1000 Section - The effect of radial extracorporeal shock wave therapy combined with botulinum toxin injection on gastrocnemius spasticity in stroke patients

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

AA

Ayşe Merve Ata, MD

MD, Associate Professor
Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital
Ankara, Ankara, Turkey

Co-Author/Coautor(s)

HB

Hüma Bölük Şenlikci, MD

MD, Associate Professor
Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital
Ankara, Ankara, Turkey
BT

Baran Tuncer, MD

MD
Yenimahalle Training and Research Hospital, Department of Physcial Medicine and Rehabilitation, Ankara, Turkey
Ankara, Ankara, Turkey
�U

Öznur Uzun, MD

MD
Ankara Bilkent City Hospital Physcial Therapy and Rehabilitation Hospital
Ankara, Ankara, Turkey
EY

Evren Yaşar, MD

Professor
Yozgat University
Yozgat, Yozgat, Turkey

Objectives :

Botilinum toxin injection (BoNT) is one of the most common treatment in focal spasticity. Extracorporeal Shock Wave Therapy (ESWT) is taking place in the treatment of focal spasticity. Radial ESWT (r-ESWT) has widespread effects in superficial tissues, and it gives a treatment option for gastrocnemius spasticity. The aim of this study was to evaluate the effects of r-ESWT alone and BoNT injection combined with r-ESWT in treating gastrocnemius spasticity in stroke patients.

Design: This prospective observational study included total of 20 patients divided into two groups. First group received r-ESWT and the second group received BoNT and r-ESWT therapy. Visual Analog Scale (VAS), Modified Ashworth Scale (MAS) and Functional Independence Measurement (FIM) were evaluated before and at the end of the r-ESWT sessions.

Results:

After treatment, MAS (p=0.011 and p=0.004, respectively), VAS (p=0.004 and p=0.005, respectively), and FIM scores were improved (both p=0.005) in both groups. The r-ESWT + BoNT group's positive impact on the MAS score was significantly greater than that of the r-ESWT alone group (p=0.035).

Table 1. Comparison of the outcome scores between two groups

	r-ESWT (n=10)	r-ESWT+ BoNT (n=10)	p
MAS (pre-treatment)	3 (3-4)	4 (3-4)	0.121
(post-treatment)	2 (2-3)	2 (1-3)	0.636
p	0.011	0.004
VAS (pre-treatment)	4 (3.8-6.3)	5.5 (5-6)	0.095
(post-treatment)	3 (2-3)	3 (2-3)	0.935
p	0.004	0.005
FIM (pre-treatment)	55.5 (40.3-71.5)	47.5 (35.8-51.5)	0.198
FIM (post-treatment)	58 (43.8-75.3)	53 (42.8-58)	0.449
p	0.005	0.005

Table 2. Comparison of the outcome changes between two groups

∆ change	r-ESWT (n=10)	r-ESWT+ BoNT (n=10)	p
MAS	1 (0-1)	1 (1-2)	0.035
VAS	2 (1-3)	3 (2-4)	0.057
FIM	4 (1.8-5.3)	4.5 (3-13.3)	0.284

Conclusion:

This pilot study showed that while treating post-stroke gastrocnemius spasticity, the use of r-ESWT alone and the addition of BoNT injection to r-ESWT had significant effects on spasticity, pain, and functional outcome.