Immobilization in a shortened position leads to muscle contracture, which is the cause of a specificity. 5 Trompetto et al 6 pointed out that in patients with UMN syndrome, weakness causes strongly decreased mobilization of the affected muscles. 4 However, there is still no agreement on the definition of spasticity, which is an indication of the complex nature and diversity of these phenomena. The most cited Lance definition of muscle spasticity describes it as ‘a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron (UMN) syndrome. 2 Studies have shown that 19% of the post-stroke subjects demonstrate spasticity within 3 months of their stroke, reaching to even 40–70% in chronic phase of stroke. 1 Global data estimated that over 12 million people suffer from muscle spasticity localized in the extremities.
Spasticity is a common phenomenon and the primary motor impairment after stroke, affecting patients’ motor recovery and challenging both researchers and clinicians. Three studies in fESWT and four in rESWT obtained Sackett’s grading system’s highest Level 1 of evidence. The mean PEDro score was 4.70☒.5 points for fESWT and 5.71☒.21 points for rESWT, thus an overall quality of evidence grade of moderate (“fair” for fESWT and “good” for rESWT). The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87☑0.45 years and duration of stroke: 40.49☒5.63 months) who were treated with ESWT.
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