Effects of extracorporeal shockwave therapy on pain intensity and functional disability in chronic low back pain: a systematic review and meta-analysis

Purpose To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain intensity and functional disability in individuals with chronic low back pain (CLBP).Materials and Methods PubMed, Embase, Web of Science, Cochrane Library, LILACS, Google Scholar, and ProQuest were searched. The PICOS framework included individuals with CLBP receiving ESWT, compared with placebo, usual care, exercise, or physiotherapy. Randomized controlled trials reporting pain intensity and/or functional disability were included. Data on participant characteristics, interventions, comparators, and ESWT dosimetry were extracted.Results Of 430 records identified, nine randomized controlled trials were included. Radial ESWT (rESWT) significantly reduced pain (SMD = −0.72; 95% CI −1.30 to −0.14; I2 = 76%), whereas focused ESWT (fESWT) showed benefit in one trial. Functional disability significantly improved overall (MD = −6.12; 95% CI −10.02 to −2.22; I2 = 75%), but the effect did not reach the minimal clinically important difference. Most studies evaluated outcomes only immediately post-intervention. Sensitivity analyses indicated influence of methodological quality and heterogeneity.Conclusion ESWT, particularly rESWT, may reduce pain in CLBP, but functional improvements are not clinically meaningful. Short follow-up and substantial heterogeneity limit the strength of recommendations. rESWT and fESWT should not be considered interchangeable.Systematic review registration number International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251085206.