Effect of Extracorporeal Shockwave Therapy Versus Low-Level Laser Therapy in Musculoskeletal Disorders: A systematic review and meta-analysis

Mariam Ismail, Ahmed Ibrahim Abdelhamed, Hadel Hesham Elkhodary, Mazen Mohamed Sayed, Afnan Hesham Mohamed, Hina Vaish, Mariam Hesham Sallam, Manar Hassan Zaghloul, Ahmed Said Ashour, Esraa Ramadan Elbathesh, Marwa Shafiek Mustafa saleh, Haidy Samy, Esraa Mohamed Mosaid, mohammed Abdulla Al-shehri
Purpose:

We aimed to systematically investigate Randomized Controlled Trials (RCTs) comparing the effects of ESWT versus LLLT on reducing pain and improving functionality in patients with musculoskeletal disorders. 

Methods:

PubMed, Scopus, Web of sciences (WOS), Cochrane (CENTRAL) database were searched from inception until June 2024. Two different independent researchers were involved in each of the three stages: titles and abstracts screening, full-text screening, and data extraction. We used Cochrane’s risk of bias tool (RoB 2) to assess the quality of the included studies and GRADE approach to assess the certainty of evidence. Random-effects meta-analyses were conducted, and effects were quantified at short-term (≤ 12 weeks) and medium-term (> 12 weeks - ≤ 6 months).

Results:

The review included 17 RCTs with 902 patients. Eight studies showed high risk of bias and nine raised some concerns. In the short-term, pooled analyses revealed no statistically significant difference in pain reduction for LET (SMD= -0.51; 95% CI: -1.29 to 0.27, P= 0.20), plantar fasciitis (SMD= -0.21; 95% CI: -1.33 to 0.91, P= 0.71), and myofascial pain syndrome (SMD= 0.22; 95% CI: -0.2 to 0.65, P= 0.31). Similarly, no significant differences were observed in functional improvement (SMD= -0.20; 95% CI: -0.53 to 0.13, P= 0.23). In the medium-term, a pooled analysis of two studies on plantar fasciitis revealed no statistically significant difference on pain (SMD= -.077; 95% CI: -4.02 to 2.48, P= 0.64). The certainty of evidence for all pain outcomes and function ranged from very low to low.

Conclusion(s):

This systematic review and meta-analysis suggest that ESWT and LLLT are equally effective in reducing pain in the short and medium term and improving functionality in the short-term in patients with MSKDs. However, the certainty of evidence ranges from very low to low. Future RCTs with larger sample sizes and higher methodological quality are required to reach a definitive conclusion. 

Implications:

Both interventions are equally safe and effective options for treating patients with MSKDs. Therefore, clinicians may determine the most suitable intervention based on patient preferences and clinical expertise until stronger evidence becomes available.

Funding acknowledgements:
NA
Keywords:
Extracorporeal Shockwave Therapy
Low-Level Laser Therapy
Pain
Primary topic:
Musculoskeletal
Second topic:
Orthopaedics
Did this work require ethics approval?:
No
Name the institution and ethics committee that approved your work:
h
Provide the ethics approval number:
h
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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