Effect of shock wave therapy combined with resisted exercise on shoulder pain

Purpose. Shoulder dysfunction is a common musculoskeletal complaint that impacts pain, function, and mobility. While Shock Wave Therapy (SWT) and resisted exercises are both established interventions, their combined effect has not been widely studied. This study aimed to evaluate the effectiveness of combined SWT and resisted exercise versus SWT alone and exercise alone in improving pain, functional disability, muscle strength, and shoulder range of motion (ROM) in individuals with mechanical shoulder pain. Objective: to compare the effectiveness of Shock Wave Therapy, Resisted Exercise, and their combination in reducing shoulder pain and improving functional outcomes, muscle strength, and range of motion in individuals with musculoskeletal shoulder disorders Material & Methods. A total of 90 participants were randomly assigned into three groups: Group A (SWT + Resisted Exercise), Group B (SWT only), and Group C (Exercise only). The intervention period lasted four weeks. Pain was assessed using the Numeric Pain Rating Scale (NPRS), functional disability with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, muscle strength using a hand-held dynamometer, and ROM using a universal goniometer. Data were analyzed using ANOVA and Tukey’s post-hoc test. Results. Group A showed significantly greater improvements in all outcome measures. Pain reduction in Group A was highest (mean difference: 2.95±0.39), with statistically significant differences compared to Group B and C (p<0.001). DASH scores improved most in Group A (mean difference: 24.51±4.83), followed by Group C and B. Muscle strength and ROM also showed superior gains in the combined therapy group. Post-hoc comparisons supported these findings, particularly for flexion, abduction, and internal rotation ROMs. Conclusions. The combination of SWT and resisted exercise is more effective than either modality alone in reducing pain and disability, while enhancing strength and ROM in patients with mechanical shoulder pain. This supports a multimodal treatment approach for optimal rehabilitation outcomes.