Effects of extracorporeal shock wave therapy on motor function in patients with cerebral palsy: a systematic review and meta-analysis

This study aims to evaluate extracorporeal shockwave therapy (ESWT) on spasticity, balance, gait patterns, and motor function in individuals with cerebral palsy (CP).
PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov were systematically searched up to 11 April 2025. Meta-analyses were conducted using Review Manager. The primary outcomes were Modified Ashworth Scale (MAS) and gait speed.
Ten randomized controlled trials (RCTs) involving 341 individuals with CP were included. Comparison between the ESWT and control groups revealed significant improvements in MAS (standardized mean difference [SMD]: −0.84, 95% confidence intervals [CIs]: −1.23 to −0.46, p < 0.001), gait speed (MD: 0.12, 95% CI: 0.02–0.23, p = 0.02), cadence (MD: −3.01, 95% CI: −6.03 to 0, p = 0.05), stride length (MD: 0.22, 95% CI: 0.16–0.28, p < 0.001), Pediatric Balance Scale (MD: 2.3, 95% CI: 0.4–4.19, p = 0.02), and Gross Motor Function Measure-88 (MD: 9.72, 95% CI: 7.36–12.08, p < 0.001).
Combining ESWT with conventional physiotherapy, botulinum toxin type A (BTX-A) injection, or ankle-foot orthotics positively affects spasticity, gait, balance, and motor function. In addition, spasticity significantly decreases, particularly with focused ESWT or ESWT targeting the upper limbs.

Spasticity significantly limits function and quality of life in individuals with cerebral palsy (CP).
Extracorporeal shock wave therapy (ESWT) is a promising noninvasive intervention that may reduce spasticity and enhance motor function in individuals with CP.
ESWT may improve clinical outcomes beyond spasticity, including gait speed, balance, and gross motor performance.
Both focused and radial ESWT show therapeutic potential, but individualized treatment planning is needed due to differences in muscle volume, affected regions, and shockwave parameters.
ESWT can complement conventional rehabilitation methods and may serve as an adjunct to botulinum toxin or orthotic interventions for optimizing patient outcomes.

Spasticity significantly limits function and quality of life in individuals with cerebral palsy (CP).
Extracorporeal shock wave therapy (ESWT) is a promising noninvasive intervention that may reduce spasticity and enhance motor function in individuals with CP.
ESWT may improve clinical outcomes beyond spasticity, including gait speed, balance, and gross motor performance.
Both focused and radial ESWT show therapeutic potential, but individualized treatment planning is needed due to differences in muscle volume, affected regions, and shockwave parameters.
ESWT can complement conventional rehabilitation methods and may serve as an adjunct to botulinum toxin or orthotic interventions for optimizing patient outcomes.