BackgroundExtracorporeal shock wave therapy (ESWT) has been widely used for pain control in musculoskeletal disorders. Whether ESWT can relieve chronic low back pain (CLBP) and improve lumbar function is still unclear. Therefore, we conducted a meta-analysis of relevant studies to comprehensively analyse and determine the efficacy and safety of ESWT for chronic low back pain.MethodsFour databases were systematically searched for randomized controlled trials (RCTs) on ESWT for CLBP. The quality of the included studies was evaluated according to Cochrane systematic review criteria, relevant data were extracted, and meta-analysis was performed using RevMan 5.4 software. The primary outcomes were pain intensity, disability status, and mental health. The data were expressed as standardized mean differences (SMD) or weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed using theI2statistic. IfI2≥ 50%, a random effects model was applied; otherwise, a fixed effects model was used.ResultsTwelve RCTs involving 632 patients were included in this meta-analysis. The ESWT group reported significantly more pain relief than the control group at 4 weeks (WMD =  − 1.04; 95% CI =  − 1.44 to − 0.65;P< 0.001) and 12 weeks (WMD =  − 0.85; 95% CI =  − 1.30 to − 0.41;P< 0.001). Regarding the dysfunction index, ESWT led to significant improvement in lumbar dysfunction compared with the control group at 4 weeks (WMD =  − 4.22; 95% CI =  − 7.55 to − 0.89;P< 0.001) and 12 weeks (WMD =  − 4.51; 95% CI =  − 8.58 to − 0.44;P= 0.03). For mental health, there was no significant difference between the ESWT group and the control group after 4 weeks of intervention (SMD = 1.17; 95% CI =  − 0.10 to 2.45;P= 0.07).ConclusionThis systematic review and meta-analysis found that ESWT provided better pain relief and improved lumbar dysfunction compared with the other interventions included, and no serious adverse effects were found. There was no significant effect of ESWT on the mental health of patients, but we hope to obtain more RCTs for further analysis in the future. Based on the pooled results, we suggest that ESWT is effective and safe for treating chronic low back pain.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-023-03943-x.