Comparison of the effects of intensities and sessions of extracorporeal shock wave therapy on nerve regeneration in rats with experimentally induced sciatic nerve injury.

Extracorporeal shock wave therapy (ESWT) has emerged as a promising treatment for neurological disorders but optimal protocols regarding energy density and session frequency remain unclear. This study aimed to evaluate the effects of different ESWT energy levels and treatment sessions on peripheral nerve regeneration in rats with sciatic nerve injury. Fifty rats were randomized into five groups: four experimental groups received ESWT at low energy (0.098 mJ/mm2) or high energy (0.229 mJ/mm2), either once or three times, and one control group received no treatment. Assessments included protein expression analysis, histological examination, and functional recovery measured by sciatic functional index and compound muscle action potentials over 9 weeks. All ESWT-treated groups showed increased levels of regeneration-associated proteins and improved nerve structure compared to controls. The high-energy groups demonstrated more significant enhancements than low-energy groups, with the high-energy three-session group showing the greatest improvements in axonal growth, myelin thickness, and functional outcomes. These findings indicate that ESWT promotes peripheral nerve regeneration in a dose-dependent manner, with repeated high-energy sessions yielding superior recovery. Further research is necessary to optimize ESWT protocols for clinical applications and understand long-term effects on nerve repair.