Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


Spasticity classically manifests as an upper motor neuron lesion (i.e., of those neurons that connect the brain with the spinal cord). It is characterized by increased resistance of muscles to passive stretching (lengthening), caused by abnormal activity of the muscle spindles. The latter leads to excessive, velocity-dependent muscle contraction and, ultimately, hyperglycemia (i.e., exaggerated deep tendon reflexes).

Spasticity usually occurs as a result of abnormal development or damage of the brain and/or the spinal cord. Cerebral palsy (CP), acquired brain injury including stroke and spinal cord injury are the most common causes of spasticity. Cerebral palsy is characterized by a persistent disorder of posture or movement caused by a non-progressive disorder of the immature brain.

The prevalence of CP is approximately two cases per 1,000 live births, with little variation among Western nations, India and China. Low birthweight, intrauterine infections, multiple gestation and birth complications are among the most important risk factors for CP. Most children with CP suffer from spasticity as the main motor disorder, which is a major challenge for rehabilitation because spasticity can cause pain, prevent or hamper function and may disturb sleep. A particular problem in CP is spasticity of plantar flexor muscles, which can cause toe walking. The latter can result in major functional implications such as disturbances in balance and walking, and interfere with gross motor function development.

The ultimate goal of any therapy program for spasticity in CP must be to achieve the child’s maximum potential in motor skills. Botulinum neurotoxin (BoNT) is an effective and widely used pharmacological treatment for focal muscle overactivity. An alternative is focal, intramuscular injection of phenol and/or alcohol. However, these treatments are not without problems. BoNT is expensive and not available in many countries.

Furthermore, a significant risk of focal, intramuscular injection of alcohol and phenol is persisting pain. Besides this, all these procedures are invasive and, thus, not without risk when applied under difficult hygienic conditions. Orthopedic surgery is considered a last resort in managing spasticity in children with CP. It is not an option for managing spasticity per se but is used to help correct the secondary problems that occur with growth alongside spastic muscles and poor motion control (including joints contractures, muscle shortening and bony deformities).

Recently, extracorporeal shock wave therapy (ESWT) has become an alternative in the treatment of spasticity.


Wang et al., Medicine (Baltimore) 2016 May;95(19):e3649.

A prospective case-control study of radial extracorporeal shock wave therapy for spastic plantar flexor muscles in very young children with cerebral palsy


Vidal et al., NeuroRehabilitation 2011;29:413-419.

Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: a randomized, placebo-controlled clinical trial.



Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2.5 to 4 bar
Air pressure Power+ 2 to 4 bar
Impulses 2,000
Frequency 8Hz to 12Hz
Applicator 36mm
Skin pressure Moderate to heavy

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