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High-Intensity Laser Therapy Versus Extracorporeal Shockwave Therapy for Lateral Elbow Tendinopathy: A Systematic
Pei-Ching Wu1,2,3, Dung-Huan Liu3,4,5,6, Yang-Shao Cheng5,7
1Department of Chinese Medicine, China Medical University Hospital, Taichung City 404327, Taiwan.
Bioengineering (Basel, Switzerland)
|February 27, 2026
Summary
High-intensity laser therapy (HILT) improved short-term upper-limb function in lateral elbow tendinopathy (LET) patients compared to extracorporeal shockwave therapy (ESWT). No significant differences were found for pain, grip strength, or tendon thickness between HILT and ESWT.
Area of Science:
- Orthopedics and Sports Medicine
- Physical Therapy and Rehabilitation
- Regenerative Medicine
Background:
- Lateral elbow tendinopathy (LET), commonly known as tennis elbow, is a prevalent condition causing significant pain and disability.
- Current treatment options for LET include conservative management and various physical modalities, with ongoing debate regarding the optimal therapeutic approach.
- High-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) are advanced physical modalities increasingly utilized for tendinopathies.
Purpose of the Study:
- To systematically review and compare the efficacy of HILT versus ESWT in treating patients diagnosed with LET.
- To evaluate the impact of these therapies on pain intensity, upper-limb function, grip strength, and tendon structural changes.
- To assess the safety profiles and certainty of evidence for both interventions in LET management.
Main Methods:
- A systematic literature search was performed across PubMed, Cochrane Library, and EMBASE up to June 23, 2025, to identify relevant randomized controlled trials (RCTs).
- Data extraction and methodological quality assessment (PEDro scale) were conducted independently by two reviewers, with evidence certainty evaluated using the GRADE approach.
- Outcomes synthesized included pain (VAS/NRS), upper-limb disability (qDASH), grip strength, common extensor tendon thickness via ultrasound, and adverse events.
Main Results:
- Four RCTs involving 169 participants met the inclusion criteria, with moderate methodological quality.
- Moderate-quality evidence indicated significant short-term and medium-term improvements in upper-limb function favoring HILT over ESWT (SMD = -0.42 to -0.50).
- No significant differences were observed between HILT and ESWT for short-term or medium-term pain, grip strength, or common extensor tendon thickness (low to moderate quality evidence).
Conclusions:
- HILT demonstrates significant short-term (<1 month) and medium-term (1-3 months) benefits for upper-limb function in LET patients.
- Pooled analyses did not reveal significant between-group differences in pain reduction, grip strength enhancement, or tendon structural modification.
- Further high-quality RCTs with longer follow-up periods (>3 months) are necessary to ascertain the long-term efficacy of HILT and ESWT for lateral elbow tendinopathy.
