Abstract Background: Hypertrophic scars are severe problems after thermal injuries. Scar contractures develop and extend to the underlying connective tissue and then muscles, leading to a reduction in joint range of motion and affecting day-to-day activities. Aim of Study: This study was conducted to determine the effect of extracorporeal shock wave therapy versus silicone gel sheet on post-burn hypertrophic scars. Patients and Methods: Thirty patients (males and females) were suffering from scar contractures which cause functional limitations or immature hypertrophic scars in different areas of the body as a result of burn injuries, their ages ranged between 20 to 45 years, they were randomly distributed into two equal groups. Group A received Extracorporeal shock wave therapy (ESWT) and a traditional physical therapy program 2 sessions/week for 2 months. Group B received a Silicone gel sheet, worn for 20-24 hours/day (The sheets were cleansed daily and reused for 4 to 8 weeks)and a traditional physical therapy program 2 sessions/week for 2 months. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out using Patient and Observer Scar Assessment Scale (PO-SAS) and was completed before and after treatment. Results: Comparison between post treatment and pre treatment in both groups showed a significant decreasein all items of P-SAS and O-SAS post-treatment compared with that pre-treatment in group A and B (p<0.001). There was a significant decrease in all items of P-SAS and O-SAS of group A compared with that of group B post-treatment (p<0.001). Conclusion: Extracorporeal shock wave therapy (ESWT) is an effective, easy to apply, noninvasive treatment modality and had more significant effect on post burn hypertrophic scars than silicone gel sheet (SGS).