A systematic review with procedural assessments and meta-analysis of low-level laser therapy in lateral elbow tendinopathy (tennis elbow)
Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI.
Institute of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College, Moellendalsvn, 6, 5009 Bergen, Norway. jmb@hib.no
BMC Musculoskelet Disord. 2008 May 29;9:75. [PMID: 18510742]
Background: Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.
Methods: Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.
Results: 18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger’s graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.
Conclusion: LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.
Effect of low-level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneus tendon.
Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia EB, Ferreira LM.
Department of Plastic Surgery, São Paulo Federal University-UNIFESP, São Paulo, SP 04024-900, Brazil.
Lasers Surg Med. 2009 Apr;41(4):271-6. [PMID: 19347936]
Background and objective: Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion.
Study design/materials and methods: Experimentally controlled randomized single blind study. Sixty male rats were used randomly and were assigned to five groups containing 12 animals each one; 42 out of 60 underwent lesion caused by dropping a 186 g weight over their Achilles tendon from a 20 cm height. In Group 1 (standard control), animals did not suffer the lesion nor underwent laser therapy; in Group 2 (control), animals suffered the lesion but did not undergo laser therapy; in Groups 3, 4, and 5, animals suffered lesion and underwent laser therapy for 3, 5, and 7 days, respectively. Animals which suffered lesion were sacrificed on the 8th day after the lesion and assessed by polarization microscopy to analyze the degree of collagen fibers organization.
Results: Both experimental and standard control Groups presented significant values when compared with the control Groups, and there was no significant difference when Groups 1 and 4 were compared; the same occurred between Groups 3 and 5.
Conclusion: Low intensity laser therapy was effective in the improvement of collagen fibers organization of the calcaneous tendon after undergoing a partial lesion.
Effect of Low-Level Lasers in de Quervains Tenosynovitis
Renu Sharma, Anjeli Thukral, Sudhir Kumar, S K Bhargava
Physiotherapy December 2002/vol 88/no 12
Abstract: Low level laser is one of the relatively new therapeutic modalities being used in physical medicine. However, its efficacy as a therapeutic tool is controversial. The purpose of this study was to observe the effect of low level laser therapy using ultrasonography for assessment in de Quervains tenosynovitis. A double-blind placebo-controlled trial was conducted on 30 limbs (28 patients) with de Quervains tenosynovitis. Fifteen limbs received the placebo treatment and 15 received a maximum of ten laser applications. The area to be treated was divided into a grid of approximately 1 cm squares, and a dosage of 2–4 joules/cm2 with continuous output of 100% was given. The placebo group followed the same protocol but with the laser switched off. Pre- and post-treatment grip strength, pinch strength, ultrasonographic measurement of antero-posterior and medio-lateral diameters of the abductor pollicis longus and extensor pollicis brevis within the sheath in transverse section were measured. The placebo group showed no improvement. A significant increase in grip (p < 0.001) and pinch strength (p = 0.0241 and significant decrease in antero-posterior (p = 0.011) and medio-lateral (p < 0.001) diameters of tendon sheaths occurred in the laser therapy group. Laser therapy may prove to be a useful modality in the treatment of de Quervains tenosynovitis.
Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy.
Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM.
Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway.
Am J Sports Med. 2008 May;36(5):881-7. Epub 2008 Feb 13. [PMID: 18272794]
Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.
Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.
Study design: Randomized controlled trial; Level of evidence, 1.
Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session.
Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.
Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.
The efficacy of low-level laser therapy in supraspinatus tendinitis
Liz Saunders
Physiotherapy Department, Derby City General Hospital, Derby
Abstract: Twenty-four subjects were randomly assigned to two groups to assess the effectiveness of low-power laser therapy for supraspinatus tendinitis. A low- power laser using a 820 nm, 40 mW probe operating at 5000 Hz to produce a dose of 30 J/cm2 was used to treat one group (L); the other group was treated with a similar, but dummy, laser (DL). The design of the trial was double-blind; patients, therapists and assessors being ignorant of the form of treatment used. The two groups each received a course of nine treatments and identical advice and educational material. Perceived pain was assessed and tenderness and secondary muscle weakness measured before and after the course of treatment.
The data revealed that the L group had less pain (p < 0.05), less secondary weakness (p < 0.01) and tenderness (p < 0.05) after the treatment than before. No such changes occurred in the DL group; indeed, secondary weakness and tenderness increased slightly in the latter group after treatment.
The degree of pain, tenderness and weakness of the two groups was similar before treatment. Comparing the two groups after treatment, L had less pain (p < 0.05) and less weakness (p < 0.001) than DL.
These data suggest that, in this small group of patients, laser therapy, advice and education improved certain symptoms of supraspinatus tendinitis, while the same advice and education but treatment with a dummy laser had no such beneficial consequences. Based on the results, low-power laser therapy with the parameters and dosage used in this study is recommended as a useful treatment for tendinitis, but the trial was limited by small numbers.