Effect of Additional Extracorporeal Shockwave Therapy on Knee Functional Score: A Study in Patients with Knee Osteoarthritis Receiving Quadriceps Set Exercises
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Published:
Jul 24, 2026
Keywords:
Extracorporeal Shockwave Therapy, Osteoarthritis, Quadriceps Set Exercises
Main Article Content
Abstract
Background: Osteoarthritis (OA) is the most common degenerative joint disease worldwide and a major cause of disability. Extracorporeal shockwave therapy (ESWT) is a novel treatment that promotes regeneration in musculoskeletal diseases. ESWT can trigger subchondral bone changes, inhibit cartilage degeneration, stimulate neovascularization, increase chondrocyte proliferation, and enhance angiogenesis, leading to improved knee function.
Objective: The goal of this study was to investigate the effect of adding ESWT on knee functional scores in patients with knee OA who perform quadriceps exercise sets.
Method: We performed a randomized controlled trial with total 28 individuals divided equally into the control (CG) and intervention groups (IG). Both groups received quadriceps exercise sets on daily basis for 4 weeks; the treatment group also received ESWT once a week for 4 weeks. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess knee function both before and after the 4 weeks treatment program.
Results: There was a significant increase in WOMAC score in both the intervention group (p = 0.001) and the control group (p = 0.001). There was a significant difference WOMAC post treatment with p 0.019 and the p value for WOMAC comparation between group was 0.377 so it could be concluded that there was no significant difference.
Conclusion: Both groups showed significant results, with IG demonstrating a greater improvement than CG. However, no significant difference was found between the groups. In conclusion, ESWT benefits patients with OA.
Keywords: Extracorporeal Shockwave Therapy, Osteoarthritis, Quadriceps Set Exercises.
Objective: The goal of this study was to investigate the effect of adding ESWT on knee functional scores in patients with knee OA who perform quadriceps exercise sets.
Method: We performed a randomized controlled trial with total 28 individuals divided equally into the control (CG) and intervention groups (IG). Both groups received quadriceps exercise sets on daily basis for 4 weeks; the treatment group also received ESWT once a week for 4 weeks. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess knee function both before and after the 4 weeks treatment program.
Results: There was a significant increase in WOMAC score in both the intervention group (p = 0.001) and the control group (p = 0.001). There was a significant difference WOMAC post treatment with p 0.019 and the p value for WOMAC comparation between group was 0.377 so it could be concluded that there was no significant difference.
Conclusion: Both groups showed significant results, with IG demonstrating a greater improvement than CG. However, no significant difference was found between the groups. In conclusion, ESWT benefits patients with OA.
Keywords: Extracorporeal Shockwave Therapy, Osteoarthritis, Quadriceps Set Exercises.
Article Details
How to Cite
Lasiga, M. N., & Handoyo, R. (2026). Effect of Additional Extracorporeal Shockwave Therapy on Knee Functional Score: A Study in Patients with Knee Osteoarthritis Receiving Quadriceps Set Exercises. Indonesian Journal of Physical Medicine and Rehabilitation, 15(1), 18 - 24. https://doi.org/10.36803/indojpmr.v15i1.476
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Original Article
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References
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11. Karsten S, Limena S, Phandu M. Translation, adaptation, and validation of western ontario and mcmaster universities osteoarthritis index (womac) for indonesian. The Journal of Indonesian Orthopaedic & Traumatology. 2019 Dec 20;2(3):17–26.
12. Ko NY, Chang CN, Cheng CH, Yu HK, Hu GC. Comparative effectiveness of focused extracorporeal versus radial extracorporeal shockwave therapy for knee osteoarthritis—randomized controlled study. Int J Environ Res Public Health. 2022 Aug 1;19(15).
13. Israwan W. Effect of static and dynamic quadriceps exercise program on pain reduction in knee osteoartrose patients in dempo surgery. Journal for Quality in Public Health [Internet]. 2022;6(1):202–9.
14. Randita ABT, Wardhani IL, Andriati A, Wardani NK, Philothra PT, Subadi I, et al. Extracorporeal shock wave therapy as regenerative medicine in knee osteoarthritis: pre-experiment for matrix metalloproteinase-3 evaluation. Curr Rheumatol Rev. 2023 Sep 26;20(2):176–81.
15. Li W, Pan Y, Yang Q, Guo ZG, Yue Q, Meng QG. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: a retrospective study. Medicine 2018;97(27):e11418.
16. Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. Journal of physical therapy science 2014;26(5):745-8.
17. Rusfid FM, Uthradevi R, Usman A, James TT. The effect of multi-angle isometric quadriceps exercise on pain and dynamic balance after total knee arthroplasty– a randomised controlled trial. Asian Journal of Orthopaedic Research 2023;6(2):151-6.
18. Kisner C, Colby LA. resistance exercise for impaired muscle performance. in: kisner c, colby la, editors. therapeutic exercise: foundations and technique. 6th ed. Philadelphia: E.A. David Company; 2012. p. 179-99.
19. Choi IJ, Jeon JH, Choi WH, Yang HE. Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: a pilot study. Medicine. 2023 Nov 17;102:e36117.
20. Naggar ME, Ghuiba K, Tabie AE, Abdelsalam MS, editors. Extracorporeal shock wave therapy and low level laser therapy in treatment of knee osteoarthritis: a comparative study. The 21th International Scientific Conference Faculty of Physical Therapy; 2022; Cairo.
2. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis and Rheumatology. 2020 Feb 1;72(2):220–33.
3. WHO. Osteoarthritis. WHO. 2023.
4. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet [Internet]. 2020 Oct;396(10258):1204–22.
5. Rosemann T, Laux G, Kuehlein T. Osteoarthritis and functional disability: results of a cross sectional study among primary care patients in germany. BMC Musculoskelet Disord. 2007;8.
6. Divisi Reumatologi Departemen Ilmu Penyakit Dalam FKUI/RSCM. Rekomendasi IRA untuk diagnosis dan penatalaksanaan osteoartritis. 2014.
7. Holla JFM, Steultjens MPM, van der Leeden M, Roorda LD, Bierma-Zeinstra SMA, den Broeder AA, et al. Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the check cohort. Osteoarthritis Cartilage. 2011 Apr;19(4):411–9.
8. Zhou G, Zhao M, Wang X, Geng X, Tian H. Demographic and radiographic factors for knee symptoms and range of motion in patients with knee osteoarthritis: a cross-sectional study in beijing, china. BMC Musculoskelet Disord. 2023 Dec 1;24(1).
9. Al-Mahmood MR, Uddin MT, Islam MT, Fuad SM, Rahman Shah T. Correlation between goniometric measurements of range of motion and radiographic scores in osteoarthritis knee: an observational study among females. Medicine (United States). 2022 Aug 12;101(32):E29995.
10. Seifeldein GS, Haseib A, Hassan HA, Ahmed G. Correlation of knee ultrasonography and western ontario and mcmaster university (womac) osteoarthritis index in primary knee osteoarthritis. Egyptian Journal of Radiology and Nuclear Medicine. 2019 Dec 1;50(1).
11. Karsten S, Limena S, Phandu M. Translation, adaptation, and validation of western ontario and mcmaster universities osteoarthritis index (womac) for indonesian. The Journal of Indonesian Orthopaedic & Traumatology. 2019 Dec 20;2(3):17–26.
12. Ko NY, Chang CN, Cheng CH, Yu HK, Hu GC. Comparative effectiveness of focused extracorporeal versus radial extracorporeal shockwave therapy for knee osteoarthritis—randomized controlled study. Int J Environ Res Public Health. 2022 Aug 1;19(15).
13. Israwan W. Effect of static and dynamic quadriceps exercise program on pain reduction in knee osteoartrose patients in dempo surgery. Journal for Quality in Public Health [Internet]. 2022;6(1):202–9.
14. Randita ABT, Wardhani IL, Andriati A, Wardani NK, Philothra PT, Subadi I, et al. Extracorporeal shock wave therapy as regenerative medicine in knee osteoarthritis: pre-experiment for matrix metalloproteinase-3 evaluation. Curr Rheumatol Rev. 2023 Sep 26;20(2):176–81.
15. Li W, Pan Y, Yang Q, Guo ZG, Yue Q, Meng QG. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: a retrospective study. Medicine 2018;97(27):e11418.
16. Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. Journal of physical therapy science 2014;26(5):745-8.
17. Rusfid FM, Uthradevi R, Usman A, James TT. The effect of multi-angle isometric quadriceps exercise on pain and dynamic balance after total knee arthroplasty– a randomised controlled trial. Asian Journal of Orthopaedic Research 2023;6(2):151-6.
18. Kisner C, Colby LA. resistance exercise for impaired muscle performance. in: kisner c, colby la, editors. therapeutic exercise: foundations and technique. 6th ed. Philadelphia: E.A. David Company; 2012. p. 179-99.
19. Choi IJ, Jeon JH, Choi WH, Yang HE. Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: a pilot study. Medicine. 2023 Nov 17;102:e36117.
20. Naggar ME, Ghuiba K, Tabie AE, Abdelsalam MS, editors. Extracorporeal shock wave therapy and low level laser therapy in treatment of knee osteoarthritis: a comparative study. The 21th International Scientific Conference Faculty of Physical Therapy; 2022; Cairo.