High-Intensity Laser Therapy Versus Extracorporeal Shockwave Therapy for Lateral Elbow Tendinopathy: A Systematic...

Purpose: In this systematic review, we compare the effectiveness of high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) in treating lateral elbow tendinopathy (LET). Methods: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was conducted from database inception to 23 June 2025 to identify randomized controlled trials (RCTs) comparing the two interventions. The primary outcome was pain intensity (visual analog scale or numeric rating scale). Secondary outcomes included upper-limb disability (qDASH), grip strength (pain-free or maximal), ultrasound-measured common extensor tendon thickness, and safety (adverse events and withdrawals). Two reviewers independently extracted data and assessed methodological quality using the Physiotherapy Evidence Database (PEDro) scale; the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effects were synthesized as SMD (95% CI) using random- or fixed-effects models based on heterogeneity (I²). Significance was set at p < 0.05. Results: Four RCTs met the inclusion criteria and 169 participants were included. Methodological quality was moderate, with moderate-quality evidence indicating a significant improvement in short-term and medium-term upper-limb function in favor of HILT (SMD = -0.42; 95% CI: -0.73 to -0.12 and SMD = -0.50; 95% CI: -0.94 to -0.06, respectively). Evidence ranging from low to moderate quality showed no significant differences between the HILT and ESWT groups in terms of short-term or medium-term resting pain (SMD = -0.50; 95% CI: -1.15 to 0.16 and SMD = -0.42; 95% CI: -1.06 to 0.22, respectively), short-term or medium-term activity pain (SMD = -0.38; 95% CI: -1.05 to 0.29 and SMD = -0.73; 95% CI: -1.65 to 0.19, respectively), short-term or medium-term grip strength (SMD = 0.24; 95% CI: -0.20 to 0.67 and SMD = 0.20; 95% CI: -0.16 to 0.55, respectively), or short-term or medium-term common extensor tendon thickness (SMD = 0.04; 95% CI: -0.50 to 0.59 and SMD = -0.00; 95% CI: -0.55 to 0.55, respectively). Conclusions: HILT appears to offer significant benefits in improving upper-limb function at short-term (<1 month) and medium-term (1-3 months) follow-up. Regarding pain, grip strength, and tendon thickness, the pooled effects did not show clear between-group differences. Evidence certainty ranged from low to moderate, demonstrating that trials with a follow-up period beyond 3 months are needed to evaluate long-term efficacy. Systematic review registration number: PROSPERO: CRD420251026387.