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Analyzing the Effect of Extracorporeal Shockwave Therapy after Botulinum Toxin Injection on Calf Muscle Spasticity
Shila Haghighat1, Marjan Ghasri1, Babak Vahdatpour1
1Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Background:
Spasticity is a frequent and disabling manifestation of multiple sclerosis (MS), characterized by increased muscle tone and stiffness that limit mobility and daily functioning. Effective management requires a multimodal therapeutic strategy. This randomized clinical trial evaluated the efficacy of adjunct extracorporeal shockwave therapy (ESWT) following botulinum toxin type A (BTX-A) injection in reducing calf muscle spasticity in MS patients.
Materials And Methods:
Twenty participants were randomly assigned to receive either BTX-A alone (n = 10) or BTX-A combined with ESWT (n = 10). Clinical outcomes, including range of motion (ROM), Modified Ashworth Scale, and pain assessed by visual analog scale (VAS), were measured at 10 days, 1 month, and 2 months post-treatment.
Results:
Dorsiflexion ROM showed no significant between-group difference (P = 0.807), whereas plantar-flexion ROM significantly improved in the BTX-A + ESWT group compared with BTX-A alone (P = 0.047). MAS scores declined significantly over time in both groups (P < 0.001) without intergroup difference. Pain reduction, assessed by VAS, was greater in the ESWT group, showing significant between-group differences (P = 0.02). Compared with BTX-A alone, adjunct ESWT produced greater VAS improvement at day 10 (mean difference - 0.90, 95% CI - 1.65 to - 0.15) and 1 month (-1.10, 95% CI - 1.76 to - 0.44).
Conclusions:
ESWT as an adjunct to BTX-A enhances pain relief and improves plantar-flexion ROM in MS-related calf spasticity compared with BTX-A alone, supporting its role as a valuable component of multimodal spasticity management.
