therapy (HILT)

Again, researchers found:

No significant overall difference in pain reduction.

Statistics

• MD: 0.21

• 95% CI: -0.51 to 0.93

• P = 0.57

However, there was one notable exception:

Tennis Elbow (Lateral Epicondylitis)

For tennis elbow specifically:

• HILT showed superior short-term pain reduction compared to shockwave

• 
  

This suggests high-intensity laser may have an advantage for some chronic tendon conditions.

Functional Improvement Results

This was where shockwave therapy showed a small advantage.

ESWT vs LLLT

Researchers found:

Shockwave therapy had a marginally superior effect on functional improvement.

While the difference was small, it suggests ESWT may improve:

• walking

• gripping

• lifting

• shoulder use

• daily movement

slightly better than low-level laser therapy.

ESWT vs HILT

This indicates:

High-intensity laser therapy performs similarly to shockwave therapy for restoring function.

Range of Motion (ROM)

Only two studies measured ROM directly.

Results showed:

• No significant difference between therapies

• Both improved movement

• Neither clearly outperformed the other

This applied mainly to shoulder impingement conditions.

Strength Outcomes

Grip strength improvements were also similar.

Neither treatment demonstrated superior strength gains.

Quality of Life Findings

Most quality-of-life outcomes were similar between therapies.

However:

Shockwave showed slight advantages in:

• physical role functioning

• activity tolerance

HILT showed some medium-term advantages in:

• mental wellbeing

• physical health scores

But the evidence was limited.

Safety & Side Effects

Both treatments were considered:

• non-invasive

• safe

• well tolerated

Reported side effects were mild and temporary.

ESWT side effects included:

• temporary soreness

• bruising

• redness

• post-treatment discomfort

No serious adverse events were reported.

Why Both Treatments Work

Shockwave Therapy Mechanisms

ESWT works by:

• stimulating tissue regeneration

• increasing collagen production

• improving blood flow

• triggering healing responses

• reducing chronic inflammation

• modulating pain pathways

Shockwave delivers mechanical acoustic energy into damaged tissue.

Laser Therapy Mechanisms

Low-Level Laser Therapy (LLLT)

LLLT primarily works through:

• photobiomodulation

• cellular repair stimulation

• anti-inflammatory effects

• pain signal modulation

High-Intensity Laser Therapy (HILT)

HILT combines:

• photobiomodulation

• deeper tissue penetration

• thermal effects

• increased circulation

• anti-inflammatory activity

HILT may penetrate deeper tissues more effectively than standard LLLT.

Important Clinical Takeaways

1. There Is No Clear “Winner”

This review suggests:

Shockwave and laser therapy are both evidence-based treatment options.

The “best” treatment likely depends on:

• the condition

• chronicity

• tissue involved

• pain sensitivity

• treatment goals

• patient preference

2. Shockwave May Be Better for Function

ESWT demonstrated:

• slightly stronger functional outcomes

• possible advantages in tendon rehabilitation

• stronger mechanical stimulation effects

This may make it useful for:

• chronic tendinopathy

• plantar fasciitis

• stubborn overuse injuries

3. HILT Appears More Comparable to Shockwave Than LLLT

One interesting finding was:

High-Intensity Laser Therapy performed more similarly to ESWT than traditional low-level laser.

This may be because HILT:

• penetrates deeper

• delivers more energy

• combines thermal and photobiomodulation effects

Final Conclusion

The review concluded:

ESWT, LLLT, and HILT all provide meaningful improvements for musculoskeletal disorders.

Main findings:

• No major difference in pain relief

• No major difference in strength or ROM

• ESWT may provide slightly better short-term functional improvement than LLLT

• HILT performs similarly to ESWT in most outcomes

• Both are safe, non-invasive treatment options

For clinics combining:

• chiropractic care

• rehabilitation

• shockwave therapy

• laser therapy

the evidence suggests these modalities can complement each other rather than compete against each other.

Shockwave Therapy May Be Better If You Have:

• chronic tendinopathy

• plantar fasciitis

• calcific conditions

• stubborn long-term pain

• loading intolerance

Laser Therapy May Be Better If You Want:

• gentler treatment

• reduced inflammation

• nerve calming

• pain reduction with minimal discomfort

• sensitive tissue management

Combining Both May Offer the Best Outcomes

Since both therapies work through different mechanisms, combining:

• chiropractic treatment

• exercise rehabilitation

• laser therapy

• shockwave therapy

About the Author

Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.

He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.

His treatment focus includes:

• Chiropractic adjustments

• Sports chiropractic

• Massage therapy

• Shockwave therapy

• Laser therapy

• Non-surgical spinal decompression

Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.

Reference

Ismail Hassan M, Shafiek Mustafa Saleh M, Hesham Sallam M, Hesham Elkhodary H, Mohamed Sayed M, Samy H, Hesham Mohamed A, Said Ashour A, Mohamed Mosaid E, Hassan Zaghloul M, Ramadan Elbathesh E, Vaish H, Mohammed Abdullah A A, Ibrahim Abdelhamed A. Extracorporeal Shock Wave Therapy versus laser therapy in treating musculoskeletal disorders: a systematic review and meta-analysis. Lasers Med Sci. 2025 Apr 15;40(1):194. doi: 10.1007/s10103-025-04392-0. PMID: 40232318; PMCID: PMC12000203.