Shock Waves in Knee Arthritis

Inclusion Criteria: * persistent knee pain for at least 3 months, measured with a VAS scale of 4 or higher, * clinical and radiological diagnosis confirming knee osteoarthritis grade 2 and 3 based on the Kellgren-Lawrence system, * no history of physical therapy in the last 3 months, * no infections, tumors in the treatment area of the knee, * no pathology other than osteoarthritis that could cause knee pain, * no pathology of the lumbar spine or hip that could refer knee pain, * free from any condition that prevents participation in exercise or physical therapy willing to participate regularly in the treatment programs were included in the study. Exclusion Criteria: * inability to walk, * a history of clinically symptomatic spinal stenosis or lumbar radiculopathy, * evidence of a neurological disorder based on history or physical examination, * generalized pain or fibromyalgia, * secondary osteoarthritis (to metabolic or rheumatologic disease), * administration of intra-articular injections (anesthetic, hyaluronic acid, cortisone) of the knee in the last 6 months, * use of NSAIDs, paracetamol or topical agents in the previous week, * a previous history of surgery involving the knee joint, * contraindications to physical therapy (PM, epilepsy, neoplasia, coagulopathy, pregnancy).