{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:17:22Z","timestamp":1787847442103,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Spasticity is a frequent and disabling manifestation of multiple sclerosis (MS), characterized by increased muscle tone and stiffness that limit mobility and daily functioning. Effective management requires a multimodal therapeutic strategy. This randomized clinical trial evaluated the efficacy of adjunct extracorporeal shockwave therapy (ESWT) following botulinum toxin type A (BTX-A) injection in reducing calf muscle spasticity in MS patients.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n Twenty participants were randomly assigned to receive either BTX-A alone (n = 10) or BTX-A combined with ESWT (n = 10). Clinical outcomes, including range of motion (ROM), Modified Ashworth Scale, and pain assessed by visual analog scale (VAS), were measured at 10 days, 1 month, and 2 months post-treatment.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Dorsiflexion ROM showed no significant between-group difference (\n P<\/jats:italic>\n = 0.807), whereas plantar-flexion ROM significantly improved in the BTX-A + ESWT group compared with BTX-A alone (\n P<\/jats:italic>\n = 0.047). MAS scores declined significantly over time in both groups (\n P<\/jats:italic>\n < 0.001) without intergroup difference. Pain reduction, assessed by VAS, was greater in the ESWT group, showing significant between-group differences (\n P<\/jats:italic>\n = 0.02). Compared with BTX-A alone, adjunct ESWT produced greater VAS improvement at day 10 (mean difference \u2212 0.90, 95% CI \u2212 1.65 to \u2212 0.15) and 1 month (\u22121.10, 95% CI \u2212 1.76 to \u2212 0.44).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n ESWT as an adjunct to BTX-A enhances pain relief and improves plantar-flexion ROM in MS-related calf spasticity compared with BTX-A alone, supporting its role as a valuable component of multimodal spasticity management.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/abr.abr_671_24","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T11:00:12Z","timestamp":1780138812000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Analyzing the Effect of Extracorporeal Shockwave Therapy after Botulinum Toxin Injection on Calf Muscle Spasticity Improvement in Patients with Multiple Sclerosis \u2013 A Randomized Clinical Trial"],"prefix":"10.4103","volume":"15","author":[{"given":"Shila","family":"Haghighat","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Ghasri","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babak","family":"Vahdatpour","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahid","family":"Shaygannejad","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, Isfahan University 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