Biological and cellular responses to mechanical impact forces have long been acknowledged and investigated by scientists and clinicians. These effects are in addition to the direct mechanical impact such forces can exert on soft or hard tissues such as in breaking calcifications or kidney stones. Musculoskeletal Extracorporeal shock wave therapy (ESWT) is a modality delivering controlled and targeted pulses of sound-based mechanical force at the skin interface. This non-invasive modality can be directed at specific affected tissues such as tendons, muscles, fascia and bones, triggering a cellular response that initiates their regeneration and healing. The procedure has been widely investigated in both healing and pain management for various tendinopathies and bony pathologies. In this chapter we will have an overview of the scientific basis for ESWT as well as its applications in management and the quicker recovery of various musculoskeletal injuries and conditions.