This systematic review aimed to compare the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) versus Laser therapy (Low-Level Laser Therapy (LLLT) and High-Intensity Laser Therapy (HILT) in treating musculoskeletal disorders (MSKDs). Systematic searches of randomized clinical trials (RCTs) were performed in six databases from inception till February 2025. Two researchers independently screened titles, abstracts, and full-text articles. Eligible studies had to report at least one of the following outcomes: pain, functionality, strength, range of motion (ROM), and quality of life (Qol). Risk of bias was assessed using the revised Cochrane Collaboration tool (RoB 2.0). Meta-analysis was conducted using Review Manager software version 5.4.1, and quality of evidence was evaluated using the GRADE approach. Twenty-eight RCTs involving 1,460 patients were included. The findings indicated that neither LLLT nor HILT showed a significant difference from ESWT in pain, strength, ROM, or quality of life. However, ESWT demonstrated a marginal statistically significant functional advantage over LLLT, but not over HILT. The GRADE certainty rating was rated as very low to moderate. According to GRDAE certainty rating, ESWT and laser therapies (LLLT and/or HILT) had equivalent effect in improving pain, strength, ROM, and Qol in patients with MSKDs, while ESWT had some short-term effects in improving functions more than LLLT but not than HILT. Large RCTs with higher methodological quality are needed to draw more incisive conclusions.