Radial Extracorporeal Shock Wave Therapy for Triceps Surae Spasticity in People With Multiple Sclerosis: A Pilot Study

BACKGROUND: Spasticity represents a major symptom of people with multiple sclerosis (MS), frequently causing disability, pain, and abnormal postures. The aim of this study is the evaluation of safety and efficacy of radial extracorporeal shock wave therapy (RESWT) for triceps surae muscle spastic hypertonia in people with MS. METHODS: Two centers recruited people 18 years or older with MS and triceps surae muscle hypertonia. People were excluded if they had other neurological conditions; had used anticoagulants; had intrathecal baclofen, botulinum toxin, and/or physiotherapy within the past 8 months; or had oral antispasmodics therapy modification in the past 4 weeks. The participants underwent triceps surae RESWT once a week for 4 weeks. Participants were scored on the Modified Ashworth Scale (MAS), the Numerical Rating Scale for spasticity (NRS-Sp), the Medical Research Council (MRC) scale, the Timed Up and Go (TUG) test, and the Timed 25-Foot Walk (T25-FW) test before RESWT (To) and immediately after RESWT (T1). Self-perceived effect was evaluated via the Global Perceived Effect (GPE) at T1. RESULTS: Twenty-six people with MS were included (10 women and 16 men; mean age ± SD, 52.46 ± 8.39 years; mean Expanded Disability Status Scale score ± SD, 5.44 ± 1.34; mean disease duration ± SD, 14.88 ± 10.83 years), and 36 triceps surae were treated. MAS and NRS-Sp scores decreased at T1, whereas TUG, T25-FW, and MRC scores were comparable over time. Via the GPE, 73% of participants reported a self-perceived positive effect of RESWT on spasticity. CONCLUSIONS: RESWT may be efficacious and safe for treating spasticity in people with MS and does not adversely affect gait, strength, or dynamic balance. Further long-term studies are needed to evaluate the possibility of using RESWT as a treatment for spasticity in people with MS.