Materials and Methods: In this randomized controlled clinical trial, a total of 75 adult patients (70 females and 5 males) with moderate KOA were randomly assigned to ESWT with exercise, PT with exercise, and exercise-only groups. Finally, patients were evaluated using the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion (ROM), Timed Up and Go (TUG) test, and high sensitivity C-reactive protein.

Results: In either treatment group, VAS, WOMAC, and TUG significantly improved toward 3 weeks and this improvement sustained until the 7-week follow-up session. In addition, patients" knee ROM significantly improved in the ESWT group throughout the course of the study. Based on the results, no significant difference was observed between the ESWT and PT after 3 weeks and both were superior to exercise alone. In the 7-week evaluation, patients in the ESWT group reported lower pain (50.42% improvement in VAS compared to 30.31%; P < 0.001 and 28.26%; P = 0.008 in PT and exercise groups, respectively) and better improvement in knee extension ROM (P = 0.004 and <0.001, respectively).

Conclusions: In general, although PT and ESWT seem to be more effective than exercise alone in the short-term treatment of patients suffering from KOA, medium intensity ESWT is better than PT and exercise in the medium-term rehabilitation of these patients resulting in better pain-relieving and knee ROM improvements.