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.