📖 Upside Analysis: Shockwave Therapy Vs Laser Therapy in Elite Sports: Key Differences, Stats, Studies, Vendors, Case Studies, Best Practices

Extracorporeal shockwave therapy (ESWT) and laser therapy (photobiomodulation, PBM/LLLT) are two non-invasive modalities used across elite sport to reduce pain, accelerate tissue remodeling, and support availability. Though both can help similar clinical pictures (e.g., plantar fasciitis, Achilles/patellar tendinopathy), they operate through different primary stimuli—mechanical (ESWT) vs. photonic (PBM)—and therefore slot into the high-performance calendar differently. Understanding indications, protocols, and adoption friction is critical to choosing the right tool for the right athlete at the right time.

What is shockwave therapy?

ESWT delivers high-energy acoustic pulses (focused or radial) to target tissues. The mechanical loading triggers mechanotransduction cascades that can modulate nociception, upregulate angiogenesis, influence fibroblast activity/collagen orientation, and stimulate remodeling at tendon/bone interfaces. ESWT has the strongest sport-specific evidence in chronic plantar fasciitis and Achilles tendinopathy, with growing (but heterogeneous) data in other conditions. Typical downsides include brief treatment discomfort and occasional transient soreness/bruising—important considerations around congested fixtures.

Picture: SoftWave

What is laser therapy?

Laser therapy (PBM/LLLT) applies red/near-infrared light (≈600–1,000 nm) to tissues. Photons are absorbed by chromophores such as cytochrome-c oxidase in mitochondria, increasing ATP and modulating nitric-oxide and ROS signaling—mechanisms associated with analgesia, anti-inflammation, and improved recovery. In sport contexts, PBM is appealing because it’s painless, low-friction, and fast to apply; evidence supports short- to medium-term pain/function improvements in plantar fasciitis and lower-extremity tendinopathies, with growing (but still quality-limited) support for exercise-recovery benefits.

Picture: Summus Medical Laser

Key differences: Shockwave vs. Laser

Source: Upside Global, confidential, August 2025

Primary stimulus

• ESWT: mechanical acoustic energy → mechanotransduction and tissue remodeling. (Source: PMC)

• PBM: photonic energy → mitochondrial/NO signaling, anti-inflammatory effects. (Source: NatureJAAD)

Clinical sweet spots

• ESWT: chronic, localized tendinopathies (plantar fascia, Achilles), sometimes adjunct in other overuse conditions. (Source: Med FoM Sports Medicine)

• PBM: short- to medium-term pain relief in plantar fasciitis/lower-extremity tendinopathy; daily recovery/DOMS support around training and travel. (Source: PubMedMDPI)

User experience & logistics

• ESWT: short weekly sessions; procedure can be uncomfortable; typically clinic-based; schedule away from must-play windows if post-session soreness is an issue. (Source: Med FoM Sports Medicine)

• PBM: painless, minutes per session; simple to repeat; easy sideline/road integration. (Source: PMC

Time-course

• ESWT: benefits accrue over weeks; evaluate response across 4–12 weeks. (Source: Med FoM Sports Medicine)

• PBM: can be deployed acutely (pre/post-session) and over weeks; effects often seen in short- to medium-term windows. (Source: PubMed)

Pros and cons

Shockwave (ESWT)
Pros:

• Strong clinical support in plantar fasciitis and Achilles tendinopathy.

• Supports structural remodeling and reduces pain, potentially reducing surgery need.

• Finite, targeted protocols.

Cons:

• Discomfort and possible soreness interfere with tight schedules.

• Variable evidence across different tendons; device parameters still evolving.

Laser (PBM/LLLT)
Pros:

• Painless, rapid, and can be repeatedly used even on travel days.

• Evidence for pain/function improvements in lower-extremity tendinopathy; promising DOMS/performance outcomes.

Cons:

• Outcomes vary based on dosage, wavelength, distance—requires rigorous standardization.

• Less definitive long-term clinical data; device heterogeneity adds complexity.

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When to use which—and why

Use ESWT when:

• The diagnosis is a stubborn, localized tendinopathy (e.g., mid-portion Achilles, plantar fascia) unresponsive to graded loading/education. ESWT’s mechanical stimulus targets tendon remodeling and has the best signal here. Plan treatments away from high-stakes games to buffer post-session soreness. (Source: Med FoM Sports Medicine)

• You need a finite, block-style intervention (e.g., 3–6 weekly sessions) integrated with progressive loading, kinetic-chain work, and return-to-run/plyo progressions. (Source: Med FoM Sports Medicine)

Use PBM when:

• You want frequent, low-friction analgesia and recovery support around dense schedules (back-to-backs, travel, minutes spikes) for athletes with low-grade tendinopathy or DOMS. Sessions can be pre- or post-training and do not disrupt availability. (Source: PubMedMDPI)

• You need broad staff adoption and player buy-in quickly; PBM is painless and simple to operationalize daily. (Source: PMC)

Combined approach:

• Trial PBM early in-season for symptom control and recovery; schedule ESWT micro-blocks in longer gaps (e.g., ASB or homestands) for structural tendinopathy cases. This balances immediate availability with medium-term remodeling. (Source: Med FoM Sports Medicine)

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Key Stats on Shockwave (ESWT) and Laser (PBM/LLLT) Therapy

Shockwave Therapy (ESWT)

• Achilles Tendinopathy Success Rates: A study on chronic refractory Achilles tendinopathy reported a 71.1% immediate success rate and an impressive 90.3% long-term success rate—suggesting ESWT can produce durable outcomes in challenging cases.
  🔗 PMC – ESWT Long-Term Achilles Outcomes PMC

• Tendinopathy Success Across Different Sites: Clinical success rates range between 60–80% across conditions like epicondylopathy, plantar fasciitis, and other tendinopathies—underscoring ESWT’s broad applicability.
  🔗 PMC – Mechanisms Review with Success Rates PMC

• Effect Size for Pain Reduction: For chronic Achilles tendinopathy, ESWT achieved a standardized mean difference (SMD) of –1.38 (95% CI: –1.66 to –1.10), and for rotator cuff tendinopathy, SMD –2.37 (95% CI: –3.58 to –1.15)—both indicating very large effects in alleviating pain.
  🔗 BMC Sports Sci Med Rehabilitation – Pain Meta-Analysis BioMed Central

• Gluteal Tendinopathy Outcome: A PLoS ONE study on gluteal tendinopathy showed an 83.3% immediate success rate, but long-term success dropped to 55.6%, highlighting divergent results by condition and time frame.
  🔗 PLoS ONE – Gluteal Tendinopathy Outcomes PLOS

• Shoulder (Rotator Cuff) Improvements: In a randomized sham-controlled trial, ESWT led to a 74.5% improvement in Constant-Murley Score (CMS) at 3 months, compared to 15.2% with placebo.
  🔗 BMC Musculoskeletal Disorders – Shoulder ESWT Study BioMed Central

• Adverse Events Rate: In 18 studies including 557 cases, 12% reported adverse events—mostly increased transient pain or skin irritation—highlighting the need for monitoring post-treatment discomfort.
  🔗 SAGE Journals – Adverse Events in ESWT SAGE Journals

• Muscle Injury Return-to-Play Benefits (Italian Findings): In muscle injury classification types 1A/2B/3A, ESWT reduced downtime by 54%, 50%, and 8%, respectively. Re-injury rates dropped dramatically: from 12–13% to 4% for functional lesions and 0% for type 3A, demonstrating elite-level application.
  🔗 Italian ESWT Wiki – Muscle Injury Data Wikipedia

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Laser Therapy (PBM / LLLT)

• Ergogenic & Protective Effects: A narrative review across 39 human PBM studies found “valuable protective and ergogenic effects” in 25—affirming its consistent positive impact on performance and recovery.
  🔗 PMC – PBM Narrative Review PMC

• Meta-Analysis on Performance & Soreness: Of 24 studies involving LLLT, 14 reported positive outcomes in muscle performance and soreness recovery—supporting meaningful applied benefits.
  🔗 MDPI Sports – LLLT Meta-Analysis MDPI

• Delayed Onset Muscle Soreness (DOMS): Meta-analysis results show that PBM reduces VAS scores with SMD –0.55 at 72h and –0.56 at 96h. Moreover, muscle strength improved significantly with SMD 0.97 at 24h and 0.99 at 48h post-exercise—indicating moderate-to-large recovery effects.
  🔗 MDPI Sports – DOMS Meta-Analysis MDPI

• Force Recovery Percentage: In one controlled trial, participants receiving higher PBM doses showed improvements in force recovery of 101.9% (±13.6%), compared to placebo.
  🔗 MSARD Journal – Force Recovery Data MSARD Journal

• Pre-Exercise Phototherapy: In 13 out of 16 comparisons, phototherapy (laser/LED) before exercise improved muscular performance and recovery outcomes—showing strong preconditioning benefit.
  🔗 ResearchGate Summary – Pre-Exercise Phototherapy ResearchGate

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• ESWT: Particularly effective for chronic tendinopathies—often delivering success rates between 60–90% in ideal conditions but with some variability depending on tissue and duration.

• PBM/LLLT: Demonstrates consistent recovery and performance support with moderate-to-large effect sizes and low friction, especially when properly dosed and timed (e.g., pre-exercise or for DOMS relief).

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Studies on shockwave therapy and laser therapy

Shockwave (ESWT)

1. Use of extracorporeal shockwave therapies for athletes and physically active individuals: systematic review (Br J Sports Med, 2024). PDF: (Study here)

2. Mechanisms review (open-access): “Extracorporeal shock wave therapy mechanisms in musculoskeletal disorders” (2020) (Source here)

3. Mechanistic fibrosis signaling review (2024): (Source here)

4. rESWT vs sham vs exercise RCT (2024 preprint version): PDF (Source here)

Laser (PBM/LLLT)

1. BMJ Open systematic review/meta-analysis (2022): Lower-extremity tendinopathy & plantar fasciitis — pain/disability benefits short–medium term. (Source here)

2. Photobiomodulation in sport—umbrella review (2024): Promise for exertion/recovery; evidence quality variable (Source here)

3. Mechanism—CCO & mitochondrial signaling (Source here)

4. DOMS systematic review (2025): Reduced soreness, improved strength recovery post-DOMS (Source here).

5. Parameter/dose considerations: review of wavelengths/energy density and protocol sensitivity (Source here).

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Key Vendors

Shockwave Therapy (ESWT)

Source: Upside Global, confidential, September 2025

SoftWave / Tissue Regeneration Technologies (TRT) – This U.S. company is famous for its OrthoGold system using broad-focused, low-intensity electrohydraulic shockwaves for pain relief, wound healing, and tissue regeneration. Its customer list includes high-profile sports teams like the Brooklyn Nets, Cleveland Indians, New York Giants, Los Angeles Lakers, and institutions such as the Cleveland Clinic and Mayo Clinic. More details: softwavetrt.com.

Winback - Winback TECAR Therapy uses high-frequency energy (RF) to activate natural healing processes deep within the body, stimulating circulation, accelerating tissue repair, and reducing inflammation. It’s non-invasive, comfortable, and delivers measurable results across rehabilitation, sports recovery & performance, and pain management. Combined with our EMS frequencies, Winback offers you and your athletes a comfortable, efficient, and versatile solution to enhance your treatments. Our innovative devices feature multi-frequency treatments, that allow for hands-on and hands-free applications, ensuring that no matter the injury, condition, or volume of athletes in your training room, Winback can integrate into your treatment plans.

Since 2021, Winback has been trusted by 75+ teams and counting across professional and collegiate settings, in the US to keep their athletes performing at their best. Making us one of the fastest growing technologies in the US, we are truly in a category of our own! Beyond technology, we are deeply committed to education. Our U.S. Academy, led by Laura Ramus, former Medical Director of the Las Vegas Aces, is building a strong foundation of clinical excellence, ensuring every partner maximizes outcomes and elevates athlete care. To learn more about them please check out their website www.winback.us or contact their team at sales@winback.com .

Storz Medical – A Swiss firm providing both focused and radial shockwave devices (e.g. DUOLITH, MASTERPULS), Storz is well known in elite sport. Its devices are used by organizations such as Villarreal CF in Spain and multiple Premier League and UK Athletics programs. More details: storzmedical.com.

Zimmer MedizinSysteme – This German manufacturer offers radial (enPulsPro, enPuls 2.0) and focused (enShock) devices and is used widely across Europe and beyond. While specific client names are less prominently published, their products are adopted by many physiotherapy and athletic recovery clinics internationally. More details: zimmer.de.

BTL Industries – A global company whose rehab, physical medicine, and aesthetics devices (including the BTL-5000 and BTL-6000 shockwave systems) are used in thousands of clinics in over 70 countries. While specific elite team users aren’t widely publicized, BTL is a strong presence in physiotherapy and sports rehab worldwide. More details: btlnet.com.

EMS (Electro Medical Systems) / DolorClast® – The Swiss company behind DolorClast radial shockwave systems, EMS claims over 100 million patients treated globally. Users include physiotherapy, chiropractic, and podiatry clinics, as well as sports medicine practitioners highlighted in their published success stories. More details: ems-dolorclast.com.

Longest Medical – A Chinese provider of shockwave and rehabilitation devices distributed in 80+ countries, Longest is known for cost-effective systems with CE and ISO13485 certifications. While marquee customers are not prominently listed, their products are widely used in rehabilitation and physiotherapy clinics worldwide. More details: longestmedical.com.

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Laser / Photobiomodulation (PBM/LLLT)

Source: Upside Global, confidential, September 2025

Kineon MOVE+ Pro – Kineon Labs
The Kineon MOVE+ Pro is a portable, modular device designed to deliver red and near-infrared (NIR) light therapy directly to joints and muscles. Its flexibility and targeted application make it popular among athletes and practitioners looking to speed up recovery from training loads, reduce inflammation, and improve joint health. Unlike bulkier clinic-based systems, the MOVE+ Pro is lightweight and wearable, allowing for hands-free use during recovery routines. Its portability has made it a favorite in elite sports environments where players often need on-the-go solutions that can travel between training facilities, stadiums, and even international competitions.

Summus Medical Laser – Summus Medical Laser
Summus Medical Laser develops and manufactures Class IV laser therapy devices such as the H1 and Horizon, designed to deliver specific red and near-infrared wavelengths that stimulate the body’s natural recovery processes. Their technology provides a non-invasive treatment option for reducing pain, decreasing inflammation, and accelerating healing, making it widely applicable across medical, dental, and veterinary practices. In elite sports, Summus lasers are used by practitioners in MLB, NFL, NHL, MLS, and NCAA teams, supporting athlete recovery and performance optimization. Beyond sports, their devices are trusted by healthcare providers worldwide for their patient-focused design, which emphasizes safety, effectiveness, and comfort during treatment.

Multi Radiance - Multi Radiance
Multi Radiance Medical specializes in the development and manufacturing of super pulsed laser devices for pain relief and accelerated recovery. Their flagship products, like the MR4 LaserStim and MR5 ACTIV PRO, utilize a unique "Cascading Energy Effect" that combines multiple wavelengths of light (red, infrared, and super pulsed infrared) and a static magnetic field to achieve deep tissue penetration without the risk of thermal damage associated with some high-powered lasers. The company's technology is FDA-cleared and has been adopted by numerous professional and collegiate athletic organizations, including teams in the NHL, NBA, NFL, MLB, and MLS, for its ability to provide safe, drug-free pain management and promote faster healing. They also offer devices for home and veterinary use.

Lyma Laser – Lyma Laser
The Lyma Laser positions itself as one of the most advanced consumer-grade infrared therapy devices, merging both aesthetic and performance recovery use cases. Marketed as the first FDA-cleared at-home laser of its kind, it is designed to penetrate deep into tissue to promote cellular regeneration, collagen production, and pain relief. In the elite sports context, it has been increasingly adopted for orthopedic recovery, particularly for muscle and tendon injuries, while also appealing to high-performance individuals who want both recovery and aesthetic benefits in one device. Its dual positioning between beauty and sports recovery has helped it reach a broader market compared to traditional PBM devices.

LightForce Therapy Lasers (by Enovis) – LightForce Lasers
LightForce Therapy Lasers, developed by Enovis, are U.S.-made, medical-grade photobiomodulation (PBM) devices widely used in professional sports and rehabilitation clinics. Known for their power and precision, these devices are capable of delivering high-intensity laser therapy to penetrate deeper into tissues, making them suitable for treating both acute injuries and chronic pain. Their adoption in elite teams across the NBA, NFL, and MLB is a testament to their effectiveness in supporting recovery and reducing downtime for athletes. The devices are typically operated by medical or performance staff in structured recovery sessions, making them a staple in clinical-grade rehab environments.

Thor Photomedicine – Thor Laser
Thor Photomedicine has established itself as a leader in professional-grade PBM therapy, with a long history of supplying devices to Olympic teams, the U.S. military, and clinical settings worldwide. Their lasers and LEDs are designed for deep tissue penetration, helping to treat musculoskeletal injuries, accelerate healing, and reduce pain. Thor has also invested heavily in clinical research, with over 1,000 published studies supporting the use of its technology, giving it credibility in both sports science and medicine. Its adoption in high-performance environments highlights its reliability and trustworthiness, especially in situations where evidence-based recovery tools are prioritized.

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Case Studies with Elite Teams

Shockwave Therapy (ESWT)

• Cleveland Indians & Brooklyn Nets: Physicians such as Dr. Martin O’Malley (team orthopedist) endorse SoftWave’s OrthoGold device for reliably reducing inflammation and improving range of motion. The tool is integrated across upper and lower extremity conditions with rapid recovery signals. ([turn0search0])

Laser Therapy (PBM/LLLT)

• San Diego Padres: In the early 2000s, the team used the "Photonic Stimulator" (infrared light therapy from CTI) for pain relief and blood flow activation during the 162-game season. The US Track & Field team also used it during the 2000 Olympics.

• Navy SEALs & NASA Astronauts: Although not team sports, high-performance recovery contexts show that elite users rely on red/NIR therapy for injury mitigation and recovery.

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Recommendations to teams

1) Match the modality to the question you’re asking.

• “Can we remodel a stubborn tendon without shutting the athlete down?” → Prioritize ESWT plus structured loading; schedule sessions 48–72 h from competition. Use consistent parameters (document energy flux density, impulses, frequency), and pair with VISA-A/VISA-P tracking. Source: Med FoM Sports Medicine)

• “Can we keep a heavy-minutes group feeling better through congestion?” → Deploy PBM 3–6×/wk pre- or post-training for analgesia/recovery; standardize device distance, wavelength(s), irradiance, and time per site. Track pain VAS, session RPE, and readiness. (Source: PubMedPMC)

2) Protocolize and socialize.

• Write one-page SOPs for each indication (e.g., PF, mid-portion AT). For ESWT, outline contraindications (coagulopathy, local malignancy, acute infection, pregnancy over treatment site), after-care, and scheduling rules. For PBM, publish dose tables (J/cm²) by site and skin tone, with photos of correct probe distance. (Contraindication/parameter standardization emphasis.) Source: ResearchGatePMC)

3) Measure adoption friction.

• If a tech adds >5 min per athlete or requires specialized staff at every session, expect low adherence in-season. Start PBM broadly (low friction), then introduce ESWT to carefully selected cases during quieter micro-cycles. (Source: PMCMed FoM Sports Medicine)

4) Integrate, don’t isolate.

• Neither modality replaces gold-standard rehab: progressive loading, kinetic-chain strength, plyometric re-intro, sleep, and nutrition. ESWT and PBM are adjuncts—your main driver of long-term tissue capacity remains training. (Source: Med FoM Sports Medicine)

5) Communicate timelines clearly.

• ESWT: set expectations that the signal grows over weeks; reassess every 2–3 sessions with pain/function tests and sport-specific KPIs (e.g., top-end sprint exposure tolerance).

• PBM: explain that effects are often symptomatic/recovery-oriented; use during dense travel or when pain threatens load adherence. (Source: PubMed)

Conclusion

In elite environments, ESWT is best positioned as a finite, remodeling-oriented intervention for recalcitrant tendinopathies—especially plantar fascia and Achilles—scheduled thoughtfully around competitions. PBM/LLLT shines as a low-friction, repeatable tool for pain modulation and recovery throughout the week, with supportive evidence in plantar fasciitis/lower-extremity tendinopathy and encouraging results for DOMS and exertional recovery. Most clubs benefit from owning both, deploying them deliberately: PBM to keep players available and comfortable in-season; ESWT to meaningfully shift tissue status when a window allows—always alongside high-quality rehab and load management.

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