The State of Extracorporeal Shockwave Therapy for Myofascial Pain Syndrome—A Scoping Review and a Call for Standardized Protocols

Abstract

Background: Extracorporeal Shockwave Therapy (ESWT) for targeting myofascial tissues is gaining increasing interest for the treatment of musculoskeletal disorders. This review evaluates the mechanisms, applications, and effectiveness of ESWT in managing myofascial pain syndrome (MPS) while identifying methodological gaps in existing research. Methods: A systematic search of PubMed, PEDro, and Cochrane Central Library was conducted up to August 2025, focusing on studies from existing meta-analyses, particularly randomized controlled trials. Eligible studies were selected based on predefined criteria, including the use of ESWT for MPS treatment, methodological rigor, and adherence to standardized protocols. Data were extracted on diagnostic criteria for MPS and myofascial trigger points (MTrPs), shockwave application parameters, adherence to International Society for Medical Shockwave Treatment (ISMST) guidelines, follow-up periods, and treatment efficacy. Results: significant inconsistencies were identified in MPS diagnosis, shockwave application technique, and study follow-up periods. Many studies did not adhere to ISMST guidelines, with variations in energy levels, impulses, and differentiation between radial pressure wave (RPW) and focused ESWT (fESWT). One-third of the studies had follow-up periods of two weeks or less, limiting the assessment of long-term outcomes. Despite these limitations, ESWT demonstrated moderate to good efficacy compared with controls. Conclusions: While ESWT appears effective for MPS, methodological inconsistencies prevent definitive conclusions. Future research should standardize protocols, differentiate RPW from fESWT, and include longer follow-up periods to optimize therapeutic potential and validate ESWT as a treatment for MPS.