120 patients with bilateral moderate knee osteoarthritis and popliteal cyamella were randomized to one of four groups to determine the efficacy of shock wave therapy in comparison to common conservative treatments. Patients in groups (I-III) received physical therapy (PT) isokinetic muscular strengthening exercises either alone (Group I), with pulse ultrasound treatment (Group II), or with shock wave therapy (Group III). A final group was used as a control (Group IV) .The evidence presented in this trial demonstrated that all patients who underwent PT demonstrated significantly reduced pain and disability, and increased muscle peak torques after treatment and at 6 months. Patients who, in addition to exercise, received ultrasound (Group II) and those that received shock wave therapy (Group III) exhibited significant improvements in range of motion . Only patients in the shock wave therapy group (Group III) reported immediate improvement in ROM after each treatment, and experienced the greatest increase in muscular strength, alongside the greatest decrease in disability.