Laser Therapy is Supported by Numerous Clinical Studies

In 1995 the editor of Archives of Physical Medicine and Rehabilitation, Dr. Jeffrey Bashford stated that Laser Therapy was still not an established tool. He pointed out that promising results in the laboratory failed to translate into positive clinical results. Today 23 years later there has has been a large increase in the number of controlled scientific studies in the field of Laser Therapy.

In Pubmed, there are now more than 6000 scientific articles about Low Level Laser Therapy (LLLT) and Photobiomodulation (PBM). In the last two years, the amount of scientific evidence for laser therapy in clinical conditions has reached a level similar or above that of painkilling pills used to treat musculoskeletal disorders. In dentistry, nerve pathologies and wound healing you also see great advances in the amount of studies.

The applications of PBM are broad. Four clinical targets, however, are the most common: shining laser light on injured sites to promote healing, remodelling and/or to reduce inflammation; on nerves to induce analgesia; on lymph nodes in order to reduce oedema and inflammation; and on trigger points (a single one of as many as 15 points) to promote muscle relaxation and to reduce tenderness. Since it is non- invasive, PLLLT/PBM is very useful for patients who are needle phobic or for those who cannot tolerate therapies with non-steroidal anti-inflammatory drugs.

Laser treatment – anti-inflammatory effect of light

The positive outcomes depend on the parameters used on the treatment. The anti-inflammatory effect of light in low intensity was reported on patients with arthritis, acrodermatitis continua, sensitive and erythematous skin, for instance. With the same basic mechanism of action, which is the light absorption by mitochondrial chromophores, mainly Cox, the consequences of LLLT/PBM are various, depending on the parameters used, on the signalling pathways that are activated and on the treated tissue. In order to apply LLLT/PBM in clinical procedures, the clinicians should be aware of the correct parameters and the consequences for each tissue to be treated. More studies have to be performed in order to fill the gaps that still linger in the basic mechanisms underlying LLLT/PBM.

Osteoarthritis

Knee Osteoarthritis

The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial

Hegedus B¹, Viharos L, Gervain M, Gálfi M. Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. arthrodent@freemail.hu. Photomed Laser Surg. 2009 Aug;27(4):577-84. doi: 10.1089/pho.2008.2297

Abstract

INTRODUCTION:

Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).

MATERIALS AND METHODS:

Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.

RESULTS:

In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature–and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.

CONCLUSION:

Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

Cervical Osteoarthritis

The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis

Ozdemir F¹, Birtane M, Kokino S. Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey. Clin Rheumatol. 2001;20(3):181-4

Abstract

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.

Arthritis

Periarthritis Humeroscapularis

Application of laser acupuncture in the treatment of periarthritis humeroscapularis

Branka Nikolic,. spec. Sport’s med. Address Zavod za zdravstvenu zastitu radnika ZTP-a “Beograd”, 11000 Beograd, Slobodana Penezica Dr. 23 Yugoslavia

Abstract

The effect of low intensity semiconductor laser was used as treatment methods for periarthritis humeroscapularis. The CC laser (Computer Controlled laser) was applied. Laser therapy has positive biological effects and anti inflammatory, angioedema effects and analgesia. We treated 18 patients with periarthritis humeroscapularis, 14 were female patients.

The laser was locally applied at the AC points Sj 14, Sj 15, Li 15, Li 10, Sj 5, Si 3, three times a week for the first week and twice a week for the second and the third week. After first treatment 12 of patients had pain – alleviating effect. After 6-7 treatments al had pain – alleviating effect and complete recovery of shoulder’s motor activity. Low intensity therapy has its place for treatment of periarthritis humeroscapularis.

Treatment of the acute Periarthritis humeroscapular with laserpuncture

Odalys Gonzáles Álvarez, Main Educational Clinic of Urgencies “Antonio Maceo”, Cerro Municipality, Havana City

Abstract

The periarthritis humeroscapular is a syndrome that contains very precise affections: the bursitis, the calcified tendinitis of supraespinoso, the bicipital tendinitis, among others. Pain and limitation of the joint movements of the shoulder characterize it. The treatment with laser of low power can produce resolution of the lesion, whenever it is made in early phases of the disease. In this study we propose the use of the laserpuncture, due to our accumulated experience in the treatment of these affection in acute phase, with acupuncture. A prospective study was carried out during 2 years (1997 – 1999), where 62 patients were selected because they accomplished the Approaches of Inclusion for the study. The sample was divided by aleatory assignment in 2 Groups of Treatment. Th study Group I was treated with laserpuncture, using Cuban laser equipment of HeNe of 632,8 nm and a dose of joule/cm2 was applied, and the Control Group II was treated with acupuncture needles. The conventional medical treatment was suspended. Daily sessions were given from Monday to Friday, for two weeks, until a total of 10. Both techniques demonstrated to be effective in the treatment of these affections, improving the clinical and radiological symptoms significantly when the treatment sessions was concluded. The patients accepted the laserpuncture better because of its painless character, less time of application, and the absence of bleeding and stress.

Rheumatoid Arthritis

Beneficial Effects of Laser Therapy in the Early Stages of Rheumatoid Arthritis Onset

Contantin Ailioaie1, Laura Marinela Lupusoru-Ailioaie2 1Medical Office for Laser Therapy, 1 Bistrita, B10-2, 6600-Iassy, Romania, 2AI.I. Cuza University, Dept. of Medical Physics, Iassy, Romania. LLLT Original Articles, Laser therapy Volume. 11-2, pg.79

Abstract

The purpose of this study was to determine the effects of laser therapy in pain reduction and/or recovery of patients at the onset of Rheumatoid Arthritis (RA), comparatively with the traditional non-steroidal anti-inflammatory drugs (NSAIDSs). Fifty-nine patients with RA of 6-12 months duration were included in the study. The patients were divided into 3 groups: Group 1 (21 patients) received laser therapy; Group 2 (18 patients) was submitted to placebo laser therapy and NSAIDs medication; Group 3 (20 patients) was treated only with NSAIDs. Physical therapy was instituted in all three groups. GaAIAs diode laser of 830 nm wavelength and 200mW maximum output power was used. Group 1 received laser therapy once each day, eight days per month, for a total of 32 treatments during a four-month period. The parameters used were 2-4 J/cm2 energy density, and a frequency of 5 Hz or 10 Hz depending on the number and severity of pain in the affected joints. Placebo laser treatment was given to group 2. the functional activity score, the acute pain phase reactants (ESR and C – reactive protein), T-lymphocytes and NK (natural killer) – cells were estimated. Synovial biopsies and Magnetic Resonance Imaging (MRI) of the synovial membrane were performed as well. The analysis of the clinical and biological parameters at the end of treatment showed a statistically significant decrease of duration of morning stiffness, of pain at rest and during movements, and improved acute phase reactants. The overall efficacy rate in these studies was 86% in the first group, 50% in laser placebo group and 40% in the NSAIDs-treated third group. After four months of treatment, our investigations showed that 830 nm infrared laser therapy promoted the restoration of function, relieved pain and limited the complications of RA.

The Effects of Laser Therapy in the Early Stages of Rheumatoid Arthritis Onset

C. Ailioaie, M. D.

Medical Office for Laser Therapy, Iassy, RO
Laura Marinela Lupusoru-Ailioaie, M. D.
“Al.I.Cuza” University, Dept. of Medical Physics, Iassy, RO

1.PURPOSE:

To study the effects of laser therapy, in comparison with other modality trials (NSAIDs), at the onset of (RA).

2.SUBJECTS and METHODS:

In the study 59 patients were included, in the first 6 – 12 months from RA onset. The patients were divided into three groups: Group 1 (21 patients) received laser therapy; Group 2 (18 patients) was submitted to placebo laser therapy and NSAIDs medication; Group 3 (20 patients) was treated only with NSAIDs. Physical therapy was instituted in all three groups.

A GaAIAs diode laser (830 nm, maximum output power 200 mW) was used. During 4 months, courses of laser therapy – once daily for 8 days, monthly – were administered to Group 1 and laser placebo Group 2. The density of energy (2 – 4 J/cm2) and frequency (5 Hz or 10 Hz) were dependent on the number and severity of pain in affected joints.

3.RESULTS:

The analysis of the clinical and biological parameters at the end of treatment showed a statistical significant decrease of duration of morning stiffness of pain at rest and during movements and improved acute phase reactants. The overall efficacy rate in these studies was 86% in group 1, 50% in the placebo laser group, and 40% in group 3.

4.DISCUSSION and CONCLUSIONS:

After 4 months of treatment, our investigations showed that infrared laser therapy was able to restore function, to relieve pain and to avoid the complications of the disease or NSAIDs therapy (digestive or renal) at RA onset, being the most perspective modality of treatment.

The effect of laser therapy in complex treatment of patients with rheumatoid arthritis

Korolkova O M et al.

Abstract

115 patients with rheumatoid arthritis (RA) of II-III degrees were treated with basic RA medications and infrared laser. In a control group of 20 patients only basic medication was given. 10 areas of the body were irradiated daily, increasing the dose every day during a period of 8-10 days. The effectiveness of the therapy was controlled through laboratory tests on i.a. inflammatory agents and the activity of lipid peroxidation. The results were statistically significant. The best effect was found in patients with degree II RA. Steroid medication could be reduced 8-10 days earlier in this group of patients and in some cases the medication could even be excluded. Degree III patients had a more moderate benefit of the laser treatment.

The interauricular laser therapy of rheumatoid arthritis

Sidorov-V-D, Mamiliaeva-D-R, Gontar-E-V, Reformatskaia-SIu.Vopr-Kurortol-Fizioter-Lech-Fiz-Kult. 1999; (3): 35-43

Abstract

Investigations have proved the ability of interauricular low- intensity infrared laser therapy (0.89 nm, 7.6 J/cm) to produce anti- inflammatory,immunomodulating action in patients with rheumatoid arthritis. The method has selective, pathogenetically directed immunomodulating effect the mechanism of which is similar to that of basic antirheumatic drugs and of intravenous laser radiation of blood. This laser therapy can be used as an alternative to intravenous blood radiation being superior as a noninvasive method.Interauricular laser therapy can potentiate the effects of nonsteroid anti-inflammatory drugs, cytostatics and diminish their side effects.

CLINICAL APPLICATION OF GaAIAs 830 NM DIODE LASER IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu. DepartmentofOrthopaedic Surgery, Osaka City UniversityMedical School, Japan

Abstract

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 recognized 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 GaAlAs diode laser system (830 nm, 60 mW C/W). 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 pain attenuation, scores were: excellent&emdash;59.6%; good&emdash;30.4%; unchanged&emdash;10%. For ROM improvement the scores were: excellent&emdash;12.6%; good&emdash;43.7%; unchanged&emdash;43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

LASER THERAPY OF RHEUMATOID ARTHRITIS

Goldman JA, Chiapella J, Casey H, Bass N, Graham J, McClatcheyW, Dronavalli RV, Brown R, Bennett WJ, Miller SB, Wilson CH, Pearson B, Haun C, Persinski L, Huey H, MuckerheideM

Abstract

Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q- switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty- one patients noted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain.

LASER THERAPY IN RHEUMATOLOGY

Judit OrtutayM.D., Klara Barabas M.D., Ph.D., *Adam Mester MD National Institute of Rheumatology and Physiotherapy, Budapest *Semmelweis University, Faculty of Medicine, Dept. of Diagnostic Radiology and Oncotherapy, National Laser Therapy Centre, Peterfy Sandor Teaching Hospital, Budapest

Abstract

Barabas irradiated first the joints of rheumatoid arthritis (RA) patients without skin ulcer. In the first open study objectively the range of motion and circumference of the treated joints were measured, Ritchie index as semiobjective parameter, subjective parameters as joint tenderness and pain on a visual analogous scale (VAS) were registered. The walking time was registered as a functional disability parameter. Laboratory activity parameters and the 99mTechnetium index was measured. The second part of the clinical study was double blinded, Infrared (10mWand 100 mW) lasers were used versus dummy devices with the same outlook. The third part of the study were in vitro experiments. Synovial membranes of rheumatoid arthritis patients The DNA/RNA ratio of the RA group was compared to the control group. Significant difference was detected between the two groups. The fourth phase of clinical studies was to detect the effects of laser irradiation in other rheumatic diseases: psoriatic arthritis, sacroileitis, osteoarthritis, entesopathy, tenosynovitis, bursitis calcarea, fibromyalgia, localised muscle spasm, periarthritis humeroscapularis etc. The different wavelengths (604, 630, 660, 670, 690, 750, 780, 790, 820, 830, 904, 1053, 1219 nm,) were compared (30 – 100 mW) with other physiotherapy modalities, like ultrasound. Acknowledgement: The Central Research Institute of the Hungarian Academy of Sciences and LASOTRONIC AG (Switzerland) was helping the research.

Low level laser therapy (classes I, II and III) in the treatment of rheumatoid arthritis

Brosseau L, Welch V, Wells G, deBie R, Gam A, Harman K, Morin M, Shea B,Tugwell P. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H-8M5

Abstract

BACKGROUND: Rheumatoid arthritis (RA) affects a large proportion of the population. Low Level Laser Therapy (LLLT) was introduced as an alternative non-invasive treatment for RA about 10 years ago. LLLT is a light source that generates extremely pure light, of a single wavelength. The effect is not thermal, but rather related to photochemical reactions in the cells. The effectiveness of ILLT for rheumatoid arthritis is still controversial.

OBJECTIVES: To assess the effectiveness of LLLT in the treatment of RA.

SEARCH STRATEGY: We searched MEDLINE, EMBASE, the registries of the Cochrane Musculoskeletal group and the field of Rehabilitation and Related Therapies as well as the Cochrane Controlled Trials Register up to January 30, 2000.

SELECTION CRITERIA: Following an a priori protocol, we selected only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA were eligible. Abstracts were excluded unless further data could be obtained from the authors.

DATA COLLECTION AND ANALYSIS: Two reviewers independently select trials for inclusion, then extracted data and assessed quality using predetermined forms. Heterogeneity was tested with Cochran’s Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results were analyzed as weighted mean differences (WMD) with 95% confidence intervals (CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept (e.g. pain). Dichotomous outcomes were analyzed with odds ratios.

MAIN RESULTS: A total of 204 patients were included in the five placebo-controlled trials, with 112 randomized to laser therapy. Relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness duration by 27.5 minutes (95%CI: 2.9 to 52 minutes) and increased tip to palm flexibility by 1.3 cm (95% CI: 0. 8 to 1.7 cm). Other outcomes such as functional assessment, range of motion and local swelling did not differ between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application or treatment length. For RA, relative to a control group using the opposite hand, there was no difference between the control and treatment hand, but all hands improved in terms of pain relief and disease activity.

REVIEWER’S CONCLUSIONS: In summary, LLLT for RA is beneficial as a minimum of a four- week treatment with reductions in pain and morning stiffness. On the one hand, this meta- analysis found that pooled data gave some evidence of a clinical effect, but the outcomes were in conflict, and it must therefore be concluded that firm documentation of the application of LLLT in RA is not possible. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques used. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this meta-analysis lacked data on how LLLT effectiveness is affected by four important factors: wavelength, treatment duration of LLLT, dosage and site of application over nerves instead of joints.

THE EFFECTIVENESS OF LASER THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

O.M. Korolkova, V.T. Burlachuk, O.V. Gordienko, E.A. Afanasevskaya Voronezh State Medical Academy, Voronezh Regional Hospital, Voronezh, Russia

Abstract

The purpose of this research is to evaluate the effectiveness of laser therapy among patients with different extents of rheumatoid arthritis (RA) disease. There has been a study of 115 patients with RA activity II-III (the main group) who apart from the basic therapy also received laser treatment.
The apparatus ALT “Mustang” with the power of 2-10 W and infrared wave range has been used. The laser influence has been aimed at the area of a damaged joint. The duration of laser influence is from 5 to 17 minutes, adding 1-2 minutes daily. The number of fields is 10, the number of treatment procedures -8-10, The control group consists of 20 patients with RA (basic therapy only).

The control of effectiveness of the therapy was based on the complex laboratory data, including definition of non-specific factors of inflammation and the factors of activity of lipid peroxidation.
The greatest effect of the therapy has been achieved in the main group of patients with activity II. In comparison with the control group we managed to receive improve-ment 8- 10 days earlier which allowed us to reduce the demand of steroids and in case of 20 patients even cancel taking them. We received statistically reliable fall of the activity of inflammation andlipidperoxidation. More moderate effect of the therapy was reached treating patients from the main group with activity III.

Arthritis

Helium-Neon Laser Reduces the Inflammatory Process of Arthritis

Claudia Reinoso Rubio, David Cremonezzi, Monica Moya, Fernando Soriano, Jose Palma, Vilma Campana. Photomedicine and Laser Surgery. -Not available-, ahead of print. doi:10.1089/pho.2008.2472

Abstract

Objective: A histological study of the anti-inflammatory effect of helium-neon laser in models of arthropathies induced by hydroxyapatite and calcium pyrophosphate in rats.

Background: Crystal deposition diseases are inflammatory pathologies induced by cellular reaction to the deposit of crystals in the joints.

Methods: Fifty-six Suquia strain rats were distributed in seven groups. Two mg of each crystal diluted in 0.05ml physiologic solution were injected six times in each back limb joint, during two weeks on alternate days. Eight J/cm2 were applied daily to the crystal-injected joints on five consecutive days. The joints were cut and put in 10% formaldehyde, stained with hematoxylin-eosin and observed by light microscopy. The percentage of area with inflammatory infiltrates was determined in five optical microscopy photographs (100X) for each group and analyzed using the Axionvision 4.6 program. A Pearson’s Chi Squared test was applied, with significance level set at p < 0.05. Results: Both crystals produced an inflammatory process in the osteoarticular structures, consisting of predominantly mononuclear infiltration, fibrosis, and granulomas of foreign body-type giant cells containing phagocytosed remains of crystals. In the arthritic joints treated with laser, a marked decrease (p < 0.0001) was found in the percentage of area with inflammatory infiltrates, although the granulomas remained in a less ostensible form, with adipose tissue cells, fibrosis bands with light residual inflammation, and an absence of or very few crystals. Laser alone or physiologic solution injection did not produce histological changes.

Conclusions: Helium-neon laser reduced the intensity of the inflammatory process in the arthritis model induced by hydroxyapatite and calcium pyrophosphate crystals.

Sport Medicine

Achilles Tendinitis

A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations

Bjordal JM¹, Lopes-Martins RA, Iversen VV. Physiotherapy Science, University of Bergen, Bergen, Norway. jmbjor@broadpark.no. Br J Sports Med. 2006 Jan;40(1):76-80; discussion 76-80

Abstract

BACKGROUND:

Low level laser therapy (LLLT) has gained increasing popularity in the management of tendinopathy and arthritis. Results from in vitro and in vivo studies have suggested that inflammatory modulation is one of several possible biological mechanisms of LLLT action.

OBJECTIVE:

To investigate in situ if LLLT has an anti-inflammatory effect on activated tendinitis of the human Achilles tendon.

SUBJECTS:

Seven patients with bilateral Achilles tendinitis (14 tendons) who had aggravated symptoms produced by pain inducing activity immediately before the study.

METHOD:

Infrared (904 nm wavelength) LLLT (5.4 J per point, power density 20 mW/cm2) and placebo LLLT (0 J) were administered to both Achilles tendons in random blinded order.

RESULTS:

Ultrasonography Doppler measurements at baseline showed minor inflammation through increased intratendinous blood flow in all 14 tendons and measurable resistive index in eight tendons of 0.91 (95% confidence interval 0.87 to 0.95). Prostaglandin E2 concentrations were significantly reduced 75, 90, and 105 minutes after active LLLT compared with concentrations before treatment (p = 0.026) and after placebo LLLT (p = 0.009). Pressure pain threshold had increased significantly (p = 0.012) after active LLLT compared with placebo LLLT: the mean difference in the change between the groups was 0.40 kg/cm2 (95% confidence interval 0.10 to 0.70).

CONCLUSION:

LLLT at a dose of 5.4 J per point can reduce inflammation and pain in activated Achilles tendinitis. LLLT may therefore have potential in the management of diseases with an inflammatory component.

Jumper´s knee, Tennis elbow and Achilles tendinitis

Low level laser therapy for sports injuries

Morimoto Y¹, Saito A, Tokuhashi Y. Surugadai Nihon University Hospital, Department of Orthopaedic Surgery, Tokyo , Japan. Laser Ther. 2013;22(1):17-20

Abstract

BACKGROUND AND AIMS:

Our hospital has used LLLT in the treatment of athletes since 1990. We had a good result about LLLT for sports injuries. However, few articles have attempted to evaluate the efficacy of LLLT for sports injuries. The aims of this study was to evaluate the efficacy of LLLT for sports injuries. Materials (Subjects) and Methods: Forty one patients underwent LLLT in our hospital. These patients included 22 men and 19 women with an average age of 38.9 years old. Patients were irradiated by diode laser at points of pain and/or acupuncture points. Patients underwent LLLT a maximum treatment of 10 times (mean 4.1 times). We evaluated the efficacy of LLLT using a Pain relief score (PRS). A score of 2 to 5 after treatment was regarded as very good, 6 to 8 as good, and 9 to 10 as poor. A PRS score of less than 5 was regarded as effective.

RESULTS:

The rate of effectiveness (PRS of 5 or less) after LLLT was 65.9% (27/41 patients).

DISCUSSION:

In this study, the resulting rate of effectiveness was 65.9% for all sports injuries. However, we have a high rate of effectiveness for Jumper’s knee, tennis elbow and Achilles tendinitis and cases that were irradiated laser by a physician.

CONCLUSIONS:

LLLT is an effective treatment for sports injuries, particularly jumper’s knee, tennis elbow and Achilles tendinitis.

KEYWORDS:

Low level laser therapy (LLLT); Sports injuries

Muscle

Low level laser therapy before eccentric exercise reduces muscle damage markers in humans

Baroni BM¹, Leal Junior EC, De Marchi T, Lopes AL, Salvador M, Vaz MA. Exercise Research Laboratory (LAPEX), Federal University of Rio Grande do Sul (UFRGS), Rua Felizardo, 750-Bairro Jardim Botânico, Porto Alegre, RS, 90690-200, Brazil. bmbaroni@yahoo.com.br. Eur J Appl Physiol. 2010 Nov;110(4):789-96. doi: 10.1007/s00421-010-1562-z. Epub 2010 Jul 3

Abstract

The purpose of the present study was to determine the effect of low level laser therapy (LLLT) treatment before knee extensor eccentricexercise on indirect markers of muscle damage. Thirty-six healthy men were randomized in LLLT group (n = 18) and placebo group (n = 18). After LLLT or placebo treatment, subjects performed 75 maximal knee extensors eccentric contractions (five sets of 15 repetitions; velocity = 60° seg(-1); range of motion = 60°). Muscle soreness (visual analogue scale–VAS), lactate dehydrogenase (LDH) and creatine kinase (CK) levels were measured prior to exercise, and 24 and 48 h after exercise. Muscle function (maximal voluntary contraction–MVC) was measured before exercise, immediately after, and 24 and 48 h post-exercise. Groups had no difference on kineanthropometric characteristics and on eccentric exercise performance. They also presented similar baseline values of VAS (0.00 mm for LLLT and placebo groups), LDH (LLLT = 186 IU/l; placebo = 183 IU/l), CK (LLLT = 145 IU/l; placebo = 155 IU/l) and MVC (LLLT = 293 Nm; placebo = 284 Nm). VAS data did not show group by time interaction (P = 0.066). In the other outcomes, LLLT group presented (1) smaller increase on LDH values 48 h post-exercise(LLLT = 366 IU/l; placebo = 484 IU/l; P = 0.017); (2) smaller increase on CK values 24 h (LLLT = 272 IU/l; placebo = 498 IU/l; P = 0.020) and 48 h (LLLT = 436 IU/l; placebo = 1328 IU/l; P < 0.001) post-exercise; (3) smaller decrease on MVC immediately after exercise (LLLT = 189 Nm; placebo = 154 Nm; P = 0.011), and 24 h (LLLT = 249 Nm; placebo = 205 Nm; P = 0.004) and 48 h (LLLT = 267 Nm; placebo = 216 Nm; P = 0.001) post-exercise compared with the placebo group. In conclusion, LLLT treatment before eccentric exercise was effective in terms of attenuating the increase of muscle proteins in the blood serum and the decrease in muscle force.

Wound Healing

Evaluation of the Effects of Low Level Laser Therapy on the Healing Process After Skin Graft Surgery in Burned Patients (A Randomized Clinical Trial)

Kazemikhoo N¹, Vaghardoost R², Dahmardehei M², Mokmeli S³, Momeni M², Nilforoushzadeh MA¹, Ansari F⁴, Razagi MR⁵, Razagi Z⁵, Amirkhani MA¹, Masjedi MR⁵

1 Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2 Burn Research Center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran. 3 Canadian Optic and Laser Center, BC, Canada. 4 Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 5 Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

J Lasers Med Sci. 2018 Spring;9(2):139-143. doi: 10.15171/jlms.2018.26. Epub 2018 Mar 20

Abstract

Introduction: Skin graft is the standard therapeutic technique in patients with deep ulcers, but like every surgical procedure, it may present some complications. Although several modern dressings are available to enhance comfort of donor site, the use of techniques that accelerate wound healing may enhance patient’s satisfaction. Low level laser therapy (LLLT) has been used in several medical fields, especially for wound healing, but it may take several months for large ulcers treated with laser to heal completely.

Methods: Nine patients with bilateral similar grade 3 burn ulcers in both hands or both feet were selected as candidates for split-thickness skin graft (STSG). One side was selected for laser irradiation and the other side as control, randomly. Laser was irradiated every day for 7 days with red 655 nm light, 150 mW, 2 J/cm² at the bed of the ulcer and with infra-red 808 nm light, 200 mW for the margins.

Results: The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019).

Conclusion: The results showed LLLT to be a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcers.

Wound-healing effects of 635-nm low-level laser therapy on primary human vocal fold epithelial cells: an in vitro study

Lou Z¹, Zhang C¹, Gong T¹, Xue C¹, Scholp A², Jiang JJ³.

1 The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China.

2 The Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.

3 The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China. jjjiang@fudan.edu.cn.

Lasers Med Sci. 2018 Sep 22. doi: 10.1007/s10103-018-2628-0. [Epub ahead of print]

Abstract

Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief for skin and oral applications. However, there is no corresponding literature reporting on vocal fold wound healing. Our purpose was to assess the potential wound-healingeffects of LLLT on primary human vocal fold epithelial cells (VFECs). In this study, normal vocal fold tissue was obtained from a 58-year-old male patient who was diagnosed with postcricoid carcinoma without involvement of the vocal folds and underwent total laryngectomy. Primary VFECs were then cultured. Cells were irradiated at a wavelength of 635 nm with fluences of 1, 4, 8, 12, 16, and 20 J/cm²(50 mW/cm²), which correspond to irradiation times of 20, 80, 160, 240, 320, and 400 s, respectively. Cell viability of VFECs in response to varying doses of LLLT was investigated by the Cell Counting Kit-8 (CCK-8) method. The most effective irradiation dose was selected to evaluate the cell migration capacity by using the scratch wound-healing assay. Real-time polymerase chain reaction (RT-PCR) was used to detect the gene expression of TGF-β1, TGF-β3, EGF, IL-6, and IL-10. Irradiation with doses of 8 J/cm² resulted in 4% increases in cell proliferation differing significantly from the control group (p < 0.05). With subsequent doses at 48 and 72 h after irradiation, the differences between the experimental and the control groups became greater, up to 9.8% (p < 0.001) and 19.5% (p < 0.001), respectively. It also increased cell migration and the expression of some genes, such as EGF, TGF-β1, TGF-β3, and IL-10, involved in the tissue healing process. This study concludes that LLLT at the preset parameters was capable of stimulating the proliferation and migration of human vocal fold epithelial cells in culture as well as increase the expression of some genes involved in tissue healing process. Additionally, successive laser treatments at 24 h intervals have an additive beneficial effect on the healing of injured tissues.

Cancer

Mucositis

Patients with moderate chemotherapy-induced mucositis: pain therapy using low intensity lasers

Nes AG, Posso MB. Buskerud University, Drammen, Norway. s-oddmun@online.no. Int Nurs Rev. 2005 Mar;52(1):68-72

Abstract

BACKGROUND: Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy-induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.

OBJECTIVE: To investigate the effect of LLLT on pain relief among patients who have developed COM.

METHOD: The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5-day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm(-2).

ANALYSIS: The results were analysed using the Wilcoxon test.

RESULTS: There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.

STUDY LIMITATIONS: The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect.

IMPLICATIONS FOR NURSING CARE: The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.

Stem Cell

Photobiomodulation with single and combination laser wavelengths on bone marrow mesenchymal stem cells: proliferation and differentiation to bone or cartilage

Fekrazad R^1,², Asefi S³, Eslaminejad MB⁴, Taghiar L⁴, Bordbar S⁴, Hamblin MR^5,^6,⁷. Lasers Med Sci. 2018 Sep 27. doi: 10.1007/s10103-018-2620-8 [Epub ahead of print]

Abstract

Tissue engineering aims to take advantage of the ability of undifferentiated stem cells to differentiate into multiple cell types to repair damaged tissue. Photobiomodulation uses either lasers or light-emitting diodes to promote stem cell proliferation and differentiation. The present study aimed to investigate single and dual combinations of laser wavelengths on mesenchymal stem cells (MSCs). MSCs were derived from rabbit iliac bone marrow. One control and eight laser irradiated groups were designated as Infrared (IR, 810 nm), Red (R, 660 nm), Green (G, 532 nm), Blue (B, 485 nm), IR-R, IR-B, R-G, and B-G. Irradiation was repeated daily for 21 days and cell proliferation, osseous, or cartilaginous differentiation was then measured. RT-PCR biomarkers were SOX9, aggrecan, COL 2, and COL 10 expression for cartilage and ALP, COL 1, and osteocalcin expression for bone. Cellular proliferation was increased in all irradiated groups except G. All cartilage markers were significantly increased by IR and IR-B except COL 10 which was suppressed by IR-B combination. ALP expression was highest in R and IR groups during osseous differentiation. ALP was decreased by combinations of IR with B and with R, and also by G alone. R and B-G groups showed stimulated COL 1 expression; however, COL 1 was suppressed in IR-B, IR-R, and G groups. IR significantly increased osteocalcin expression, but in B, B-G, and G groups it was reduced. Cartilage differentiation was stimulated by IR and IR-B laser irradiation. The effects of single or combined laser irradiation were not clear-cut on osseous differentiation. Stimulatory effects on osteogenesis were seen for R and IR lasers, while G laser had inhibitory effects.

Cardiovascular

Arteriosclerosis

Low Level Laser Therapy in the Treatment of Arteriosclerosis of the Lower Limbs

Attia M.A., EI-Kashef H. Laser center, Alhikmah Hospital, EI-Mansoura, Egypt Physics Department, Faculty of Science, Tanta Egypt

Abstract

Twenty patients with arteriosclerosis in the lower limbs were treated by low level laser therapy with lumbar paravertebral application a 20mW continuous wave He-Ne laser(632nm> and simultaneously a 250mW continuous diode laser (830 nm> was applied transcutaneously to the lumbar region by the scanner for 30 minutes 6 days per week for 2 months. The mean value of percentage of success was 87.2%. The results of the study indicate that low level laser therapy can influence beneficially arteriosclerosis in the lower limbs which is generally difficult to treat.

Introduction
Arteriosclerosis is a chronic obliterative disease affecting the lower portion of the aorta, its main branches and the arteries supplying the extremities. The condition occurs predominantly in patients between the ages of 45 and 70 years. It is present much more frequently in males than in females. It may be caused by an error in the metabolism of lipids (Oliver, 1955). Buck (1959) believed that the abnormal vascularization of the arterial wall has also been proposed as a significant factor in the development of the disease. Also, the Question of heredity as a factor in the pathogenesis of the disease must be raised (McKusick, 1958). The patient complains of pain in the extremities typical of intermittent calculation and difficulty in walking, finally rest pain is experienced particularly at night, characterized by a sensation of coldness or burning, hyperesthesia and tingling (Abramson, 1974). The purpose of the study was to evaluate the efficacy of low power laser in the treatment of arteriosclerosis. Materials and methods Twenty patients with arteriosclerosis of the lower limbs from the out-patient clinic of the General medicine Department of both Tanta University Hospital and Alhikmah Hospital, Mansoura were included in the study. The male to female ratio was 4:1. The ages ranged from 45 to 69 years. The duration of symptoms ranged from one to 8 months (table 1). The patients were experiencing pain in both calf muscles after walking distances (claudication distance) ranging from 200 to 500 meters. Three patients experienced rest pain at night. Clinical examinations revealed palpable walls of superficial arteries, particularly the dorsalis pedis. In the study, the claudication distance was determined for every patient in meters prior to treatment. Control normal individuals within the patients’ age group walked an average of 1500 meters without experiencing calf pain.

Results
Pain was relieved in 16 patients who received 3 to 7 courses of treatment. Eight patients were able to walk 1500 meters without experiencing any pain in the calf muscles, hence their rate of success was 100%. The remaining patients showed improvement from 73% to 95 (table 2). Three patients discontinued treatment for reasons not related to the treatment. One patient, age 69, with 4 months duration and claudication distance of 240 meters showed no improvement after receiving 7 courses of treatment. The mean rate of success was 87.2%.

Discussion
It was not easy to discuss the treatment of arteriosclerosis and only in the last 20 years have advancements been made. Although physical therapy is only part of the total management of arteriosclerosis of the lower limbs, it could play an important role in the management. No references were found in literature concentrating the use of low level laser therapy in the management of arteriosclerosis. This work has shown that low level laser therapy is capable of increasing the circulation in muscles and, with prolonged treatment, a considerable significant improvement in circulation can be achieved in cases of arteriosclerosis. Low level laser therapy not only influences the superficial circulation but also deep circulation. The mechanism of this action is probably due to the sympathetic effect, but it could also be used on the action of normal skin excitation. It can be assumed that apart from the increase in the pain threshold (Nikolova, 1968) and muscular excitation threshold, there is also an increase in the threshold for sympathicus stimulation (Pabst, 1960). By this paravertebral application, we must concede more importance to the sympathicus action, than to the direct action on the vasometer assumed by some authors (Monode, 1951; Zinn, 1956). The results obtained in the treatment of arteriosclerosis by means of low level laser therapy are certainly based on a number of different effects. First, there is sympathetic action. Also, the analgesic action of this type of current deserves special attention, since it is the cause of the subjective improvement which frequently precedes the objective improvement in cases of sever arteriosclerosis when pain is felt while resting. Also, rest pain did not mean the presence of irreversible pathologic change as the three patients with rest pain showed a good degree of improvement. The patient who showed no improvement after 7 courses of treatment may have an irreversible pathologic change and, this age of 69 years may have also contributed to the failure of treatment.

Conclusion
Low level laser therapy may be considered in the treatment of peripheral arteriosclerosis.

Table 1 – Clinical data and claudication distance

No	age	sex	Duration of pain in months	Claudication distance in meters
1.	45	Male	7	250
2.	50	Male	6	300
3.	49	Male	4	Rest pain
4.	55	Female	3	360
5.	54	Male	4	380
6.	60	Male	6	200
7.	58	Male	8	320
8.	69	Male	4	240
9.	63	Male	3	Rest pain
10.	60	Male	4	350
11.	62	Male	3	380
12.	59	Male	4	400
13.	58	Female	5	450
14.	56	Female	6	500
15.	60	Male	7	300
16.	55	Male	2	250
17.	54	Male	1	Rest pain
18.	60	Female	3	350
19.	64	Male	2	300
20.	58	Male	5	260

Table 2 – Claudication distance in metres before treatment and the distance walked without experiencing pain after treatement.

No	Distance before treatment	Distance after treatment	Improvement
1.	250	1300	84%
2.	300	1450	85.8%
3.	Rest pain	1100	73.3%
4.	360	1500	100%
5.	380	1500	100%
6.	200	Discontinued	–
7.	320	1350	87.2%
8.	240	No improvement	0%
9.	Rest pain	1200	80%
10.	350	Discontinued	–
11.	380	1500	100%
12.	400	1500	100%
13.	450	1500	100%
14.	500	1500	100%
15.	300	1500	100%
16.	250	1350	88%
17.	Rest pain	1250	83.3%
18.	350	1500	100%
19.	300	1400	91.6%
20.	260	Discontinued	–

Circulation

Low-level laser therapy accelerates collateral circulation and enhances microcirculation

Ihsan FR. Department of Anatomy, AL-Kindy College of Medicine, University of Baghdad, Iraq. PMID: 15954817 [PubMed – indexed for MEDLINE]

Abstract

OBJECTIVE: To evaluate the efficacy of low-level laser therapy (LLLT) on collateral circulation and microcirculation if a blood vessel is occluded.

BACKGROUND DATA: Investigators have attempted prostaglandin and ultrasound therapy to promote improvements in the vascular bed of deprived tissue after an injury, which may lead to occlusion of the blood vessels.

MATERIALS AND METHODS: Thirty-four adult rabbits were used in this study, two of them considered 0-h reading group, while the rest were divided into two equal groups, with 16 rabbits each: control and those treated with LLLT. Each rabbit underwent two surgical operations; the medial aspect of each thigh was slit, the skin incised and the femoral artery exposed and ligated. The site of the operation in the treated group was irradiated directly following the operation and for 3 d after, one session daily for 10 min/session. The laser system used was a gallium-aluminum-arsenide (Ga-Al-As) diode laser with a wavelength of 904 nm and power of 10 mW. Blood samples collected from the femoral artery above the site of the ligation were sent for examination with high-performance liquid chromatography (HPLC) to determine the levels of adenosine, growth hormone (GH) and fibroblast growth factor (FGF). Tissue specimens collected from the site of the operation, consisting of the artery and its surrounding muscle fibers, were sent for histopathological examination to determine the fiber/capillary (F/C) ratio and capillary diameter. Blood samples and tissue specimens were collected at 4, 8, 12, 16, 20, 24, 48 and 72 h postoperatively from the animals of both groups, control and treated.

RESULTS: Rapid increases in the level of adenosine, GH, and FGF occurred. The F/C ratio and capillary diameter peaked at 12-16 h; their levels declined gradually, reaching normal values 72 h after irradiation in the treated group. Numerous collateral blood vessels proliferated the area, with marked increases in the diameters of the original blood vessels.

CONCLUSIONS: The results indicated that LLLT accelerated collateral circulation and enhanced microcirculation and seemed to be unique in the normalization of the functional features of the injured area, which could lead to occlusion of the regional blood vessels.

Skin

Herpes Simplex

Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection. Results from a randomized double-blind placebo-controlled study

Schindl A¹, Neumann R. J Invest Dermatol. 1999 Aug;113(2):221-3

Abstract

Recurrent infection with herpes simplex virus is a common disease. Recently, alternative therapies have been introduced. Among those, low-intensity laser therapy mainly used for the acceleration of wound healing and in pain therapy has previously been shown to be of benefit in herpes zoster infections. In this study we evaluated the influence of low-intensity laser therapy (wavelength 690 nm, intensity: 80 mW per cm2, dose: 48 J per cm2) in 50 patients with recurrent perioral herpes simplex infection (at least once per month for more than 6 mo) in a randomized, double-blind placebo-controlled trial design. Patients in the laser group received daily irradiations for 2 wk, whereas patients in the placebo group were sham-irradiated. After completion of the laser/sham treatment, patients were asked to return to the Department of Dermatology, University of Vienna Medical School at the time of recurrence. All except two patients completed the study and were monitored for 52 wk. The median recurrence-free interval in the laser-treated group was 37.5 wk (range: 2-52 wk) and in the placebo group 3 wk (range: 1-20 wk). This difference was found to be statistically significant (p < 0.0001; Wilcoxon’s Rank Sum Test). In conclusion, we demonstrated that a total of 10 irradiations with low-intensity laser therapy significantly lowers the incidence of local recurrence of herpes simplex infection. Since this athermic phototherapeutic modality represents a safe, noninvasive treatment, it might be considered as an alternative to established therapeutic regimens in this indication.

Musculoskeletal

Achilles Tendinopathy

Low level laser therapy reduces : Inflammation in activated achilles tendinitis

BJORDAL Jan Magnus ; IVERSEN Vegard ; BRANDAO MARTINS-LOPES Rodrigo Alvaro;
Progress in biomedical optics and imaging ISSN 1605-7422
2006, vol. 7, no26, [Note(s): 31400G.1-61400G.8]
Society of Photo-Optical Instrumentation Engineers, Belligham, ETATS-UNIS (2001) (Revue)

Abstract

Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon.

Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE2 in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test.

Results: PGE2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT.

Conclusion: LLLT can be used to reduce inflammatory musculoskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy

Apostolos Stergioulas, PT, PhD*, Marianna Stergioula, PT*, Reidar Aarskog, PT, MSc , Rodrigo A. B. Lopes-Martins, MPharm, PhD and Jan M. Bjordal, PT, PhD ,||, From the * Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Laconia, Greece, the Institute of Physical Therapy, Bergen University College, Bergen, Norway, the Laboratory of Pharmacology and Phototherapy of Inflammation, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, and the || Section of Physiotherapy Science, Department of Public Health and Primary Care, University of Bergen, Bergen, Norway Address correspondence to Jan M. Bjordal, PT, PhD, Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway (e-mail: jmb@hib.no)

Abstract

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 ( = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 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.

Articular Cartilage

Histological and clinical responses of articular cartilage to low-level laser therapy: Experimental study

I. Ruiz Calatrava, J. M. Santisteban Valenzuela, R. J. Gómez-Villamandos, J. I. Redondo, J. C. Gómez-Villamandos, I. Avila Jurado. June 1997, Volume 12, Issue 2, pp 117–121

Abstract

This study was carried out to evaluate the effects of low-level laser irradiation on experimental lesions of articular cartilage. A standard lesion was practised on the femoral trochlea of both hindlimbs of 20 clinically normal Californian rabbits. These animals were divided into two groups of 10 individuals each, depending on the laser equipment used for treatment. Onc group was treated with He-Ne laser (8 J cm^-2, 632.8 nm wavelength) and the other with infra-red (IR) laser (8 J cm^-2, 904 nm wavelength). In both groups, five points of irradiation to the right limb alone were irradiated per session for a total of 13 sessions, applied with an interval of 24 h between sessions. These points were the following: left and right femoral epicondyles, left and right tibial condyles and the centre of articulation. The distance between these points was approximately 1 cm. The untreated left limb was left as a control. During treatment, extension angle and periarticular thickness were considered. At the end of the treatment, samples were collected for histopathologi-cal study and stained with: Haematoxylin-Eosin, PAS and Done. The results show a statistically higher anti-inflammatory capacity of the IR laser (p < 0.0001). The functional recovery was statistically similar for both treatments (p < 0.176). Histological study showed, at the end of the treatment, hyaline cartilage in the IR group, fibrocartilage in the He-Ne group and granulation tissue in the control limbs. Clinical and histological results indicated that this laser treatment had a clear anti-inflammatory effect that provided a fast recuperation and regeneration of the articular cartilage.

Carpal Tunnel Syndrome

The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies

Dincer U¹, Cakar E, Kiralp MZ, Kilac H, Dursun H. Photomed Laser Surg. 2009 Feb;27(1):119-25. doi: 10.1089/pho.2008.2211

Abstract

OBJECTIVE:

The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS).

BACKGROUND DATA:

CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS.

MATERIALS AND METHODS:

In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography.

RESULTS AND CONCLUSION:

The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.

Chronic Neck Pain

The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study

Chow RT¹, Heller GZ, Barnsley L. Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27

Abstract

A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain. Subjects were randomized to receive a course of 14 treatments over 7 weeks with either active or sham laser to tender areas in the neck. The primary outcome measure was change in a 10 cm Visual Analogue Scale (VAS) for pain. Secondary outcome measures included Short-Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill PainQuestionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS. Measurements were taken at baseline, at the end of 7 weeks’ treatment and 12 weeks from baseline. The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group (difference 3.0, 95% CI 3.8-2.1). Significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI. The results of the SF-36 – Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups. Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.

Neurology

Cerebral Palsy

Efficiency of laser therapy applied in labial traumatism of patients with spastic cerebral palsy

Moreira LA, Santos MT, Campos VF, Genovese WJ.
Laser Disciplines in Dentistry, Implantdontics and Integrated Dentistry Clinic, University of Cruzeiro do Sul (UNICSUL), SÃo Paulo, SP, Brazil. lam@apcd.org.

Abstract

The aim of this study was to report the effectiveness of laser therapy applied to traumatic labial injury of patients with spastic cerebral palsy. We report two cases of patients with internal mucosa and lower lip traumatism caused by oral reflex automatism with spastic tonic bite and lower lip interposition. One patient presented extensive lower lip ulceration, loss of tissue, crusty and hemorrhagic areas, with increasing pain and spasticity. The other patient presented local congestion signs, extremely enlarged tissue growth and increased labial volume. Laser therapy was applied to all injured areas, with a low-potency diode InGaAlP laser [685 nm Quasar (Dentoflex), 190 J/ cm2, with a 24-h interval between the first and second administration, and a 7-day interval between the two subsequent ones. At first re-evaluation, 24 h later, there was a striking reduction in inflammation, a decrease in vascular congestion, and a reduction of the ulcerated area with spasticity and pain reduction. At the 14-day re-evaluation, significant clinical differences in the advanced healing process were seen. Low-intensity laser showed to be effective in traumatic soft tissue treatment in cerebral palsy patients by accelerating the healing process, reducing secondary contamination, promoting analgesia; thus, it can be an important tool in the treatment of these patients.

Nerve Regeneration

Stimulation Effect of Low Level Laser Therapy on Sciatic Nerve Regeneration in Rat

Mashhoudi Barez M¹, Tajziehchi M¹, Heidari MH¹, Bushehri A², Moayer F³, Mansouri N¹, Safavi Naini N⁴, Movafagh A⁴. J Lasers Med Sci. 2017 Summer;8(Suppl 1):S32-S37. doi: 10.15171/jlms.2017.s7. Epub 2017 Aug 29

Abstract

Introduction: Recent studies showed that low-level laser therapy (LLLT) accelerates the regeneration process of injured peripheral nervetissue. The objective of this study was investigate the effect of LLLT (780 nm) on regeneration of injured right sciatic nerve of male Wistar rat.

Methods: In this research work, the effect of LLLT (780 nm) on the regeneration process and reconstruction of injured peripheral right side sciatic nerve was investigated. Twelve adult male Wistar rats underwent surgery in aseptic conditions under general anesthesia to induce a lesion to their right side sciatic nerve according to standard protocol. Before suturing the location, only the experimental group was treated by laser. The damaged nerve was directly irradiated with (2 J, 100 mW, 40 seconds). The irradiation procedure was terminated in 21 days with little improvement (4 J, 200 mW, 40 seconds) across the skin surface of experimental group. Rats were selected randomly from each group to be sacrificed on different periods and histopathological examination was carried out on the extracted nerves.

Results: Significant acceleration of revascularization and angiogenesis of the injury site was observed in the experimental group. Furthermore, a reduction of hemorrhages and increase in blood supply was observed. Also, Wallerian degeneration decreased while higher axonal density compared to the control rats was observed. Moreover, the cross-section analysis of the injured area on the 14th and 21st days as post-surgery showed that the nerve sheath diameter in the lesion area of the experimental group was reduced. While the ratio between thicknesses increased in the control group.

Conclusion: The results of the current study suggest that laser phototherapy at 780 nm exactly could accelerate the regeneration process of injured peripheral nerves tissue.

Male Disease

Male Infertility

Effectiveness of low level laser therapy for treating male infertility

Vladimirovich Moskvin S¹, Ivanovich Apolikhin O². Biomedicine (Taipei). 2018 Jun;8(2):7. doi: 10.1051/bmdcn/2018080207. Epub 2018 May 28

Abstract

In half of the cases, the infertility of the couple is due to the disorder of the male fertility. The leading factors that cause male infertility are urogenital infections, disorders of the immune system, testicular and prostate pathology, as well as endocrine disorders. Low level laser therapy (LLLT) is a very effective physical therapy method, used in many areas of medicine, including obstetrics and gynaecology, andrology and urology; and it is recommended as an integral part of the complex treatment of infertility. The literature review showed that LLLT is beneficial in treating male infertility. Laser can significantly improve the survival, motility and speed of movement of spermatozoa. Lasertherapy of patients with prostatitis and vesiculitis can eliminate infiltrative-exudative changes, improve reproductive and copulatory functions. Local illumination of red (635 nm) and infrared (904 nm) spectra should be combined with intravenous laser blood illumination (ILBI) of red (635 nm) and ultraviolet (UV) (365 nm) spectra.

Female Disease

Lymphedema

Managing postmastectomy lymphedema with low-level laser therapy

Lau RW, Cheing GL. Photomed Laser Surg. 2009 Oct;27(5):763-9

Abstract

OBJECTIVE: We aimed to investigate the effects of low-level laser therapy (LLLT) in managing postmastectomy lymphedema.

BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common complication of breast cancer treatment that causes various symptoms, functional impairment, or even psychosocial morbidity. A prospective, single-blinded, controlled clinical trial was conducted to examine the effectiveness of LLLT on managing PML.

METHODS: Twenty-one women suffering from unilateral PML were randomly allocated to receive either 12 sessions of LLLT in 4 wk (the laser group) or no laser irradiation (the control group). Volumetry and tonometry were used to monitor arm volume and tissue resistance; the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was used for measuring subjective symptoms. Outcome measures were assessed before and after the treatment period and at the 4 wk follow-up.

RESULTS: Reduction in arm volume and increase in tissue softening was found in the laser group only. At the follow-up session, significant between-group differences (all p < 0.05) were found in arm volume and tissue resistance at the anterior torso and forearm region. The laser group had a 16% reduction in the arm volume at the end of the treatment period, that dropped to 28% in the follow-up. Moreover, the laser group demonstrated a cumulative increase from 15% to 33% in the tonometry readings over the forearm and anterior torso. The DASH score of the laser group showed progressive improvement over time.

CONCLUSION: LLLT was effective in the management of PML, and the effects were maintained to the 4 wk follow-up.

Acupuncture

Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial

Hübscher M¹, Vogt L, Ziebart T, Banzer W. Eur J Appl Physiol. 2010 Sep;110(2):353-8. doi: 10.1007/s00421-010-1510-y. Epub 2010 May 25

Abstract

The present study investigated the immediate efficacy of acupuncture compared to sham acupuncture and placebo laser acupuncture on strength performance. A total of 33 recreational athletes (25.2 +/- 2.8 years; 13 women) were randomized to receive acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser acupuncture (deactivated laser device) in a double-blind crossoverfashion with 1 week between trials. Assessment included bipedal drop jumps for maximum rebound height and quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface electromyography (EMG) was used to measure the EMG activity of the rectus femoris muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF) analysis was applied to characterize muscular endurance. Measurements were performed at baseline and immediately after treatment by a blinded investigator. Repeated measures ANOVA and post hoc paired-sample t test with Bonferroni-Holm correction were used for statistical analysis. The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N). ANOVA did not show statistically significant treatment effects for drop jump height or MPF. The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performanceenhancement, but also for rehabilitation programs aimed at restoring neuromuscular function.

Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: Systematic Review

Chang WD¹, Wu JH, Yang WJ, Jiang JA. Photomed Laser Surg. 2010 Jun;28(3):327-36. doi: 10.1089/pho.2009.2558

Abstract

BACKGROUND:

Low-level laser therapy (LLLT) is a conservative treatment for lateral epicondylitis (LE), but it is also an alternative intervention between the very different approaches of Chinese and Western medicine.

OBJECTIVE:

The purpose of this study was to systematically review and meta-analyze the therapeutic effects of LLLT on LE.

METHODS:

We searched several electronic databases, including Medline, PubMed, and CINAHL, and explored studies that were randomized controlled trials on the therapeutic effects of LLLT on LE from 1990 to February 2009. These studies were systematically reviewed for the difference in therapeutic effects among various LLLTs on acupuncture points and on tender and myofascial trigger points (MTrPs). The reviewed therapeutic effects included pain, grip strength, range of motion (ROM), and weight tests, and were compared by meta-analysis.

RESULTS:

We selected ten articles, and in seven of them the irradiation was conducted on tender points or MTrPs in the experimental groups. In two other articles, the irradiation was conducted on acupuncture points, and the last one was conducted on both kinds of points. Only three articles provided sufficient data for meta-analysis. The results revealed that applying LLLT on tender points or MTrPs is an effective means to improve the effect size (ES) of pain release after treatment (pooled ES: 0.71, 95% CI: 0.82- approximately 0.60) and follow-up (pooled ES: 1.05, 95% CI: 1.16- approximately 0.94). LLLT application was also able to increase the grip force, ROM, and weight test (p < 0.05).

CONCLUSIONS:

We suggest that using LLLT on tender points or MTrPs of LE could effectively improve therapeutic effects.

Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial

Gottschling S¹, Meyer S, Gribova I, Distler L, Berrang J, Gortner L, Graf N, Shamdeen MG. Pain. 2008 Jul 15;137(2):405-12. Epub 2007 Nov 19

Abstract

To investigate whether laser acupuncture is efficacious in children with headache and if active laser treatment is superior to placebo lasertreatment in a prospective, randomized, double-blind, placebo-controlled trial of low level laser acupuncture in 43 children (mean age (SD) 12.3 (+/-2.6) years) with headache (either migraine (22 patients) or tension type headache (21 patients)). Patients were randomized to receive a course of 4 treatments over 4 weeks with either active or placebo laser. The treatment was highly individualised based on criteria of Traditional Chinese medicine (TCM). The primary outcome measure was a difference in numbers of headache days between baseline and the 4 months after randomization. Secondary outcome measures included a change in headache severity using a 10 cm Visual Analogue Scale (VAS) for pain and a change in monthly hours with headache. Measurements were taken during 4 weeks before randomization (baseline), at weeks 1-4, 5-8, 9-12 and 13-16 from baseline. The mean number of headaches per month decreased significantly by 6.4 days in the treated group (p<0.001) and by 1.0 days in the placebo group (p=0.22). Secondary outcome measures headache severity and monthly hours with headache decreased as well significantly at all time points compared to baseline (p<0.001) and were as well significantly lower than those of the placebo group at all time points (p<0.001). We conclude that laser acupuncture can provide a significant benefit for children with headache with active laser treatment being clearly more effective than placebo laser treatment.

Ear-Nose-Throat

Chronic Rhinosinusitis

A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis

Naghdi S¹, Ansari NN, Fathali M, Bartley J, Varedi M, Honarpishe R. Physiother Theory Pract. 2013 Nov;29(8):596-603. doi: 10.3109/09593985.2013.775204. Epub 2013 Mar 22

Abstract

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients’ quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp(2) ηp(2) = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.

Tinnitus

Effectiveness of transmeatal low power laser irradiation for chronic tinnitus

Gungor A¹, Dogru S, Cincik H, Erkul E, Poyrazoglu E. Department of Otolaryngology, Haydarpasa Military Hospital, Istanbul, Turkey. J Laryngol Otol. 2008 May;122(5):447-51. Epub 2007 Jul 12.

Abstract

OBJECTIVE:

To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus.

STUDY DESIGN:

Prospective, randomised, double-blind study.

METHODS:

This investigation included 66 ears in 45 patients with chronic unilateral or bilateral tinnitus. A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week. A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement.

RESULTS:

The loudness, duration and degree of annoyance of tinnitus were improved, respectively, in up to 48.8, 57.7 and 55.5 per cent of the patients in the active laser group. No significant improvement was observed in the placebo laser group.

CONCLUSION:

Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus.

Lichen Sclerosus

Diagnosis and Treatment of Lichen Sclerosus

An Update

Susanna K. Fistarol and Peter H. Itin. Department of Dermatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Am J Clin Dermatol. 2013 Feb; 14(1): 27–47. Published online 2012 Dec 14. doi: [10.1007/s40257-012-0006-4]

Abstract

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.