Laser Therapy For Tendinitis

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.