Unlike a machine, SMT is done by hand in a sensitive, gentle and smooth motion. The feedback of the tissues’ reactions is constantly in contact with the therapist who will apply a little more or a little less force and movement every moment of the treatment period. A machine has not been able to replace a good pair of hands in the art of Spinal Mobilization Therapy.

Discs separate the movable vertebrae in the spinal column. Each of the twenty-three discs is made of fibrocartilaginous material that is held in place by concentric girdle-like bands that criss-cross diagonally. There are no direct blood vessels to supply oxygen and nutrients to maintain disc health. The less efficient process of osmosis nourishes them.

As the discs wear down in height, even the small amount of 1/23 of an inch of wear for each disc will collectively equal a one-inch height loss. With only 1/12 of an inch of wear, one would lose two inches of height. Spinal Mobilization Technique safely and comfortably relaxes tension and increases the spinal motion of the vertebra and discs. Spinal mobilization gently moves each vertebra and disc through its individual range of motion, something that cannot be accomplished though massage, general stretching or yoga techniques. The criss-cross girdle-like bands of the discs are also repeatedly stretched.

Some of the many benefits of spinal mobilization are; relief of muscular tension and congestion around the spine, enhancement of the process of osmosis that nourishes the discs, helpful stretching of the girdle bands, and increasing the range of motion of each vertebra/disc complex. All of which result in maintaining a healthier disc structure and minimizing the disc wear that will make a person shorter.

Hip joints and knee joints can be replaced as people age. There is no replacement for a person’s spine. However people can maximize their spinal health and integrity with Spinal Mobilization Therapy.

Anyone with any type of impairment of the spine who experiences pain, limitation or discomfort in his or her range of motion may be a candidate for Spinal Mobilization Techniques (SMT). People with spinal arthritic changes and disc thinning are significantly helped.

SMT is for people, who have sustained injuries resulting in spinal disc herniations, protruding disc bulges or fractured vertebra, all resulting in restricted connective tissue mobility.

Patients confined to a hospital or who require extensive bed rest that results in joint stiffness can greatly benefit from SMT to keep the spine mobile and insure a more comfortable and quicker full recovery.

People involved in sports or yoga that seek better performance or are recovering from sports injuries will also benefit from SMT.

SMT helps in conditioning and reconditioning of the spine to facilitate healing for preoperative or postoperative surgical procedures as well as pre-chiropractic vertebral joint mobility for easier adjustments and with longer lasting results.

People with spinal curvatures or postural problems that often cause stiffness, headaches, backaches and acute or chronic pain are ideally treated by Spinal Mobilizations Therapies.

People that desire to feel and function at an optimum are also benefited by SMT.

The largest segment of the U.S. “aging” population is the Baby-Boom Generation, which will continue to expand in numbers over the next two decades. They will live longer and be more affluent than any post-60-year-old generation in the past. Most importantly, they want to remain active and mobile and they resent physical limitations. After all, what good is living longer and having economic means to travel and participate in life if you are in pain of have difficulty moving about?

Spinal mobilization is one of many conservative treatments therapists use for low back pain. In this method, the therapist applies a low velocity, repetitive movement to the spine. It’s a passive treatment so the patient doesn’t usually participate in any way.

The theory behind spinal mobilization for back pain is that it can decrease joint stiffness and reposition joints that are slightly off center. Adhesions or fibrous tissue around the joints can keep the joint from moving. Mobilization can help free these up. Mobilization can also have a pain reducing effect.

correcting and maintaining the function of the spine so that the body’s musculoskeletal and neurological systems will perform optimally

Manipulations are not generally dangerous, but in people with osteoarthritis, the bony spurs may rarely cause serious complications if the twisting maneuver brings the spurs into contact with and damages the spinal cord or nerves

Spinal manipulation can be helpful for some people in the first month of low back symptoms. It is unlikely to help those with a disc prolapse and may be unsafe for people who have had:

• Previous back surgery
• Back injury from disease affecting the back

There are many types of headache. The most common type of headache that can be helped with physiotherapy is called cervicogenic headache. This means that the cause of the headache is tissue strain, damage or stress on the neck (cervical spine). The main causes of cervicogenic headache are trauma such as falls or motor vehicle accidents, poor sitting postures such as prolonged typing at a computer, stress, lack of sleep and other disease processes that affect joints such as arthritis.

The cause of cervicogenic headaches is often overlooked as the patient may not complain of any neck pain. The headache often does not respond as expected to the usual medications or painkiller prescribed for the relief of pain in headaches.

Physiotherapy can help manage headache in a number of ways.
1. Physiotherapist does an assessment of the spine. If the pain is reproduced or increased with specific movements, especially of the neck, then the problem is probably from the neck or spine.
2. Physiotherapist can also tell the difference between a cervicogenic headache and other types of headache, such as migraine and stress tension headache. These headaches sometimes overlap with the symptoms of cervicogenic headache and it is important to get the appropriate treatment for the particular headache you have.
3. Physiotherapist can provide relevant and effective treatment for the cervicogenic headache.

Recent physiotherapy research has shown that the most effective way to manage a cervicogenic headache is by combining exercises designed to improve posture and strengthen the muscles that support the spine, with mobilisation and manipulation to the joints of the neck. This treatment produces excellent short term and long term results, significantly reducing the number of headaches patients get, and how long patients feel the headache.

Your physiotherapist will also provide education about your work environment and other factors that might cause your headaches.

In our physiotherapy clinic- Physiolife, our physiotherapists also uses electromedical treatment- cranial electrical stimulation, which can be successful in treating tension-type headaches and migraines.

Click here to Read more about electromedical treatment

Reference
Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Emberson, J., et al. (2002). A randomised control trial of physiotherapy management of cervicogenic headache. Spine, 27, 1835-1843.

Spinal manipulation may be used effectively in  for the treatment neck and back pain by chiropractor, osteopathy and physiotherapists.

There are limited evidence on effectiveness long term treatment with spinal manipulations for whiplash with neck pain, although in short terms it helps to relieve pain, increase flexibility, ‘feel good’ temporarily. Also rarely, potential serious side effects may happen include: vertebrobasilar accidents (VBA), strokes, death, spinal disc herniation, rib fractures.

Edzard Ernst has written:

“…there is little evidence to demonstrate that spinal manipulation has any specific therapeutic effects. On the other hand, there is convincing evidence to show that it is associated with frequent, mild adverse effects as well as with serious complications of unknown incidence. Therefore, it seems debatable whether the benefits of spinal manipulation outweigh its risks. Specific risk factors for vascular accidents related to spinal manipulation have not been identified, which means that any patient may be at risk, particularly those below 45 years of age. Definitive, prospective studies that can overcome the limitations of previous investigations are now a matter of urgency. Until they are available, clinicians might tell their patients to adopt a cautious approach and avoid the type of spinal manipulation for which the risk seems greatest: forceful manipulation of the upper spine with a rotational element

News report on chiropractor spinal manipulation:

It is important to seek a professional physiotherapist to assess the need for a spinal manipulation, as there are many alternative treatment approaches that may be more effective.

To find out alternative pain treatments, please speak to our physiotherapists: 64388725

Reference:

Spinal manipulation: Its safety is uncertain. Edzard Ernst, CMAJ, January 8, 2002; 166 (1)

^ Martín Saborido C, García Lizana F, Alcázar Alcázar R, Sarría-Santamera A (May 2007). “[Effectiveness of spinal manipulation in treating whiplash injuries"] (in Spanish; Castilian). Aten Primaria 39 (5): 241–6. PMID 17493449.

http://en.wikipedia.org/wiki/Spinal_manipulation#cite_note-13

RESEARCH STUDIES

Effects of Low-Level Laser and Plyometric Exercises in the Treatment of Lateral Epicondylitis

Jun 2007, Vol. 25, No. 3 : 205 -213

Apostolos Stergioulas, P.T., Ph.D.

Faculty of Human Movement & Quality of Life, Peloponnese University, Sparta, Greece.

Objective: This study was undertaken to compare the effectiveness of a protocol of combination of laser with plyometric exercises and a protocol of placebo laser with the same program, in the treatment of tennis elbow. Background Data: The use of low-level laser has been recommended for the management of tennis elbow with contradictory results. Also, plyometric exercises was recommended for the treatment of the tendinopathy. Methods: Fifty patients who had tennis elbow participated in the study and were randomised into two groups. Group A (n = 25) was treated with a 904 Ga-As laser CW, frequency 50 Hz, intensity 40 mW and energy density 2.4 J/cm², plus plyometric exercises and group B (n = 25) that received placebo laser plus the same plyometric exercises. During eight weeks of treatment, the patients of the two groups received 12 sessions of laser or placebo, two sessions per week (weeks 1–4) and one session per week (weeks 5–8). Pain at rest, at palpation on the lateral epicondyle, during resisted wrist extension, middle finger test, and strength testing was evaluated using Visual Analogue Scales. Also it was evaluated the grip strength, the range of motion and weight test. Parameters were determined before the treatment, at the end of the eighth week course of treatment (week 8), and eight after the end of treatment.

Results: Relative to the group B, the group A had (1) a significant decrease of pain at rest at the end of 8 weeks of the treatment (p < 0.005) and at the end of following up period (p < 0.05), (2) a significant decrease in pain at palpation and pain on isometric testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (3) a significant decrease in pain during middle finger test at the end of 8 weeks of treatment (p < 0.01), and at the end of the follow-up period (p < 0.05), (4) a significant decrease of pain during grip strength testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (5) a significant increase in the wrist range of motion at 8 weeks follow-up (p < 0.01), (6) an increase in grip strength at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.01), and (7) a significant increase in weight-test at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.005).

Conclusion: The results suggested that the combination of laser with plyometric exercises was more effective treatment than placebo laser with the same plyometric exercises at the end of the treatment as well as at the follow-up. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.

Low power laser therapy of shoulder tendonitis.

England S; Farrell AJ; Coppock JS; Struthers G; Bacon PA

Scandinavian journal of rheumatology; VOL: 18 (6); p. 427-31 /1989/

Department of Rheumatology, Coventry & Warwickshire Hospital, UK.

30 patients with supraspinatus or bicipital tendonitis were randomly allocated to active infrared laser therapy at 904 nm three times weekly for 2 weeks, dummy laser or drug treatment for 2 weeks. Objectively maximum active extension, flexion and abduction of the shoulder, and subjectively pain stiffness movement and function were measured at 0 and 2 weeks.

Significant improvement of active over dummy laser was noted for all seven assessments. Active laser therapy produced significant improvement over drug therapy for all three objective measures and pain. Naproxen sodium significantly improved only movement and function compared to dummy laser.

These results demonstrate the effectiveness of laser therapy in tendonitis of the shoulder.

Low level laser therapy can be effective for Tendinitis: A Meta-analysis

J.M. Bjordal, C. Couppe University of Bergen, Dept. Physiotherapy Science, Bergen, Norway

Purpose: To investigate if low level laser therapy (LLLT) with previously defined optimal treatment parametres can be effective for tendinitis. Material : Randomized controlled trials with LLLT for tendinitis. Method : Literature search for trials published after 1980 using LLLT on Medline, Embase, Cochrane Library and handsearch of physiotherapy journals in English and Scandinavian languages. Only trials that compared laser exposure of the skin directly over the injured tendon with optimal treatment parametres with identical placebo treatment were included.
Results: The literature search identified 77 randomized controlled trials with LLLT, of which 18 included tendinitis. Three trials were excluded for lack of placebo control, of which one trial was comparative, another lacked patients with tendinitis in the treatment group, while the last unwittingly gave the placebo group active treatment. Four trials used too high power density or dose, and three trials did not expose the skin directly overlying the injured tendon. The remaining eight trials were included in a statistical pooling, where the mean effect of LLLT over placebo in tendinitis was calculated to 32% [25.0-39.0, 95% CI].

Conclusion: Low level laser therapy with optimal treatment procedure/parametres can be effective in the treatment of tendinitis.

Low level laser therapy for tendinopathy. Evidence of a dose-response pattern.
Physical Therapy Reviews. 2001; 6: 91-99.
Bjordal J M, Couppé C, Ljunggren E.

To investigate whether low-level laser therapy can reduce pain from tendinopathy, the authors performed a review of randomised placebo-controlled trials with laser therapy for tendinopathy. Validity assessment of each trial was done acc. to predefined criteria for location-specific dosage and irradiation of the skin directly overlying the affected tendon.

The literature search identified 78 randomised control trials of which 20 included tendinopathy. Seven trails were excluded for not meeting the validity criteria on treatment procedure and trial design. 12 of the remaining 13 trials investigated the effect of laser therapy for patients with subacute and chronic tendinopathy and provided a pooled mean effect of 21%.

If results from only the nine trials adhering to assumed optimal treatment parameters were included, the mean effect over placebo increased to 32%.

Laser therapy can reduce pain in subacute and chronic tendinopathy if a valid treatment procedure and location-specific dose is used.

THE BIOLOGICAL EFFECTS OF LASER THERAPY AND OTHER PHYSICAL MODALITIES ON CONNECTIVE TISSUE REPAIR PROCESSES

Chukuka S. Enwemeka, P.T., Ph.D., FACSM, G. Kesava Reddy, Ph.D.,
Department of Physical Therapy and Rehabilitation Sciences,
University of Kansas Medical Center,
Kansas City, KS 66160-7601, USA
Laser Therapy Vol. 12 Special Millennium Edition, 2000.

Connective tissue injuries, such as tendon rupture and ligamentous strains, are common. Unlike most soft tissues that require 7-10 days to heal, primary healing of tendons and other dense connective tissues take as much as 6 – 8 weeks during which they are inevitably protected in immobilization casts to avoid re-injury. Such long periods of immobilization impair functional rehabilitation and predispose a multitude of complications that could be minimized if healing is quickened and the duration of cast immobilization reduced.

In separate studies, we tested the hypothesis that early function, ultrasound, 632.8 nm He-Ne laser, and 904 nm Ga-As laser, when used singly or in combination, promote healing of experimentally severed and repaired rabbit Achilles tendons as evidenced by biochemical, biomechanical, and morphological indices of healing. Our results demonstrate that: (1) appropriate doses of each modality, i.e., early functional activities, ultrasound, He-Ne and Ga-As laser therapy augment collagen synthesis, modulate maturation of newly synthesized collagen, and overall, enhance the biomechanical characteristics of the repaired tendons. (2) Combinations of either of the two lasers with early function and either ultrasound or electrical stimulation further promote collagen synthesis when compared to functional activities alone. However, the biomechanical effects measured in tendons receiving the multi-therapy were similar, i.e., not better than the earlier single modality trials.

Although tissue repair processes in humans may differ from that of rabbits, these findings suggest that human cases of connective tissue injuries, e.g., Achilles tendon rupture, may benefit from appropriate doses of He-Ne laser, Ga-As laser, and other therapeutic modalities, when used singly or in combination. Our recent meta-analysis of the laser therapy literature further corroborate these findings.

BONE REPAIR

EFFECT OF LOW-LEVEL LASER ON CALVARIAL BONE DEFECT

M. KHADRA1, N. KASEM2, H.R. HAANÆS1, and S.P. LYNGSTADAAS1
1Oslo University, Norway, 2Karolinska Institute, Stockholm, Sweden

Objective: The purpose of the present study was to evaluate by animal means the effect of laser therapy with GaAlAs diode laser device on bone healing and growth in rat calvarial bone defects.

Methods: The study was performed as an animal trial of 4 weeks duration with blinded, placebocontrolled design. 20 rats had a standardised round osseous defect 2,7 mm in diameter made in each parietal bone (2 defects). The animals were then randomly divided into two equal groups. A GaAlAs diode laser (wavelength 830 nm, output power 75 mw and energy density 23 J/cm2) was used immediately after surgery and carried out daily for 7 consecutive days. The rats were thereafter sacrificed at day 14 and 28 after surgery. Levels of calcium, phosphorous and protein were determined in 20 bone defects, while the histological analyses were performed in the other 20 defects. Statistical analyses between the test and control were performed using Student’s t-test.

Results: The results indicate that calcium, phosphorous and protein contents were significantly higher in the laser-irradiated healing tissues than in the sham group on both time-points. The histological analyses showed that proliferation of fibroblasts, osteoid tissue and bone were more prominent in the irradiated group.

Conclusion: The findings suggest that Laser Therapy may promote metabolism and/or mineralisation in bone forming tissues during the healing of bone defects.

BONE REPAIR OF THE PERIAPICAL LESIONS TREATED OR NOT WITH LOW INTENSITY LASER

Laser Surg Med. Abstract Issue 2002. abstract 303.
Sousa G R, Ribeiro M S, Groth E B.

The effect of bone repair in periapical lesions has been studied by Sousa. 15 patients with atotal of 18 periapical lesions were divided into two groups. One group received endodontic treatment and/or periapical surgery. The patients in the other group were submitted to the same procedure and in addition the lesions were irradiated by GaAs laser, 11 mW, 9 J/cm2. This therapy was performed during 10 sessions with an interval of 72 hours. Bone regeneration was evaluated through X-ray examination. The results showed a significant difference between the laser and the control group in favour of the laser group.

THE INFLUENCE OF LOW LEVEL INFRA RED LASER THERAPY ON THE REGENERATION OF CARTILAGE TISSUE.

P.Lievens , Ph.van der Veen

This study concerns the influence of Laser treatment on the regeneration process of cartilage tissue. There is no need saying that the regeneration of cartilage tissue is a very big problem in rheumatic diseases for example. The lack of blood supply is one of the most important factors involved. Lots of previous publications give us proof of the regeneration capacities of Laser therapy (in wound healing, bone repair etc.)

In this study we have chosen to experiment on cartilage tissue of the ear of mice. We are aware of the fact that the elastic cartilage tissue of the ear is not totally comparable with the hyaline cartilage of articulations. For technical reasons however and because of the fact that the chondrocytes are comparable, we decided to use mice ears in our experiment. A 0,4 mm hole was drilled in both ears on 30 mice. The right ears remain untreated, while the left ears were treated daily with IR-Laser (904 nm) for 3 minutes. Macroscopical as well as histological evaluations were performed on the cartilage regeneration of both ears.

Our results show that after one day post-surgery no differences were found between the irradiated and the non-irradiated group. After the second day, only in the irradiated group there is a clear activation of the perichondrium. After four days, there is a significant ingrowth of the perichondrium into the drill hole in the experimental group and there is only an active perichondrium zone in our control group.

LOW-POWER DIODE LASER STIMULATION OF SURGICAL OSTEOCHONDRAL DEFECTS: RESULTS AFTER 24 WEEKS.

Artificial cells, blood substitutes, and immobilization biotechnology. 2001.29 (3): 235-44.
Guzzardella G A, Tigani D, Torricelli P, Fini M, Martini L, Morrone G, Giardino R.

The purpose of this study was to evaluate osteochondral lesions of the knee, treated intraoperatively with low-power laser stimulation, and assess results at 24 weeks. Surgery was performed under general anesthesia on six rabbits; a bilateral osteochondral lesion was created in the femoral medial condyles with a drill. All of the left lesions underwent immediate stimulation using the diode Ga-Al-As laser (780nm), whereas the right knees were left untreated as control group. After 24 weeks, the explants from the femoral condyles, either treated employing laser energy or left untreated, were examined histomorphometrically. Results obtained on the lased condyles showed good cell morphology and a regular aspect of the repaired osteocartilaginous tissue.

ASSESSMENT OF LASER BIOSTIMULATION ON CHONDRAL LESIONS: AN “IN VIVO”: EXPERIMENTAL STUDY.

Artificial cells, blood substitutes, amd immobilization biotechnology.
2000;28 (5): 441-449.
Guzzardella-G-A, Morrone-G, Torricelli-P et al.

The purpose of this study was to evaluate whether intraoperative laser biostimulation can enhance healing of cartilaginous lesions of the knee. Surgery was performed on eighteen rabbits: a bilateral chondral lesion of 1.25 +/- 0.2 mm in length and 0.8 +/- 0.2 mm in width was created in the femoral media l condyle with a scalpel. The lesion in the left knee of each animal was treated intraoperatively using the diode Ga-Al-As 780nm. laser (300 Joules/cm2, 1 Watt, 300 Hertz, 10 minutes), while the right knee was left untreated, as control group. The animals were divided into three groups, A, B and C, according to the survival time after surgery, two, six and twelve weeks, respectively. The explants from the femoral condyles, both treated employing laser energy and left untreated, were examined histologically. Results showed a progressive filling with fibrous tissue of the cartilaginous lesion treated with laser irradiation, while no changes in the original lesion of the untreated group were observed at the end of the study.

LIGAMENT REPAIR

THERAPEUTIC LOW ENERGY LASER IMPROVES THE MECHANICAL STRENGTH OF REPAIRING MEDIAL COLLATERAL LIGAMENT.

Fung DT, Ng GY, Leung MC, Tay DK. Lasers Surg Med. 2002; 31:91-96.
Twenty-four rats received surgical transection to their right MCL and eight received sham operation. After surgery, 16 received a single dose of gallium aluminum arsenide laser to their transected MCL for 7.5 minutes or 15 minutes and eight served as control with placebo laser, while the sham group didn’t receive any treatment. The MCLs were biomechanically tested at either 3 or 6 weeks post-operation. The normalized ultimate tensile strength (UTS) and stiffness of laser and sham groups were larger than control (P < 0.001). The UTS of laser and sham groups were comparable. Laser and sham groups had improved in stiffness from 3 to 6 weeks (P < 0.001). A single dose of low energy laser therapy improves the UTS and stiffness of repairing MCL at 3 and 6 weeks after injury.

THE CLINICAL EFFICACY OF LOW-POWER LASER THERAPY ON PAIN AND FUNCTION IN CERVICAL OSTEOARTHRITIS.

Oezdemir F, Birtane M, Kokino S
Clinical Rheumatology. 2001; 20(3): 181-184.

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

IMPROVEMENT OF PAIN AND DISABILITY IN ELDERLY PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS OF THE KNEE TREATED WITH NARROW-BAND LIGHT THERAPY.

Stelian J, Gil I, Habot B et al.
J Am Geriatr Soc. 1992; 40: 23-26.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open.

Patients were treated twice daily, 15 minutes each time, for 10 days. The patients treated themselves after instruction.

Total dose for each session was 10.3 J for red and 11.1 for infrared.

Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated.

There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2 months to 1 year.

THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE.

Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.

Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p<0.05). There was no significant change in range of motion of the Knee.

CLINICAL APPLICATION OF LASER (LLLT) IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Aoada, Yasutaka Ytani, Akira Sakawa and Akira Shimazu – Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected Joints, thereby seriously restricting the patient’s quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient’s QOL at a reasonable level. The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognised in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data). From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAIAs diode laser system (830 nm, 60 mW CIW). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement?, good (clearly apparent improvement), and unchanged (little or no improvement). For, pam attenuation, scores were: excellent — 59.6%; good — 30.4%; unchanged — 10%. For ROM improvement the scores were: excellent — 12.6%; good — 43.7%; unchanged — 43.7 Yo. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

INFARED DIODE LASER IN LOW REACTIVE-LEVEL LASER THERAPY (LLLT) FOR KNEE OSTEOARTHROSIS

Laser Therapy 1991, 3:149-153
M. A. Trelles, J. Rigau, P. Sala, G. Calderhead and T. Ohshiro

Degenerative joint disease (DJD) in particular in the knee. is difficult to, cure successfully at present often requiring surgical intervention. In addition the chronic DJD patient often exhibits symptoms cl both a physiological and psychological nature. A study is presented using high reactive-level laser therapy (LLLT) with an 830 nm infra red continuous wave gallium aluminium (or aluminium) arsenide (GaAlAs) diode laser with an output power of 60 mW. in light contact Laser therapy for a population of 40 patients (power density of approximately 3 W/cm2). Four points around the patella were irradiated for 60 s each (energy density of 18 J/cm2 per point. total of 72 J/cm2 per session) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immediately after at 4 months after the final LLT session. All other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT and returned to their original pretherapy medication. The side effects were minimal LLLT is concluded to to be safe, effective and non-invasive alternative to conventional surgical and medical treatment modalities for DJD patients.

A SYSTEMATIC REVIEW OF LOW LEVEL LASER THERAPY (LLLT) WITH LOCATION-SPECIFIC DOSES FOR PAIN FROM CHRONIC JOINT DISORDERS.

Aust J Physiother 2003;49(2):107-16
Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

THE CLINICAL EFFICACY OF LOW-POWER LASER THERAPY (LLLT) ON PAIN AND FUNCTION IN CERVICAL OSTEOARTHRITIS.

Clin Rheumatol 2001;20(3):181-4
Ozdemir F, Birtane M, Kokino S.

Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.
Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LLLT) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

IMPROVEMENT OF PAIN AND DISABILITY IN ELDERLY PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS OF THE KNEE TREATED WITH NARROW-BAND LIGHT THERAPY (LLLT).

J Am Geriatr Soc. 1992; 40: 23-26
Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy (LLLT) on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.
Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.
Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.
Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial. Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively)

Conclusions: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee. Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people.1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symptomatic manifestations of osteoarthritis increase with ageing, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

MECHANISMS OF THE ANALGESIC EFFECT OF THERAPEUTIC LASERS IN VIVO

L. Vavratil (1) and I. Dylevsky (2)

(1) Outpatient Department of Radiobiology, Institute of Biophisics, First Medical Faculty

(2) Department of Functional Anatomy, Second medical Faculty and Faculty of Physical Education
Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based repors have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action. There are several different possible responses induced by non-invasive low level laser therapy (LLLT).
The purpose of the present communication is to review the arrangement and characterization of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

A SYSTEMATIC REVIEW OF LOW LEVEL LASER THERAPY WITH LOCATION-SPECIFIC DOSES FOR PAIN FROM CHRONIC JOINT DISORDERS.

Australian J Physiother. 2003; 49: 107-116.
Bjordal J M, Couppè, C, Chow R, Tunér J, Ljunggren A E.

The authors investigated if low level laser therapy of the joint capsule can reduce pain in chronic joint disorders (CJD). A literature search identified 88 randomised-controlled trials, of which 20 trials included patients with CJD. Six trials had to be excluded for not irradiating the joint capsule. Three trials used doses lower than a denominated a priori dose range for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials, including 565 patients, were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose-range was administered to the knee, temporomandibular and zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS by 45.6 % (95 % CI 35.0 to 56.2) in favour of LLLT. Global status was improved for 33.4 % (95% CI 20.9 to 45.9) more patients in the LLLT group. LLLT with the suggested dose range significantly reduces pain in CJD, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

THE EFFECT OF INFR-ARED LASER IRRADIATION (LLLT) ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K., General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of postoperative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6- 8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand postoperative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups. Controls n = 5.5: LLLT n = 2.5. No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group. Controls n = 9: LLLT n = 4. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

Low Level Laser Therapy promotes healing in many conditions because it penetrates deep into the tissues, transforming a cell from unstable/unhealthy condition! Laser energy can strengthen damaged cells. Using photochemical processes, laser light inserts bio-photons into damaged cells. The cells begin to produce energy (ATP), which improves their function, assists their division, strengthens the body’s immune system, and causes the secretion of various hormones. The tissues are healed, and pain disappears. If damaged cells have died, the bio-photons help the division of neighboring cells, generating new tissues, and thus bring about healing.

Proven benefits:

• Provides pain relief, reducing medication needs
• Improves blood circulation
• Reduces swelling
• Stimulates cell growth
• Stimulates cell metabolism
  (activation of ATP and protein synthesis)
• Stimulates enzyme synthesis
• Enhances collagen synthesis
• Provides antioxidant effect
• Strengthening the immune system response via increasing levels of lymphocyte activity.
• Generate new healthy cells & tissues
• Promotes faster wound healing & clot formation

Treatments are safe and can be easily performed by a professional physiotherapist by holding the emitter and/or moving it in a circular motion on the painful body section.

Treatment can be continued once a day on each individual point for 12-15 consecutive days. Upon completion of a full course (12-15 days), a further course can be undertaken after a three-day break. Up to 10 courses a year can be completed on each individual point.

Clinically Proven to Reduce Pain in numerous trials:
88% positive effect was demonstrated in the studies conducted for the efficacy in relieving pain caused by arthritis of small and medium joints.

Conditions Treated: Acute, Subacute and chronic pain relief, Shoulder pain, Carpal tunnel syndrome, Back pain, Sciatica, Tennis elbow, Arthritic pain, Fibromyalgia, Post operative wound care, Myofascial pain syndrome, sports injuries, sprains & strains etc.

RESEARCH ARTICLES ON COLD LASER:

• Pain Management (Click Here)

• Tendinitis (Click Here)

• Headache    (Click Here)

• Joint Problems such as Arthritis, Osteoarthritis, Rheumatoid Arthritis (Click Here)

• Wound Healing   (Click Here)

• Tissue Repair/ Bone Repair/ Cartilage Repair/ Ligament Healing

Free radicals are produced by stress, heat, tobacco smoke, sunlight, sports injuries, infection, air pollution, car emissions, inadequate sleep, etc. It can cause oxidative damage to cells and tissues, which accelerate aging. Without adequate protection, we age faster, develop stiff joints and aching, wrinkles sooner.

By eliminating these free radicals, we can assist our bodies in returning us to a healthy state, live longer, and pain- free lives.

A study that shows pine bark extract can reduce arthritis pain:

Available in our clinic

Flexall with unique aloe vera gal formula provides Fast, Long Lasting Relief

Now at Only $20/-

• Arthritis
• Backache
• Muscle Strains and Sprains

• apply generously to affected area
• massage into painful area until thoroughly absorbed into skin
• repeat as necessary, but no more den 4 times daily

• Please consult a doctor

• Pain Management in rheumatology, neck, back and joint pain and sports injuries.

• Wound Healing/Tissue Repair for leg ulcers, pressure sores, burns (it is in fact used in the Concord Hospital Burns Unit), diabetic gangrene, wound healing after operations and/or trauma.

• Skin conditions such as acne, psoriasis, eczema, and scar tissue.
• Cosmetic uses include fine facial lines, cellulite and general skin care.

• Microcirculation,
• Harmonize metabolic processes,
• Reinforce human defence system,
• relieve pain or decrease its intensity,
• stimulate the regenerative and repair process of the whole organism.

• Safe- No side effects, no UV radiations
• Short treatment time- 10 minutes only
• Painless- No injections, abrasions, redness
• Portable- For home/travel use
• Cost Effective- Reduced treatment cost
• Light Weight- Easy to use
• Effective for Pain Relief and Sport Injuries

A new technology with a combination of TENS, EMS, ICT and Cupping Therapy at once!

Now at only $285

• Electronic Acupuncture
• Acute pain/ Chronical pain control
• Slimming/ Beauty & Diet
• Body toning & Muscle training
• [Buhang]Vaccum Cup Therapy

• Increase blood flow
• Relieves muscle cramp
• Relieves pain & tissue tightness
• Mobilize immune system
• Muscles toning and training
• Electro- Acupunture effects
• Utilize fat and glycogen results for better contour

What is TENS?

TENS stands for Transcutaneous [meaning 'across skin' Electrical Nerve Stimulation]. TENS is a safe and drug-free method of managing acute and long-term pain. TENS can also be used to stimulate the contraction of muscle fibres and as a non-invasive method of accupuncture point stimulation.

Free Q is the only Tens machine which uses wireless technology and does not require leads and electrodes which degenerate and need to be replaced regularly.

Free-Q’s use of water as a contact medium (no messy gels needed), remote control “one touch” operation, vacuum cup attachments and ingrained Nano-Silver technology for easy cleaning make Free-Q the easist to use TENS Machine on the market.

The advanced stimulation features of Free-Q such as the availability of medium frequency, low frequency and electro-acupuncture stimulation modes with multiple alternating wave frequencies within each mode and it is clear that Free-Q is the most advanced TENS unit available in the world today.

Free Q single electrode

Each Free-Q single electrode is a TENS unit in itself, having a positive (cathode) and negative (anode) pole within the same cup. This allows for individual adjustment of each electrode and the use of only one, or as many electrodes as required, all controlled by one lightweight remote control device. Single electrodes are best for local stimulation and treatment.

Features of Free Q

• Wireless Operation: No wires to break or become caught in clothes and body parts.
• No Gel Required: Water is used as the contact medium. Eliminates the mess and effort needed to apply and wipe off sticky gels.
• Individual Settings of electrodes: Treatment mode and intensity can be adjusted for each electrode exclusively
• Utilisation of Medium frequency current : Up to 4800 Hz resulting in deeper tissue penetration and reduced irritation compared to normal tens units (1-200 Hz)
• Five different treatment modes: Medium Frequency (2), Low Frequency (2), and electro-acupuncture stimulation modes.
• One touch push button programming: No “fine-touching” of dials and switches
• Remote control operation: Easy operation of as many electrodes as required from the one unit
• Alternating Wave Frequencies within Each Mode: Eliminates the “tolerance effect” and targets a wide range of pathologies.
• Vacuum Cup Attachments: Eliminates the need for adhesive electrodes and mess caused by sticky gels
• Nanover™ Nano-Silver Technology: Vacuum cups and electrodes are embedded with silver nano particles stabilised which possess a strong anti-microbial effect for advanced hygiene and easier cleaning.
• Each electrode is a self contained unit!
  An advantage over a standard tens device is the ability to program each electrode seperately. For example, you may want to treat your back and upper leg at the same time, each requiring a different stimulation mode.

Physiotherapy treatment can commence immediately after an injury has occurred, even as soon as the same day.

Immediately after an injury, our physiotherapist will assess the injury and determine a diagnosis as well as the severity of the condition. The physiotherapist will be able to advise you on your condition and whether further action needs to be taken such as an x-ray or referral to an orthopedic surgeon.

You will receive immediate care and education of your injury by the physiotherapist.

It depends entirely on your injury, however the following is a general expected goals when seeing a typical physiotherapist:

- Pain relief
- Decrease muscles tightness or spasms
- Increase flexibility and movement
- Issue of supports, braces or strapping or walking aids.
- Education on your condition and how to look after your condition

It is not necessary to wait until the pain or swelling goes down before starting treatment. The early you begin treatment, the earlier you will recover. Because your physiotherapist will assist the injured body part with a more rapid reduction of your symptoms with different physiotherapy techniques.

Our specialized treatments will not only relieved your pain, but most importantly, to repair your injured tissues and regeneration of stronger tissues to prevent reoccurrence of your condition.

If you experience an injury and are unsure what to do, please do not hesitate to contact us at 64388725.

We will be more than happy to assist you.

Call today at 64388725

Don’t torture yourself another day with your pain!

CH-Alpha is high in protein called collagen hydrolysate. It is this compound which represents 90% to 95% of the collagen found in joints. It contains high concentrations of joint-building amino acids such as glycine and proline. When you ingest CH-Alpha, Bioactive Collagen Peptides are remitted into the intestine during digestion. The collagen hydrolysate then moves into the bloodstream in the form of large chains of proteins and amino acids. At that point, Bioactive Collagen Peptides accumulate in highly stressed joints.

• Joint Pains
• Overweight joints
• Stiff joints
• Damaged cartilage

• Women: There are more women experience chronic joint symptoms than men.
• Overweight Individuals: Excess weight can affect your overall joint health.
• Active Folks: Athletes may not be aware that cartilage in their joints can wear away even if they haven’t sustained serious sports related injuries.
• Seniors: As we grow old, bone, muscle and connective tissue are all affected.

Though you cannot stop time, there are things you can do to improve your joint flexibility.

What is cartilage?

Cartilage acts as a cover for your joints and protects your bones from rubbing together, which can cause chronic joint symptoms (CJS) such as stiffness and pain.

Drink one vial containing daily. In clinical studies, participants experienced increased flexibility and reduced stiffness after just 2 to 3 months.

Today is the day to try CH Alpha, you’ll not only feel better, you’ll also love its citrus fruit flavor.

Your joint will undergo a certain amount of wear and tear as you age. Many of the day to day things that you do can place extra stress upon your joints without you knowing it consciously. Practicing good joint protection is important for everyone, especially if you have experienced joint pain, aches or stiffness.

Genacol can help:

- Reduce the pain of arthritis and rheumatism

- Regenerate cartilage and ligaments

- Increase muscle tone

-Tone the body and internal organs

- Improve the skin’s elasticity (firms the skin)

-Reduces wrinkles (aging causes collagen and the skin’s elastin fibres to thin, weakening the skin’s tissues)

-Increase endurance, strength and vitality

-Improve the quality of sleep

-Reduce back pain and cramps in leg muscles

-Speed recovery from accident or injury

Genacol can be purchased at the following clinics:

1) PhysioLife

2) The Pain Relief Practice (http://www.painrelief.sg)

360 Orchard Road, International Building, #09-10

Tel: 67355368