The present study has examined the effectiveness of extracorporeal shock wave therapy along with conventional physical therapy on functional ability in grade IV knee osteoarthritis. Intervention program was performed for four weeks. Conventional physical therapy included ultrasound therapy, isometric quadriceps, straight leg raising (SLR) and isometric hip adductor strengthening exercises. Functional ability was assessed using the Lower Extremity Functional Scale (LEFS) score.

Inclusion Criteria:

• Grade IV primary knee Osteoarthritis (OA) diagnosed by an orthopaedic surgeon based on the Kellgren-Lawrence score

Exclusion Criteria:

• Secondary knee OA,
• rheumatoid arthritis,
• psoriatic arthritis,
• the presence of any red flags (metastatic growth, thrombophlebitis),
• neurologic or psychiatric impairments,
• tissue injuries of the knee joint,
• previous knee joint replacement or other surgeries in the knee joint,
• already received ESWT,
• Intra articular injection
• unable to walk independently