BACKGROUND: Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment. PURPOSE: To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients. STUDY DESIGN: Systematic review; level of evidence, 2. METHODS: We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies. RESULTS: ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain (p < 0.01), American Orthopaedic Foot and Ankle Society scale (p = 0.01), Likert scale for satisfaction (p = 0.03), Roles and Maudsley scale (p < 0.01), Victorian Institute of Sports Assessment-Achilles questionnaire (p < 0.01), and numerical rating scale (p = 0.02). The 2 patient groups did not differ significantly in tenderness (p = 0.34) or pain threshold (p = 0.24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06 to 0.11 mJ/mm2) and medium-energy level (0.12 to 0.25 mJ/mm2) and at both shorter (< 6 months) and longer (>= 6 months) follow-up. CONCLUSION: ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.

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