Focused shock wave versus radial pressure wave therapy for musculoskeletal disorders: A systematic review and meta-analysis

Abstract

BackgroundFocused shock wave therapy (FSWT) and radial pressure wave therapy (RPWT) are commonly used noninvasive modalities for managing musculoskeletal disorders (MSKDs), yet their distinct physical properties and inconsistent evidence make it unclear which modality provides better outcomes.ObjectiveTo compare the FSWT with the RPWT in terms of pain, function, strength, and range of motion (ROM) in patients with MSKDs.MethodsWe searched PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, MEDLINE, the Physiotherapy Evidence Database, and Google Scholar from inception to October 5, 2025. The risk of bias was assessed via the RoB 2.0 tool, and meta-analyses were conducted via RevMan 5.4. Sensitivity analysis was used to examine the effect of excluding studies at high risk of bias. The certainty of evidence was evaluated via the GRADE approach.ResultsTwenty-one randomized controlled trials (RCTs) (16 RCTs and 5 pilot RCTs) were included (n = 1030). Meta-analyses revealed that neither modality for pain nor function was favored across short-, medium-, or long-term follow-ups. For short-term grip strength, low-certainty evidence favored the FSWT (MD = 3.09; 95% CI: 0.31-5.88), whereas the RPWT was superior for improving medium-term wrist extensor strength (MD = -2.39; 95% CI: -4.34-0.44) in patients with lateral epicondylitis. For shoulder ROM, no significant difference was observed in the short term (P > 0.05). Excluding studies with a high risk of bias in the sensitivity analysis did not change the pooled effect estimates.ConclusionVery low- to low-certainty evidence suggests no significant difference between FSWT and RPWT for pain, function, or ROM. Low-certainty evidence suggests a potential short-term advantage of FSWT for grip strength and a potential medium-term advantage of RPWT for wrist extensor strength in patients with lateral epicondylitis. However, these findings should be considered exploratory because they are based on a limited number of studies with small sample sizes and require confirmation in adequately powered, high-quality randomized controlled trials before informing clinical recommendations.