Extracorporeal shockwave therapy, or ESWT, is a noninvasive treatment that utilizes sound waves to reduce pain and promote tissue healing, although its exact therapeutic mechanism remains unclear. Physical therapists and physical therapist assistants should familiarize themselves with the evidence and scope of practice considerations related to ESWT. Clinicians interested in using ESWT should ensure they understand the responsibilities, regulations, and resources related to this treatment, as well as payment options.