A Comprehensive Systematic Review of Effect of Extracorporeal Shockwave Therapy on the Pain, Functional Capacity and Quality of Life in Patients with Chronic Low Back Pain

Abstract

Introduction: Chronic low back pain (CLBP) is a prevalent and debilitating condition with significant socioeconomic impact, often refractory to conventional treatments. Extracorporeal shockwave therapy (ESWT) has emerged as a promising non-invasive modality, but its overall efficacy, optimal protocols, and comparative effectiveness for CLBP require comprehensive synthesis (Çelik, Altan & Ökmen, 2019; Yue et al., 2021).

Methods: A systematic review of 67 studies, including randomized controlled trials (RCTs) was conducted. Studies involving adult patients with CLBP (≥12 weeks) receiving ESWT as a primary intervention were included. Data on pain (VAS, NRS), functional capacity (ODI, Roland-Morris), quality of life (SF-36, HADS), safety, and protocol parameters (type, energy, pulses) were extracted and synthesized (Liu et al., 2023; Wu et al., 2023).

Results: ESWT demonstrated statistically and clinically significant reductions in pain intensity (e.g., VAS MD = -1.14 to -2.37) and improvements in functional disability (e.g., ODI MD = -6.01 to -14.10), with benefits sustained up to 12 months in some studies (Nedelka et al., 2025; Rajfur et al., 2022). Quality of life, particularly physical domains and depression scores, also improved (Çelik, Altan & Ökmen, 2019; Han et al., 2015). ESWT showed a favorable safety profile with mostly minor, transient adverse events. Comparative effectiveness varied: ESWT was superior to conventional physical therapy and sham, comparable to laser therapy, but sometimes less effective than manual therapies like Maitland mobilization or mechanical traction in specific contexts (Ejaz et al., 2024; Kızıltaş et al., 2022).

Discussion: The therapeutic effects of ESWT are mediated by biological mechanisms including neovascularization, tissue regeneration, and pain gate modulation. Outcome heterogeneity is explained by variations in ESWT protocols (focused vs. radial, energy density), patient selection (specific vs. non-specific CLBP), and the presence of co-interventions like exercise. Focused ESWT with moderate energy (0.15-0.35 mJ/mm²) targeting identifiable pain generators (e.g., myofascial trigger points, facet joints) within a multimodal rehabilitation framework appears most effective (Sun et al., 2022; Ferdinandov, 2024).

Conclusion: ESWT is an effective, safe, and non-invasive therapeutic option for CLBP, providing meaningful relief in pain, function, and quality of life. It is best applied as part of a multimodal strategy for patients with identifiable musculoskeletal pain generators who have not responded to first-line treatments. Future research should standardize protocols and focus on long-term outcomes and cost-effectiveness.