Comparison of high-intensity laser therapy and extracorporeal shock wave therapy for the treatment of plantar flexor spasticity in post-stroke patients.

BACKGROUND: Post-stroke plantar flexor spasticity impairs gait and functional mobility. Noninvasive modalities such as radial extracorporeal shock wave therapy (rESWT) and high-intensity laser therapy (HILT) have been proposed as adjunctive treatments; however, comparative evidence is limited. OBJECTIVE: This study aimed to compare the effects of rESWT and HILT, applied to ankle plantar flexor muscles, on spasticity and functional gait parameters in stroke patients. METHODS: This prospective, randomized, controlled, parallel-group clinical trial included 42 stroke patients with ankle plantar flexor spasticity graded 1+ to 3 according to the Modified Ashworth Scale (MAS). Patients were randomly assigned to three groups: rehabilitation alone, rESWT plus rehabilitation, and HILT plus rehabilitation.All groups received a standardized rehabilitation program for 1 hour per day, 5 days per week, for 3 weeks. The rESWT group received three sessions of rESWT once weekly for three consecutive weeks (5 Hz, 0.340 mJ/mm2, 2000 pulses,15-mm applicator) applied to the gastrocnemius muscle. The HILT group received laser therapy in biostimulatory mode (5 W, 50 J/cm2) for 4 minutes per session, three times weekly for 3 weeks.Patients were evaluated using the MAS, passive ankle dorsiflexion range of motion (ROM), Fugl-Meyer Assessment for the Lower Extremity (FM-LE), Timed Up and Go (TUG) test, 10-Meter Walk Test (10-MWT), and Berg Balance Scale (BBS) at baseline, immediately after treatment (week 3), and at 3-month follow-up. RESULTS: MAS scores improved significantly at 3 weeks and 3 months in the rESWT (p = 0.001) and HILT groups (p = 0.028), but not in the rehabilitation group (p = 0.210). Ankle ROM improved only in the HILT group (p = 0.004). FM-LE, 10-MWT, and BBS improved significantly in all groups (p < 0.05). TUG improved in the rehabilitation and HILT groups (p < 0.001), with a smaller effect in the rESWT group (p = 0.02). No significant between-group differences were observed for any outcome. CONCLUSIONS: rESWT and HILT, when combined with rehabilitation, may reduce plantar flexor spasticity after stroke; however, neither intervention demonstrated superiority over rehabilitation alone in functional outcomes.