Shockwave Therapy or Acupoint Stimulation Combined With Physiotherapy for Spasticity and Motor Function in Post-Stroke Recovery: A Randomized Controlled Trial.

The short version

This multicenter randomized controlled trial with 120 stroke survivors explored whether adding one of two non-drug therapies to standard physiotherapy could better ease post-stroke spasticity-the abnormal muscle tightness and stiff reflexes that affect roughly a quarter to a third of people after a stroke. The two add-ons were extracorporeal shockwave therapy (ESWT), which delivers mechanical pressure-wave pulses through the skin into stiff muscle tissue, and acupoint-based TENS (Acu-TENS), a mild electrical current applied over traditional acupuncture points rather than through needles. Both are theorized to calm overactive stretch reflexes and support the nervous system's own capacity for recovery (neuroplasticity, the brain and nerves' ability to reorganize and adapt). Participants, aged 40 to 70 with spasticity in one arm and leg after an ischemic stroke, were randomly assigned to 18 supervised sessions over six weeks: shockwave therapy plus physiotherapy, Acu-TENS plus physiotherapy, or physiotherapy alone. The shockwave group received pulses at set energy levels over affected muscle bellies; the Acu-TENS group received electrical stimulation over four standardized acupuncture points on the weak side. Physiotherapy itself included stretching, range-of-motion work, strength training, balance, and gait practice. Blinded assessors measured spasticity, arm and leg movement, walking speed, and quality of life at 6 and 18 weeks. Everyone improved on physiotherapy alone, but the shockwave group saw the biggest gains. Upper-limb spasticity scores dropped significantly more with shockwave therapy than physiotherapy-only (mean difference -0.73, close to a full point less muscle tightness on the 5-point Ashworth scale), and Acu-TENS also beat physiotherapy-only (-0.40). Arm movement scores (Fugl-Meyer Assessment) rose 6 to 8 points more with shockwave therapy than physiotherapy alone-a difference generally considered clinically noticeable-and Acu-TENS added 3.5 to 4.3 points. Quality-of-life scores climbed roughly 12 points more with shockwave therapy than physiotherapy alone by 18 weeks, with Acu-TENS partway between the two. Walking speed improved in every group, though the therapies didn't clearly separate from each other on that measure. The differences between the two add-on therapies themselves were mostly small. Thirteen people had minor, short-lived side effects-mostly brief soreness or tiredness-and nobody had a serious complication. These results suggest shockwave therapy, and to a lesser extent Acu-TENS, may give stroke survivors an extra edge on top of standard physiotherapy for loosening spastic muscles and regaining movement. Physiotherapy remains the backbone of recovery regardless of which add-on, if any, is used. Limitations include a single-country sample, therapists and patients knowing their assigned treatment, no direct nerve or muscle imaging to confirm how the therapies work, and only 18 weeks of follow-up. Bigger, longer, multi-country trials are the next step before either add-on becomes routine stroke-rehab practice.

Key findings

• In a 120-person trial of stroke survivors with limb spasticity (abnormally tight, stiff muscles caused by nerve signal imbalance), adding extracorporeal shockwave therapy (ESWT, mechanical pressure-wave pulses delivered through the skin into stiff muscle tissue) to standard physiotherapy produced the biggest improvements in spasticity, arm and leg movement, walking speed, and quality of life.
• Acupoint-based TENS (Acu-TENS, mild electrical stimulation delivered over traditional acupuncture points rather than with needles) also improved outcomes compared with physiotherapy alone, though its benefits were generally smaller than those seen with shockwave therapy.
• All three groups, including those who received physiotherapy alone, improved significantly over the 18-week study, underscoring that structured physiotherapy is the foundation of stroke recovery and these are add-on options rather than replacements for it.
• Side effects were mild and temporary, such as brief muscle soreness, fatigue, or stiffness, in all three groups, and no serious adverse events occurred.
• Because this is a single trial from one country with follow-up limited to 18 weeks, more research is needed before shockwave therapy or Acu-TENS can be considered a definitive standard of care for post-stroke spasticity.

Common questions