Radial shockwave therapy for addressing spasticity

Spasticity is a component of the multifaceted motor disability of Cerebral Palsy (CP) and is present in around 80% of cases.⁽¹⁾Although it is not the main factor that interferes with the patients' function, participation or activity⁽²⁾, plays a significant role in limiting your ability to move and participate in activities of daily living by interfering with limb function, causing pain secondary to muscle spasms.^(3-5) and, in the long term, produce fixed contractures and secondary musculoskeletal deformities^(6-7). Addressing spasticity in CP is complex and presents a great challenge for the rehabilitation team.There is considerable variation in the availability of treatments (pharmacological, physiotherapeutic, orthopedic, surgical, etc.) and the intensity of their use.^(8-9)The goals of the therapeutic approach to spasticity include: reducing pain and muscle spasms, facilitating the use of orthopedic aids, improving posture, minimizing contractures and deformity, facilitating mobility and dexterity. with the ultimate goal of maximizing the patient's potential and promoting their independence and quality of life⁽¹⁰⁾.

Extracorporeal shock wave therapy (ESWT) has proven to be valuable in the treatment of a variety of musculoskeletal and neurological conditions. Several studies have demonstrated the benefits of ESWT in addressing spasticity in patients with cerebral palsy, multiple sclerosis, traumatic brain injury, and stroke. ^(11-14), has been established in recent years as an effective, non-invasive alternative with few side effects (small bruises or discomfort during application) for the management of spasticity.

There are two types of extracorporeal shock waves; radial shock waves (rESW) and focal shock waves (fESW). Radial shock waves are ballistic waves generated by the injection of compressed air into an applicator that fires a projectile into it, and impacts the application head. The wave propagates superficially in a radial direction from the applicator where the maximum pressure is⁽¹⁵⁾. The biological effects of shock waves found so far are three: tissue regeneration, angiogenesis and analgesia.^(16-19). Despite the clinical effectiveness rate of shock waves, the biological mechanism of action has not been fully established; it is believed that the tissue regeneration and angiogenesis produced by shock waves is due to the phenomenon of mechanotransduction, which is the mechanism by which a mechanical stimulus produces a biological response from the stimulated tissues. Mechanical signals modulate almost all aspects of cellular function, including growth, differentiation, migration, gene expression, protein synthesis, and even apoptosis.^(20-21).

Current literature agrees that treatment with rESWT is effective in addressing spasticity in people with cerebral palsy; this effect has been studied mainly in the Triceps Suralis or plantar flexor muscle. It has been shown that the effect of shock waves lasts up to 12 weeks after treatment., with positive results in the modulation of spasticity assessed with the Modified Ashworth Scale (MAS) and the Tardieu Scale, in passive range of motion (pROM) values, in global motor function scores (GMFM), in gait parameters, and in the reduction of pain secondary to spasticity, among others.^(22-27).

At the Aspace Catalonia Foundation we are committed to continuing research and continuing the two studies already carried out at the Foundation^(22-26), on the benefits of radial shockwave therapy in addressing spasticity in patients with cerebral palsy, a young but promising therapy, which is obtaining very positive evaluations from our patients.

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