How Shockwave and Laser Therapy Are Changing Pain Management

Chronic pain and musculoskeletal conditions can be frustrating for patients and challenging for clinicians to manage. But recent research shows that extracorporeal shockwave therapy (ESWT) and photobiomodulation therapy (PBMT, or laser therapy) are delivering measurable relief in conditions ranging from low back pain to plantar fasciitis.

In this post, we break down the latest findings and what they mean for clinical practice.

What Is Shockwave Therapy?

Shockwave therapy has been used since the 1980s, originally for breaking down kidney stones. Today, it’s a proven option for treating musculoskeletal pain.

There are two main types:

• Focused Shockwave (FSW): Reaches deep tissues, up to 12 cm.
• Radial Pressure Wave (RPW): Works on more superficial tissues closer to the skin.

Both work through mechanotransduction — using acoustic waves to trigger biochemical changes that promote pain relief and tissue healing.

Shockwave Therapy in Action: Key Research

• Chronic Low Back Pain
  Patients treated with radial ESWT alongside core stability exercises showed significantly lower pain scores and better function up to 3 months post-treatment compared to exercises alone (Walewicz et al, 2020).
• Rotator Cuff Calcific Tendinitis
  Adding ESWT to conventional physiotherapy improved pain relief and range of motion by over 80%, outperforming physiotherapy alone (Duymaz and Sindel, 2019)
• Achilles Tendinopathy
  ESWT combined with eccentric training and stretching led to a 75% greater reduction in pain than exercise alone, with benefits lasting beyond 16 months (Abdelkader et al, 2021).

What Is Photobiomodulation (Laser Therapy)?

Often called “cold laser” or “low-level laser therapy (LLLT),” PBMT uses light energy to stimulate cellular repair without causing thermal damage.

High-Intensity Laser Therapy (HILT) has emerged as a faster, deeper-reaching alternative to LLLT. Both forms of PBMT promote pain reduction, tissue healing, and improved function.

Laser Therapy in Action: Key Research

• Plantar Fasciitis
  PBMT added to usual care led to clinically significant pain reduction lasting up to 6 months. Patients also used fewer pain medications compared to exercise-only groups (Ketz et al 2024)
• Adhesive Capsulitis (Frozen Shoulder)
  Both HILT and LLLT improved outcomes, but HILT proved superior, reducing pain and disability more effectively (Ordahan et al, 2023).
• Chronic Low Back Pain
  Patients receiving HILT plus exercise experienced a 74% decrease in pain at 3-month follow-up, compared to just 30% with ultrasound therapy (Gocevska et al, 2019)
• Hamstring Tendinopathy
  Athletes treated with high-power laser therapy reported greater pain relief and improved function versus conventional therapy (Verma et al, 2022)

Shockwave + Laser: A Winning Combination

One study found that combining ESWT and PBMT for plantar fasciitis provided the best results, with a 90% reduction in pain scores and a 56% improvement in function — far outperforming either therapy alone.

What This Means for Clinicians

The evidence is clear:

• Shockwave therapy is highly effective for tendon-related conditions and chronic pain.
• Laser therapy (PBMT/HILT) offers powerful pain reduction, particularly in soft tissue injuries.
• Combining both therapies can maximize outcomes for difficult-to-treat conditions.

For physiotherapists, chiropractors, and rehab specialists, incorporating these modalities can enhance treatment protocols, improve patient satisfaction, and deliver long-term relief.

About Enovis™

Enovis™ is a global medical technology company committed to creating better patient outcomes with innovative solutions like Chattanooga® shockwave devices and LightForce® therapy lasers.

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References available on request.