Page Title
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Cold Laser Therapy
Studies
Treatment of repetitive use carpal tunnel syndrome
Smith CF, Vangsness CT, Anderson T & Good W (1995)
Proceedings SPIE (1995) 2395; 658-661.
In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point
conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated
with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both
groups were subjected to an ergonomically correct eight-point work modification program. A
counterfeit LLLT unit was used in Group A, while an actual LLLT unit was used in Group B.
Groups A and B were statistically significantly different in terms of return to work, conduction study
improvement, and certain range of motion and strength studies.
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Noninvasive laser neurolysis in carpal tunnel syndrome
Weintraub MI, MD, FACP
Muscle Nerve (1997) 20:1029-1031.
The peripheral nervous system is photosensitive providing the scientific rationale for this study,
which determines the efficacy and safety to laser light exposure in 30 cases with CTS. Nine joules
of energy over 5 points (7-15 treatments) reversed CTS in 77% of cases with three-fold
normalization of CMAP. A photobiologic response was seen in 80% of nerves. This unique and
novel approach is cost-effective and will play a role in future management of CTS.
Comparison between low level laser therapy, transcutaneous electro-neural stimulation, visible
incoherent polarised light and placebo in the treatment of lateral epicondylitis: A pilot clinical study
on 120 patients
Simunovic Z and Trobonjaca T
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Lasers in Surgery and Medicine (2002) Supplement 14, Atlanta, Georgia
The aim of this pilot study was to compare the efficacy of Low Level Laser therapy (LLLT),
Transcutaneous Electro-Neural Stimulation (TENS), visible incoherent polarized (VIP) light and
placebo in the treatment of lateral epicondylitis-tennis elbow. The patient population (n=120) was
randomly allocated into four groups according to treatment applied. The therapy lasted three
weeks per each treatment modality, where total number of treatments per patient was twelve
(5+4+3 per three weeks). LLLT was applied as trigger points technique in all patients, using an
infrared diode laser in a dosage of 4 J/point. TENS was applied using gummy plates in the same
sizes and by exactly measuring the amount of mA, mV and Hertz in all patients. VIP light was
applied in a dosage of 4/J.cm2 . Placebo was applied by using a laser device with no active laser
emission. All patients suffered from chronic form of lateral epicondylitis, with x-ray proved no
changes on the cervical spine. The outcome measurement was focused on the level of pain relief,
estimated according to the Visual Analogue Scale (VAS). The results have demonstrated that the
highest percentage of pain relief was achieved in patients treated with LLLT (over 45% of lased
patients reported 90-100% pain relief). The second best pain relief was reported in the group of
patients treated with TENS. None of the patients treated with VIP light reported 90-100% pain
relief. The worst results were reported in placebo group (<20% of average pain relief). This pilot
study indicates epicondylitis compared to other treatments modalities and placebo. Carefully
conducted multicenter, randomized, placebo controlled clinical studies are recommended for
assessing the efficacy of LLLT, TENS and VIP light in the treatment of chronic form of lateral
epicondylitis.
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Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial
Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E.
Lasers in Medical Science (2002) 17(1):57-61.
Low energy lasers are widely used to treat a variety of musculoskeletal conditions including
fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomized,
single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser
therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly
allocated to active (GaAs) laser or placebo laser treatment daily for two weeks except weekends.
Both the laser and placebo laser groups were evaluated for the improvement in pain, number of
tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In
both groups, significant improvements were achieved in all parameters (p<0.05) except sleep
disturbance, fatigue and skinfold tenderness in the placebo laser group (p>0.05). It was found that
there was no significant difference between the two groups with respect to all parameters before
therapy whereas a significant difference was observed in parameters as pain, muscle spasm
morning stiffness and tender point numbers in favour of laser group after therapy (p<0.05). None
of the participants reported any side effects. Our study suggests that laser therapy is effective on
pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and
suggests that this therapy method is a safe and effective way of treatment in the cases with
fibromyalgia.
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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 were clinically and
radiologically diagnosed COA were included in the study. They were randomized 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 finds, 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.
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Low level laser therapy for tendinopathy. Evidence of a dose-response pattern
Bjordal J M, Couppe´ C, Ljunggren E
Physical Therapy Reviews (2001) 6: 91-99
To investigate whether low-level laser therapy can reduce pain from tendinopathy, the authors
performed a review of randomized placebo-controlled trials with laser therapy for tendinopathy.
Validity assessment of each trail was done according 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 trials 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 wereincluded, 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.
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Clinical evaluation of the low intensity laser antialgic action of GaAIAs (wavelength=785 nm) in
the treatment of the temporomandibular disorders
Sanseverino NTM, Sanseverino CAM, Ribeiro MS et al.
Lasers in Medicine and Surgery (2002) Supplement 14, Atlanta, Georgia.
The improved outcome of laser therapy, if higher doses are given, is documented in the study by
Sanseverino 10 patients with pain and limitation of movements of the jaw were treated by 785 nm
GaAIAs laser, dose 45 J/cm2. The joint and tender points in the masticatory and otherwise
involved muscles was applied three times per week during three weeks. A control group of 10
patients was given sham laser therapy. The evaluation was performed through subjective pain
assessment and measurement of the movements of the jaw. There was a significant
improvement in the laser group only.
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Treatment of medial and lateral epicondylitis - tennis and golfer's elbow - with LLLT: a
multicenter double blind, placebo-controlled clinical study on 324 patients.
Simunovic Z, Trobonjaca T, Trobonjaca Z
Journal of Clinical Laser Medicine and Surgery (Jun 1998) 16(3):145-151.
Among the other treatment modalities of medial and lateral epicondylitis, LLLT has been
promoted as a highly successful method. The aim of this clinical study was to assess the efficacy
of LLLT using trigger points (TPs) and scanner application techniques under placebo-controlled
conditions. The current clinical study was completed at two Laser Centers (Locarno, Switzerland
and Opatija, Croatia) as a double-blind, placebo controlled, crossover clinical study. The patient
population (n=324), with either medical epicondylitis (Golfer's elbow; n=50) or lateral epicondylitis
(Tennis elbow; n=274), was recruited. Unilateral cases of either type of epicondylitis (n=283) were
randomly allocated to one of three treatment groups according to the LLLT technique applied: (1)
Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs and scanner technique).
Bilateral cases of either type of epicondylitis (n=41) were subject to crossover, placebo-controlled
conditions. Laser devices used to perform these treatments were infrared (IR) diode laser
(GaAIAs) 830 nm continuous wave for treatment of TPs and He-Ne 632.8 nm combined with IR
diode laser 904 nm, pulsed wave for scanner technique. Energy doses were equally controlled
and measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of
patients. The treatment outcome (pain relief and functional ability) was observed and measured
according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2)
visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; and (5) hand
dynamometer. Total relief of the pain with consequently improved functional ability was achieve in
82% of acute and 66% of chronic cases, all of which were treated by combination of TPs and
scanner technique. The best results were obtained using combination treatment (i.e., TPs and
scanner technique). Good results are obtained from adequate treatment technique correctly
applied, individual energy doses, adequate medical education, clinical experience, and correct
approach of laser therapist. Under-and over irradiation dosage can result in the absence of
positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The data gave further
evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.
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Wound healing of animal and human body sport and traffic accident injuries using low-level
therapy treatment; a randomized clinical study of seventy-four patients with control group.
Simunovic Z, Ivankovich AD, Depolo A.
Journal of Clinical Laser Medicine and Surgery (2000) Apr;18(2):67-73
Background and Objective: The main objective of current animal and clinical studies was to
assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans.
Study Design/Materials and Methods: In the initial part of our research we conducted a
randomized controlled animal study, where we evaluated the effects of laser irradiation on the
healing of surgical wounds on rabbits. The manner of the application of LLLT on the human body
are analogous to those of similar physiologic structure in animal tissue, therefore, this study was
continued on humans. Clinical study was performed on 74 patients with injuries to the following
anatomic locations: ankle and knee, bilaterally, Achilles tendon; epicondylitis; shoulder; wrist;
interphalangeal joints of hands, unilaterally. All patients had had surgical procedure prior to LLLT.
Two types of laser devices were used: infrared diode laser (GaAIAs) 830 nm continuous wave for
treatment of trigger points (TPs) and HeNe 632.8 nm combined with diode laser 904 nm pulsed
wave for scanning procedure. Both were applied as monotherapy during current clinical study. The
results were observed and measured according to the following clinical parameters: redness,
heat, pain, swelling and loss of function, and finally submitted to statistical analysis via chi2 test.
Results: After comparing the healing process between two groups of patients, we obtained the
following results: wound healing was significantly accelerated (25%-35%) in the group of patients
treated with LLLT. Pain relief and functional recovery of patients treated with LLLT were
significantly improved comparing to untreated patients. Conclusion: In addition to accelerated
wound healing, the main advantages of LLLT for postoperative sport-and traffic-related injuries
include prevention of side effects of drugs, significantly accelerated functional recovery, earlier
return to work, training and sport competition compared to the control group of patients, and cost
benefit.
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LLLT with trigger points technique: a clinical study on 243 patients
Simunovic Z
Journal of Clinical Laser Medicine and Surgery (Aug. 1996) 14(4):163-167.
Among the various methods of application techniques in LLLT (He-Ne 632.8 nm visible red or
infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising
"trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of
focal pain points, due to ischemic conditions. The effect of LLT and the results obtained after
clinical treatment of >200 patients (headaches and facial pain, skeletomuscular ailments,
myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, low back and radicular
pain, Achilles tendonitis) to whom the "trigger points" were applied were better than we had ever
expected.. According to clinical parameters, it has been observed that the rigidity decreases, the
mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even
disappears, by movement, too. LLLT improves local microcirculation and it can also improve
oxygen supply to hypoxic cells in the TP areas and at the same time, it can remove the collected
waste products. The normalization of the microcirculation, obtained due to laser applications,
interrupts the "circulus vitiosus" of the origin of the pain and its development (Melzak: muscular
tension->pain->increased tension->increased pain, etc.). Results measured according to
VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. Clinical effectiveness
(success or failure) depends on the correctly applied energy dose - over/under dosage produces
opposite, negative effects on cellular metabolism. We noted no negative effects and the use of
analgesic drugs could be reduced or completely excluded. LLLT can be used as monotherapy or
as a supplementary treatment to other therapeutic procedures for pain treatment.
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Laser-Accelerated
INFLAMMATION/PAIN
REDUCTION AND HEALING
by Richard Martin, BS, CLT
Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. Effect of
laser amplifies more easily in damaged cells and tissue because the particular emitted enzymes
encourage receipt of LLLT treatment.
LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the
author separates those processes categorically for identification.
Acute Inflammation Reduction (flowchart provided in the original article) - After the injury, tissues
initiate a series of biological responses and cellular membrane reactions which manifest in a
combination of edema, inflammation, pain and functional debility. LLLT mediates the situation by:
(1) Stabilization of cellular membrane; (2) Enhancement of molecule ATP production and
synthesis; (3) Stimulated vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4)
Beneficial acceleration of leukocytic activity; (5) Increased Prostaglandin synthesis; (6) Reduction
in Interleukin-1; (7) Enhanced lymphocyte response; (8) Increased angiogenesis; (9) Temperature
modulation; (10) Enhanced superoxide dismutase levels; and (11) Decreased C-reactive protein
and neopterin levels.
Pain Reduction (flowchart provided in the original article) - A body of medical evidence justifies a
conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2)
Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4)
Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6)
Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel
normalization.
Tissue Healing - LLLT enhances wound healing through a series of processes: (1) Enhanced
leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4)
Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7)
Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed
wound tensile strength.
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Thermographic study of Low Level Laser Therapy for Acute-Phase Injury
Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3, 1. Shinano Handicapped
Children`s Hospital Shimosuwa, Nagano, Japan 2. Department of Orthopaedic Surgery, Tokyo
Medical University Shinjuku, Tokyo, Japan 3. Japan Medical Laser Laboratory, Shinanomachi,
Tokyo, Japan
Acute-phase injury is generally treated by localized cooling of the region, and rarely by the active
use of low level laser therapy (LLLT) in Japan. Thermographic studies of acute-phase injury
revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on
the day following the injury, and that skin temperature was high at the site of the trauma and low at
the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the
high temperature zone around the site of trauma fell by 3 degrees on the average, but at the
periphery the low temperature rose by 3 degrees on the average to nearly normal skin
temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis
of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet,
which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful
in treating swelling and edema in acute-phase injury and in accelerating healing of surgical
wounds.
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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
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 metaanalysis of the laser therapy literature further corroborate these
findings.
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Low-energy laser irradiation promotes the survival and cell cycle entry of skeletal muscle
satellite cells.
J Cell Science. 2002; 115: 1461-1469.
Shefer G, Partridge T A, Heslop L et al.
Shefer has demonstrated that HeNe laser can stimulate cell cycle entry and the accumulation of
satellite cells around isolated single fibers, grown under serum-free conditions. It is
demonstrated that laser therapy promotes the survival of muscle fibers and their adjacent cells,
as well as cultured myogenic cells, under serum-free conditions that normally lead to apoptosis.
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The Japanese Experience in Sumo Wrestling
Toshio Ohshiro (1), Katsumi Sasaki (2), Shouhei Yasuda (2), Shunji Fujii (3), Takafumi Ohshiro
(3), Takeo Touno (4), Shigeru Matsumoto (4) 1) Japan Medical Laser Laboratory , 2) Oshiro Clinic,
3) Keio University Dept. of Plast. and Reconst. Surgery, 4) Nihon Sport Science University.
Sumo Wrestling is the only national endorsed sport in Japan. Professional Sumo Wrestlers
belong to the Nihon Sumo Kyokai (Japan Sumo Wrestling Association). Sumo Wrestling meets
bimonthly, 6 times a year. Each Sumo sessions has 15 days where the Wrestlers must wrestle
for 15 consecutive days against 15 different opponents. This national sport is popular and there
are many Sumo Wrestling Teams for all ages. The strongest person from these teams are
recruited to the Nihon Sumo Kyokai and become professional. Most Sumo Wrestlers have some
symptoms such a pain due to prior injuries and their hard training. We recently had the opportunity
to perform Laser Therapy on 6 Sumo Wrestlers who were complaining of various symptoms. We
would like to explain about the removal of those symptoms by LLLT, and how Laser therapy
affected their performance. All 6 performed better both subjectively and objectively while their
symptoms were alleviated by Laser and their winning rate increased following treatment. We will
discuss major and common injuries associated with Sumo Wrestling and the treatment thereof.
We would like to comment on treatment methodology and statistical analysis.
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BIOMODULATORY EFFECTS OF LLLT ON BONE REGENERATION
Antonio L.B. Pinheiro1, Marilia G. Oliveira2, Pedro Paulo M. Martins3, Luciana Maria Pedreira
Ramalho4, Marcos A. Matos de Oliveira5, Aurelício Novaes Júnior and Renata Amadei Nicolau 1
School of Dentistry, Department of Diagnostic and Therapeutics, Universidade Federal da Bahia,
Salvador, BA, 40110-150,Brazil; 2 School of Dentistry, Post-Graduate Program on Oral and
Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS,
Brazil;
3School of Dentistry, University of Pernambuco, Camaragibe, 50000-000,Brazil; 4School of
Dentistry, Laser Center, Universidade Federal da Bahia, Salvador, BA, 40110-150,Brazil; 5Lecture,
Institute of Research and Development (IP&D) Universidade Vale do Paraíba (UNIVAP) - São José
dos Campos,SP, 12244-000, Brazil
Tissue healing is a complex process that involves local and systemic responses. The use of Low
Level Laser Therapy (LLLT) for wound healing has been shown to be effective in modulating both
local and systemic response. Usually the healing process of bone is slower than that of soft
tissues. The effects of LLLT on bone are still controversial as previous reports show different
results. This paper reports recent observations on the effect of LLLT on bone healing. The amount
of newly formed bone after 830nm laser irradiation of surgical wounds created in the femur of rats
was evaluated morphometricaly. Forty Wistar rats were divided into four groups: group A (12
sessions, 4.8J/cm2 per session, 28 days); group C (three sessions, 4.8J/cm2 per session, seven
days). Groups B and D acted as non-irradiated controls. Forty-eight hours after the surgery, the
defects of the laser groups were irradiated transcutaneously with a CW 40mW 830nm diode
laser, (f~1mm) with a total dose of 4.8J/cm2. Irradiation was performed three times a week.
Computerized morphometry showed a statistically significant difference between the areas of
mineralized bone in groups C and D (p=0.017). There was no significant difference between
groups A and B (28 days) (p=0.383). In a second investigation, we determined the effects of LLLT
on bone healing after the insertion of implants. It is known that dental implants need four and six
months period for fixation on the maxillae and on the mandible before receiving loading. Ten male
and female dogs were divided into two groups of five animals that received the implant. Two
animals of each group acted as controls. The animals were sacrificed 45 and 60 days after
surgery. The animals were irradiated three times a week for two weeks in a contact mode with a
CW 40mW 830nm diode laser, (f ~1mm) with a total dose per session of 4.8J/cm2 and a dose
per point of 1.2J/cm2. The results of the SEM study showed better bone healing after irradiation
with the 830nm diode laser. These findings suggest that, under the experimental conditions of the
investigation, the use of LLLT at 830nm significantly improves bone healing at early stages. It is
concluded that LLLT may increase bone repair at early stages of healing.
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ADVANCES IN LASER THERAPY FOR BONE REPAIR
A. Barber 1, JE. Luger 1, A. Karpf 1 , Kh. Salame 2 , B. Shlomi 3, G. Kogan 3, M. Nissan 4, M. Alon
5, and S. Rochkind 2,6.
1Foot & Ankle Unit, Departments of Orthopedic Surgery "B", Departments of 2Neurosurgery, 3Oral
and Maxillofacial Surgery, and 5Rehabilitation, 6Division of Peripheral Nerve Reconstruction, Tel
Aviv Sourasky Medical Center, Tel Aviv University; 4Ben Gurion University, Israel.
During the last decade, it was discovered that low-power laser irradiation has stimulatory effects
on bone cell proliferation and gene expression. The purposes of this review are to analyze the
effects of low- power laser irradiation on bone cells and bone fracture repair, to examine what has
been done so far, and to explore the additional works needed in this area. The studies reviewed
show how laser therapy can be used to enhance bone repair at cell and tissue levels. As noted by
researchers, laser properties, the combinations of wavelength and energy dose need to be
carefully chosen so as to yield bone stimulation.
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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 randomized 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
randomized 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.
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TREATMENT OF MEDIAL AND LATERAL EPICONDYLITIS - TENNIS AND GOLFER¨S ELBOW - WITH
LOW
LEVEL LASER THERAPY: A MILTICENTER, DOUBLE - BLIND, PLACEBO - CONTROLLED CLINICAL
STUDY ON 324 PATIENTS.
Zlatko Simunovic, M.D. F.M.H. (1), Tatjana Trobonjaca, M.D. (2), Zlatko Trobonjaca, M.D. (3). (1)
Pain Clinic, Laser Center, Locarno, Switzerland; (2) Laser Center, Opatija, Croatia; (3) Department
of Physiology and Immunology, Faculty of Medicine, University of Rijeka, Croatia.
Among the other treatment modalities of medial and lateral epicondylitis, Low Level Laser
Therapy (LLLT) has been promoted as highly successful method. The aim of this clinical study
was to determine the efficacy of LLLT on medial and lateral epicondylitis using Trigger Points
(TPs) and scanning application technique under placebo - controlled conditions in two
independent Laser Centers located at Locarno, Switzerland and Opatija, Croatia. Unilateral cases
of either type of epicondylitis (n=283) were randomly allocated to one of three treatment groups
according to the LLLT technique applied: (1) TPs; (2) scanning; (3) combination of TPs and
scanning. Bilateral cases of either type of epicondylitis (n=41) were subject to crossover,
placebo-controlled conditions. Laser devices used in all groups of patients were infrared diode
laser (GaAlAs) 830 nm continuous wave for treatment of TPs and HeNe 632,8 nm combined with
infrared diode laser 904 nm. Pulsed wave for scanning technique. Treatment outcome was
observed and measured according to the following methods: (1) short form McGill's Pain
Questionnaire; (2) Visual Analogue Scales; (3) Verbal Rating Scales; (4) Patient's pain diary; and
(5) hand dynamometer. The result have demonstrated that total relief of pain with consequently
improved functional ability was achieved in 82% of chronic cases all of which were treated by
combination of TPs and scanning technique. The current clinical study provides further evidence
of the efficacy of LLLT in the management of lateral and medial epicondylitis.
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LOW LEVEL LASER THERAPY OF SOFT TISSUE INJURIES UPON SPORT ACTIVITIES AND TRAFFIC
ACCIDENTS: A MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL STUDY ON
132 PATIENTS.
Zlatko Simunovic, M.D., F.M.H. (1), Tatjana Trobonjaca, M.D. (2) (1) Pain Clinic-Laser Center,
Locarno, Switzerland; (2) 2 Laser Center, Opatija, Croatia. (3)
The aim of current multicenter clinical study was to assess to efficacy of Low Level Laser Therapy
(LLLT) in the treatment of sport- and traffic-related soft tissue injuries compared to the placebo
and classical physiotherapeutic procedures. This study was conducted in two centers located in
Locarno, Switzerland (n=94) and Opatija, Croatia (n=38). Two types of irradiation techniques were
used: (1) direct, skin contact technique for treatment of Trigger Points (TPs) where infrared diode
laser (GaAIAs) 830 nm continuous wave was applied; and (2) scanning technique for irradiation of
larger surface area with use of Helium Neon (HeNe) laser 632.8 nm combined with infrared diode
laser 904 nm pulsed wave. Control group of patients was treated with classical physiotherapeutic
procedures. Results were evaluated according to the clinical parameters like: hematoma, edema,
heat, pain and loss of function. All findings were scored and statistically analyzed according to the
chi-square test. The results have demonstrated that the recovery process was accelerated
(35-50%) in 85% of patients treated with LLLT compared to the control group of patients, what is
especially important by professional athletes. The advantages of LLLT observed in this study
appear to be efficient withdrawal of all clinical symptoms, functional recovery, no risks or side
effects, painlessness, good toleration by any age and sex, cost benefit, etc. The results and
advantages obtained proved once again the efficacy of LLLT as new as successful way in the
treatment of soft tissue injuries.
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Biostimulation of human chondrocytes with Ga-Al-As diode laser: 'In vitro' research. Artificial
Cells, Blood Substitutes, and Immobilization Biotechnology.
2000; 28(2):193-201. Morrone G, Guzzardella G A, Tigani D et al.
The aim of the study was to verify the effects of lllt performed with GaAlAs (780 nm, 2500 mW) on
human cartilage cells in vitro. The cartilage sample used for the biostimulation treatment was
taken from the right knee of a 19-year-old patient. After the chondrocytes were isolated and
suspended for cultivation, the cultures were incubated for 10 days. The cultures were divided into
four groups. Groups I, II, III were subject to biostimulation with the following laser parameters:
300J, 1W, 100Hz,10 min. exposure, pulsating emission; 300J, 1W, 300Hz, 10 min. exposure,
pulsating emission; and 300J, 1W, 500Hz, 10 min. exposure, pulsating emission, respectively.
Group IV did not receive any treatment. The laser biostimulation was conducted for five
consecutive days. The data showed good results in terms of cell viability and levels of Ca and
Alkaline Phosphate in the groups treated with laser compared to the untreated group. The results
obtained confirm our previous positive in vitro results that the GaAlAs Laser provides
biostimulation without cell damage.
___________________________________________________________________________
LOW LEVEL LASER THERAPY IN TENDON INJURIES? - A REVIEW OF IN VITRO AND IN VIVO
TRIALS
J.M. Bjordal, C. Couppe University of Bergen, Dept. Physiotherapy Science, Bergen, Norway
Purpose: To investigate the effect of different laser treatment parameters on fibroblast
inflammation and production of collagen fibers.
Material : Controlled in vitro or in vivo trials with low level laser therapy (LLLT) 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. Optimal treatment
parameters regarding timing, treatment frequency, dose and power density at target tissue were
synthesized.
Results : The literature search identified 31 controlled trials with LLLT on collagen tissue. Three in
vitro trials were performed on stretch-induced and inflammation in fibroblast cultures and five in
vitro trials were performed on collagen production. Optimal dose and power density for inhibition
of prostaglandin PGE2 and interleukin 1- beta production was found to be 3.2-6.3 J/cm2 and 5.3
mW/cm2 measured at the target fibroblast cells after 5 days of irradiation. Data on upper range
limits for anti-inflammatory treatment were inconclusive. Optimal dose and power density for
collagen production was found to be in the range 0.2-2.0 J/cm2 and 2 .20 mW/cm2 measured at
the target fibroblast cells. Daily treatment for 2 weeks with optimal parameters yielded a maximum
increase in collagen production of 37%. The results from three in vivo trials showed similar
increase in collagen production. Doses in excess of 4.5 J/cm2 and power densities higher than
30 mW/cm2 inhibited fibroblast metabolism and decreased collagen production.
Conclusion : There is evidence of a dose-response pattern for LLLT in the treatment of tendon
injuries during the proliferative phase of regeneration.
____________________________________________________________________________
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
parameters 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 parameters 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/parameters can be effective
in the treatment of tendinitis.
____________________________________________________________________________
THE USE OF LASER THERAPY AND ADDITIONAL THERAPEUTIC MODALITIES AFTER
ARTHROSCOPY OF THE KNEE AT ALPINE SKI TEAM
Lilic Alen, physiotherapist; 2Kozlevcar _ivec Maja, dr. med. spec.fiz.reh.med.; 3Marcan Radoslav,
dr.med., spec.ortop 1FIZIO, Ilirska Bistrica, Slovenija, 2Iskra Medical, Ljubljana, Slovenija,
3Ortopedska bolni_nica Valdoltra, Slovenija
In the present article we will review different kind of injuries in the alpine ski sport and we will
concentrate on the injuries of the ligamentar part of the knees and meniscs in slovenian ski team.
After the description of the injuries follows detailed presentation of the rehabilitational procedures
from the first day of the injury till the return in to the competition arena. We will try to explain the
modalities of the rehabilitational procedures and their influence in the tissues, their main and side
effects. Our main attention will be focused to the use of the biostimulative laser of higher power -
1,2 W and wave length of 830 nm and it's influence on the velocity of recovery in the patients and
their success in following competitions.
____________________________________________________________________________
Asagai reports on the use of GaAlAs (100 mW) laser treatment in a group of 1000 patients with
cerebral palsy.
The laser reduces muscle spasm and increases the mobility of the muscles. Although the
duration of the LLLT effect was limited to one to several hours, it can be applied in conjunction
with conventional functional therapies, thereby enhancing the effects of the latter. Asagai Y et al.
Application of low reactive-level laser therapy (LLLT) in the functional training of cerebral palsy
patients. Proc. 2nd Congress World Assn for Laser Therapy, Kansas City, September 1998; p.
99-100.
____________________________________________________________________________
Bjordal J M. Low level laser therapy can be effective for tendinitis: a meta-analysis.
A literature search identified 77 randomized clinical trials with LLLT, of which 18 included
tendinitis. Three trials were excluded for lack of placebo control, of which one 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 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
29.5% (19.5-39.0). LLLT with optimal treatment procedure/parameters can be effective in the
treatment of tendinitis.
____________________________________________________________________________
Laser's effect on bone and cartilage change induced by joint immobilization: an experiment
with animal model.
Akai M, Usuba M, Maeshima T, Shirasaki Y, Yasuoka S. Lasers Surg Med. 1997. 21(5): 480-4.
The influence of low-level (810 nm)) laser on bone and cartilage during joint immobilization was
examined with rats' knee model. The hind limbs of 42 young Wistar rats were operated on in order
to immobilize the knee joint. They were assigned to three groups 1 wk after operation; irradiance
3.9 W/cm2, 5.8 W/cm2, and sham treatment. After 6 times of treatment for another 2 wk both hind
legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss
tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused
regions. The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8
W/cm2 therapy. Soft laser treatment may possibly prevent biomechanical changes by
immobilization.
____________________________________________________________________________
LLLT is as well documented as NSAIDs and steroid injections for shoulder tendinitis/bursitis
and epicondylaglia.
The Norwegian physiotherapist Jan M Bjordal published his thesis .Low level laser therapy in
shoulder tendinitis/bursitis, epicondylalgia and ankle sprain. in 1997, at the Division of
Physiotherapy Science, University of Bergen. It has also been published in Physical Therapy
Reviews. 1998; 3: 121-132.
Here is the Conclusion of the thesis: .A systematic review has been performed on the effect of
LLLT for three diagnoses. LLLT was evaluated on similar criteria for methodological
assessments of trials as previously established for medical interventions. No evidence was found
to indicate that randomized controlled trials on LLLT for tendinitis/bursitis of the shoulder, lateral
epicondylalgia and ankle sprains were methodologically inferior to RCTs on medical
interventions. The clinical effects of LLLT were found to be supported by scientific evidence
regarding short (0-4 weeks) and medium term (<3 months) efficacy for subacute or chronic lateral
epicondylitis, and short term efficacy (>3 months) for subacute or chronic lateral epicondylitis, and
short term efficacy (> 3 months) for subacute or chronic shoulder tendinitis/bursitis. The evidence
of effect from LLLT for acute ankle sprain in inconclusive, although there seems to be a slight
tendency in favor of LLLT. Adverse effects of LLLT are rarely seen and only in minor forms
(nausea, headache) compared to medication, where more serious gastrointestinal discomfort or
ulcers are not uncommon. It has also been shown that trials in favor of active treatment had more
treatments per week than the trials showing no difference in effect. In short one could say that
LLLT should be used much in the same way as NSAID are used for short periods of time. Most
trials showing significant effects used an IR 904 nm laser, but some results in favor of IR lasers
with wavelengths of 780, 820 and 830 nm were also observed. Clinical effects of LLLT were best
in subacute conditions. In chronic conditions a higher dosage and more treatments seem to be
needed. The results of the high quality LLLT trials were all in favor of treatment with confidence
intervals not including zero, and the trials came from several different research groups. Evidence
was found to be at the highest or the second highest level depending on what level of clinical
significance is decided according to the classification of Oxman (1994) and McQuay (1997). The
review found little support for the alleged large placebo effects of LLLT. In chronic cases the
placebo effect is probably less that 10%, after the natural history of the complaints is taken into
account..
In the .Summary of discussion on clinical effect estimates for LLLT. the author writes:
.The majority of the included LLLT-trials found significant clinical effect from LLLT. Seven of the
eleven LLLT-trials with acceptable methods included calculations of 95% confidence limits above
zero, and one LLLT-trial on ankle sprain included zero (Axelsen & Bjerno 1993). The clinical effect
estimates from LLLT-trials for shoulder tendinitis/bursitis are similar or higher than for NSAID or
steroid injections. For lateral epicondylalgia estimates for short term clinical effects are similar or
lower for LLLT than for steroid injections, but medium clinical effect estimates are similar or
higher for LLLT. Recurrence of symptoms in lateral epicondylalgia is less likely after LLLT than
after steroid injections. Evidence of clinical effects from ankle sprain is inconclusive. Adverse
effects from LLLT are seldom seen and they appear less serious than for patients treated with
NSAID and steroid injections..
Smith CF, Vangsness CT, Anderson T & Good W (1995)
Proceedings SPIE (1995) 2395; 658-661.
In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point
conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated
with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both
groups were subjected to an ergonomically correct eight-point work modification program. A
counterfeit LLLT unit was used in Group A, while an actual LLLT unit was used in Group B.
Groups A and B were statistically significantly different in terms of return to work, conduction study
improvement, and certain range of motion and strength studies.
____________________________________________________________________________
Noninvasive laser neurolysis in carpal tunnel syndrome
Weintraub MI, MD, FACP
Muscle Nerve (1997) 20:1029-1031.
The peripheral nervous system is photosensitive providing the scientific rationale for this study,
which determines the efficacy and safety to laser light exposure in 30 cases with CTS. Nine joules
of energy over 5 points (7-15 treatments) reversed CTS in 77% of cases with three-fold
normalization of CMAP. A photobiologic response was seen in 80% of nerves. This unique and
novel approach is cost-effective and will play a role in future management of CTS.
Comparison between low level laser therapy, transcutaneous electro-neural stimulation, visible
incoherent polarised light and placebo in the treatment of lateral epicondylitis: A pilot clinical study
on 120 patients
Simunovic Z and Trobonjaca T
____________________________________________________________________________
Lasers in Surgery and Medicine (2002) Supplement 14, Atlanta, Georgia
The aim of this pilot study was to compare the efficacy of Low Level Laser therapy (LLLT),
Transcutaneous Electro-Neural Stimulation (TENS), visible incoherent polarized (VIP) light and
placebo in the treatment of lateral epicondylitis-tennis elbow. The patient population (n=120) was
randomly allocated into four groups according to treatment applied. The therapy lasted three
weeks per each treatment modality, where total number of treatments per patient was twelve
(5+4+3 per three weeks). LLLT was applied as trigger points technique in all patients, using an
infrared diode laser in a dosage of 4 J/point. TENS was applied using gummy plates in the same
sizes and by exactly measuring the amount of mA, mV and Hertz in all patients. VIP light was
applied in a dosage of 4/J.cm2 . Placebo was applied by using a laser device with no active laser
emission. All patients suffered from chronic form of lateral epicondylitis, with x-ray proved no
changes on the cervical spine. The outcome measurement was focused on the level of pain relief,
estimated according to the Visual Analogue Scale (VAS). The results have demonstrated that the
highest percentage of pain relief was achieved in patients treated with LLLT (over 45% of lased
patients reported 90-100% pain relief). The second best pain relief was reported in the group of
patients treated with TENS. None of the patients treated with VIP light reported 90-100% pain
relief. The worst results were reported in placebo group (<20% of average pain relief). This pilot
study indicates epicondylitis compared to other treatments modalities and placebo. Carefully
conducted multicenter, randomized, placebo controlled clinical studies are recommended for
assessing the efficacy of LLLT, TENS and VIP light in the treatment of chronic form of lateral
epicondylitis.
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Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial
Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E.
Lasers in Medical Science (2002) 17(1):57-61.
Low energy lasers are widely used to treat a variety of musculoskeletal conditions including
fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomized,
single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser
therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly
allocated to active (GaAs) laser or placebo laser treatment daily for two weeks except weekends.
Both the laser and placebo laser groups were evaluated for the improvement in pain, number of
tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In
both groups, significant improvements were achieved in all parameters (p<0.05) except sleep
disturbance, fatigue and skinfold tenderness in the placebo laser group (p>0.05). It was found that
there was no significant difference between the two groups with respect to all parameters before
therapy whereas a significant difference was observed in parameters as pain, muscle spasm
morning stiffness and tender point numbers in favour of laser group after therapy (p<0.05). None
of the participants reported any side effects. Our study suggests that laser therapy is effective on
pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and
suggests that this therapy method is a safe and effective way of treatment in the cases with
fibromyalgia.
____________________________________________________________________________
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 were clinically and
radiologically diagnosed COA were included in the study. They were randomized 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 finds, 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.
____________________________________________________________________________
Low level laser therapy for tendinopathy. Evidence of a dose-response pattern
Bjordal J M, Couppe´ C, Ljunggren E
Physical Therapy Reviews (2001) 6: 91-99
To investigate whether low-level laser therapy can reduce pain from tendinopathy, the authors
performed a review of randomized placebo-controlled trials with laser therapy for tendinopathy.
Validity assessment of each trail was done according 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 trials 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 wereincluded, 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.
____________________________________________________________________________
Clinical evaluation of the low intensity laser antialgic action of GaAIAs (wavelength=785 nm) in
the treatment of the temporomandibular disorders
Sanseverino NTM, Sanseverino CAM, Ribeiro MS et al.
Lasers in Medicine and Surgery (2002) Supplement 14, Atlanta, Georgia.
The improved outcome of laser therapy, if higher doses are given, is documented in the study by
Sanseverino 10 patients with pain and limitation of movements of the jaw were treated by 785 nm
GaAIAs laser, dose 45 J/cm2. The joint and tender points in the masticatory and otherwise
involved muscles was applied three times per week during three weeks. A control group of 10
patients was given sham laser therapy. The evaluation was performed through subjective pain
assessment and measurement of the movements of the jaw. There was a significant
improvement in the laser group only.
____________________________________________________________________________
Treatment of medial and lateral epicondylitis - tennis and golfer's elbow - with LLLT: a
multicenter double blind, placebo-controlled clinical study on 324 patients.
Simunovic Z, Trobonjaca T, Trobonjaca Z
Journal of Clinical Laser Medicine and Surgery (Jun 1998) 16(3):145-151.
Among the other treatment modalities of medial and lateral epicondylitis, LLLT has been
promoted as a highly successful method. The aim of this clinical study was to assess the efficacy
of LLLT using trigger points (TPs) and scanner application techniques under placebo-controlled
conditions. The current clinical study was completed at two Laser Centers (Locarno, Switzerland
and Opatija, Croatia) as a double-blind, placebo controlled, crossover clinical study. The patient
population (n=324), with either medical epicondylitis (Golfer's elbow; n=50) or lateral epicondylitis
(Tennis elbow; n=274), was recruited. Unilateral cases of either type of epicondylitis (n=283) were
randomly allocated to one of three treatment groups according to the LLLT technique applied: (1)
Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs and scanner technique).
Bilateral cases of either type of epicondylitis (n=41) were subject to crossover, placebo-controlled
conditions. Laser devices used to perform these treatments were infrared (IR) diode laser
(GaAIAs) 830 nm continuous wave for treatment of TPs and He-Ne 632.8 nm combined with IR
diode laser 904 nm, pulsed wave for scanner technique. Energy doses were equally controlled
and measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of
patients. The treatment outcome (pain relief and functional ability) was observed and measured
according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2)
visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; and (5) hand
dynamometer. Total relief of the pain with consequently improved functional ability was achieve in
82% of acute and 66% of chronic cases, all of which were treated by combination of TPs and
scanner technique. The best results were obtained using combination treatment (i.e., TPs and
scanner technique). Good results are obtained from adequate treatment technique correctly
applied, individual energy doses, adequate medical education, clinical experience, and correct
approach of laser therapist. Under-and over irradiation dosage can result in the absence of
positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The data gave further
evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.
____________________________________________________________________________
Wound healing of animal and human body sport and traffic accident injuries using low-level
therapy treatment; a randomized clinical study of seventy-four patients with control group.
Simunovic Z, Ivankovich AD, Depolo A.
Journal of Clinical Laser Medicine and Surgery (2000) Apr;18(2):67-73
Background and Objective: The main objective of current animal and clinical studies was to
assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans.
Study Design/Materials and Methods: In the initial part of our research we conducted a
randomized controlled animal study, where we evaluated the effects of laser irradiation on the
healing of surgical wounds on rabbits. The manner of the application of LLLT on the human body
are analogous to those of similar physiologic structure in animal tissue, therefore, this study was
continued on humans. Clinical study was performed on 74 patients with injuries to the following
anatomic locations: ankle and knee, bilaterally, Achilles tendon; epicondylitis; shoulder; wrist;
interphalangeal joints of hands, unilaterally. All patients had had surgical procedure prior to LLLT.
Two types of laser devices were used: infrared diode laser (GaAIAs) 830 nm continuous wave for
treatment of trigger points (TPs) and HeNe 632.8 nm combined with diode laser 904 nm pulsed
wave for scanning procedure. Both were applied as monotherapy during current clinical study. The
results were observed and measured according to the following clinical parameters: redness,
heat, pain, swelling and loss of function, and finally submitted to statistical analysis via chi2 test.
Results: After comparing the healing process between two groups of patients, we obtained the
following results: wound healing was significantly accelerated (25%-35%) in the group of patients
treated with LLLT. Pain relief and functional recovery of patients treated with LLLT were
significantly improved comparing to untreated patients. Conclusion: In addition to accelerated
wound healing, the main advantages of LLLT for postoperative sport-and traffic-related injuries
include prevention of side effects of drugs, significantly accelerated functional recovery, earlier
return to work, training and sport competition compared to the control group of patients, and cost
benefit.
____________________________________________________________________________
LLLT with trigger points technique: a clinical study on 243 patients
Simunovic Z
Journal of Clinical Laser Medicine and Surgery (Aug. 1996) 14(4):163-167.
Among the various methods of application techniques in LLLT (He-Ne 632.8 nm visible red or
infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising
"trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of
focal pain points, due to ischemic conditions. The effect of LLT and the results obtained after
clinical treatment of >200 patients (headaches and facial pain, skeletomuscular ailments,
myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, low back and radicular
pain, Achilles tendonitis) to whom the "trigger points" were applied were better than we had ever
expected.. According to clinical parameters, it has been observed that the rigidity decreases, the
mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even
disappears, by movement, too. LLLT improves local microcirculation and it can also improve
oxygen supply to hypoxic cells in the TP areas and at the same time, it can remove the collected
waste products. The normalization of the microcirculation, obtained due to laser applications,
interrupts the "circulus vitiosus" of the origin of the pain and its development (Melzak: muscular
tension->pain->increased tension->increased pain, etc.). Results measured according to
VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. Clinical effectiveness
(success or failure) depends on the correctly applied energy dose - over/under dosage produces
opposite, negative effects on cellular metabolism. We noted no negative effects and the use of
analgesic drugs could be reduced or completely excluded. LLLT can be used as monotherapy or
as a supplementary treatment to other therapeutic procedures for pain treatment.
____________________________________________________________________________
Laser-Accelerated
INFLAMMATION/PAIN
REDUCTION AND HEALING
by Richard Martin, BS, CLT
Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. Effect of
laser amplifies more easily in damaged cells and tissue because the particular emitted enzymes
encourage receipt of LLLT treatment.
LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the
author separates those processes categorically for identification.
Acute Inflammation Reduction (flowchart provided in the original article) - After the injury, tissues
initiate a series of biological responses and cellular membrane reactions which manifest in a
combination of edema, inflammation, pain and functional debility. LLLT mediates the situation by:
(1) Stabilization of cellular membrane; (2) Enhancement of molecule ATP production and
synthesis; (3) Stimulated vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4)
Beneficial acceleration of leukocytic activity; (5) Increased Prostaglandin synthesis; (6) Reduction
in Interleukin-1; (7) Enhanced lymphocyte response; (8) Increased angiogenesis; (9) Temperature
modulation; (10) Enhanced superoxide dismutase levels; and (11) Decreased C-reactive protein
and neopterin levels.
Pain Reduction (flowchart provided in the original article) - A body of medical evidence justifies a
conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2)
Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4)
Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6)
Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel
normalization.
Tissue Healing - LLLT enhances wound healing through a series of processes: (1) Enhanced
leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4)
Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7)
Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed
wound tensile strength.
____________________________________________________________________________
Thermographic study of Low Level Laser Therapy for Acute-Phase Injury
Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3, 1. Shinano Handicapped
Children`s Hospital Shimosuwa, Nagano, Japan 2. Department of Orthopaedic Surgery, Tokyo
Medical University Shinjuku, Tokyo, Japan 3. Japan Medical Laser Laboratory, Shinanomachi,
Tokyo, Japan
Acute-phase injury is generally treated by localized cooling of the region, and rarely by the active
use of low level laser therapy (LLLT) in Japan. Thermographic studies of acute-phase injury
revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on
the day following the injury, and that skin temperature was high at the site of the trauma and low at
the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the
high temperature zone around the site of trauma fell by 3 degrees on the average, but at the
periphery the low temperature rose by 3 degrees on the average to nearly normal skin
temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis
of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet,
which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful
in treating swelling and edema in acute-phase injury and in accelerating healing of surgical
wounds.
____________________________________________________________________________
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
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 metaanalysis of the laser therapy literature further corroborate these
findings.
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Low-energy laser irradiation promotes the survival and cell cycle entry of skeletal muscle
satellite cells.
J Cell Science. 2002; 115: 1461-1469.
Shefer G, Partridge T A, Heslop L et al.
Shefer has demonstrated that HeNe laser can stimulate cell cycle entry and the accumulation of
satellite cells around isolated single fibers, grown under serum-free conditions. It is
demonstrated that laser therapy promotes the survival of muscle fibers and their adjacent cells,
as well as cultured myogenic cells, under serum-free conditions that normally lead to apoptosis.
____________________________________________________________________________
The Japanese Experience in Sumo Wrestling
Toshio Ohshiro (1), Katsumi Sasaki (2), Shouhei Yasuda (2), Shunji Fujii (3), Takafumi Ohshiro
(3), Takeo Touno (4), Shigeru Matsumoto (4) 1) Japan Medical Laser Laboratory , 2) Oshiro Clinic,
3) Keio University Dept. of Plast. and Reconst. Surgery, 4) Nihon Sport Science University.
Sumo Wrestling is the only national endorsed sport in Japan. Professional Sumo Wrestlers
belong to the Nihon Sumo Kyokai (Japan Sumo Wrestling Association). Sumo Wrestling meets
bimonthly, 6 times a year. Each Sumo sessions has 15 days where the Wrestlers must wrestle
for 15 consecutive days against 15 different opponents. This national sport is popular and there
are many Sumo Wrestling Teams for all ages. The strongest person from these teams are
recruited to the Nihon Sumo Kyokai and become professional. Most Sumo Wrestlers have some
symptoms such a pain due to prior injuries and their hard training. We recently had the opportunity
to perform Laser Therapy on 6 Sumo Wrestlers who were complaining of various symptoms. We
would like to explain about the removal of those symptoms by LLLT, and how Laser therapy
affected their performance. All 6 performed better both subjectively and objectively while their
symptoms were alleviated by Laser and their winning rate increased following treatment. We will
discuss major and common injuries associated with Sumo Wrestling and the treatment thereof.
We would like to comment on treatment methodology and statistical analysis.
____________________________________________________________________________
BIOMODULATORY EFFECTS OF LLLT ON BONE REGENERATION
Antonio L.B. Pinheiro1, Marilia G. Oliveira2, Pedro Paulo M. Martins3, Luciana Maria Pedreira
Ramalho4, Marcos A. Matos de Oliveira5, Aurelício Novaes Júnior and Renata Amadei Nicolau 1
School of Dentistry, Department of Diagnostic and Therapeutics, Universidade Federal da Bahia,
Salvador, BA, 40110-150,Brazil; 2 School of Dentistry, Post-Graduate Program on Oral and
Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS,
Brazil;
3School of Dentistry, University of Pernambuco, Camaragibe, 50000-000,Brazil; 4School of
Dentistry, Laser Center, Universidade Federal da Bahia, Salvador, BA, 40110-150,Brazil; 5Lecture,
Institute of Research and Development (IP&D) Universidade Vale do Paraíba (UNIVAP) - São José
dos Campos,SP, 12244-000, Brazil
Tissue healing is a complex process that involves local and systemic responses. The use of Low
Level Laser Therapy (LLLT) for wound healing has been shown to be effective in modulating both
local and systemic response. Usually the healing process of bone is slower than that of soft
tissues. The effects of LLLT on bone are still controversial as previous reports show different
results. This paper reports recent observations on the effect of LLLT on bone healing. The amount
of newly formed bone after 830nm laser irradiation of surgical wounds created in the femur of rats
was evaluated morphometricaly. Forty Wistar rats were divided into four groups: group A (12
sessions, 4.8J/cm2 per session, 28 days); group C (three sessions, 4.8J/cm2 per session, seven
days). Groups B and D acted as non-irradiated controls. Forty-eight hours after the surgery, the
defects of the laser groups were irradiated transcutaneously with a CW 40mW 830nm diode
laser, (f~1mm) with a total dose of 4.8J/cm2. Irradiation was performed three times a week.
Computerized morphometry showed a statistically significant difference between the areas of
mineralized bone in groups C and D (p=0.017). There was no significant difference between
groups A and B (28 days) (p=0.383). In a second investigation, we determined the effects of LLLT
on bone healing after the insertion of implants. It is known that dental implants need four and six
months period for fixation on the maxillae and on the mandible before receiving loading. Ten male
and female dogs were divided into two groups of five animals that received the implant. Two
animals of each group acted as controls. The animals were sacrificed 45 and 60 days after
surgery. The animals were irradiated three times a week for two weeks in a contact mode with a
CW 40mW 830nm diode laser, (f ~1mm) with a total dose per session of 4.8J/cm2 and a dose
per point of 1.2J/cm2. The results of the SEM study showed better bone healing after irradiation
with the 830nm diode laser. These findings suggest that, under the experimental conditions of the
investigation, the use of LLLT at 830nm significantly improves bone healing at early stages. It is
concluded that LLLT may increase bone repair at early stages of healing.
____________________________________________________________________________
ADVANCES IN LASER THERAPY FOR BONE REPAIR
A. Barber 1, JE. Luger 1, A. Karpf 1 , Kh. Salame 2 , B. Shlomi 3, G. Kogan 3, M. Nissan 4, M. Alon
5, and S. Rochkind 2,6.
1Foot & Ankle Unit, Departments of Orthopedic Surgery "B", Departments of 2Neurosurgery, 3Oral
and Maxillofacial Surgery, and 5Rehabilitation, 6Division of Peripheral Nerve Reconstruction, Tel
Aviv Sourasky Medical Center, Tel Aviv University; 4Ben Gurion University, Israel.
During the last decade, it was discovered that low-power laser irradiation has stimulatory effects
on bone cell proliferation and gene expression. The purposes of this review are to analyze the
effects of low- power laser irradiation on bone cells and bone fracture repair, to examine what has
been done so far, and to explore the additional works needed in this area. The studies reviewed
show how laser therapy can be used to enhance bone repair at cell and tissue levels. As noted by
researchers, laser properties, the combinations of wavelength and energy dose need to be
carefully chosen so as to yield bone stimulation.
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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 randomized 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
randomized 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.
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TREATMENT OF MEDIAL AND LATERAL EPICONDYLITIS - TENNIS AND GOLFER¨S ELBOW - WITH
LOW
LEVEL LASER THERAPY: A MILTICENTER, DOUBLE - BLIND, PLACEBO - CONTROLLED CLINICAL
STUDY ON 324 PATIENTS.
Zlatko Simunovic, M.D. F.M.H. (1), Tatjana Trobonjaca, M.D. (2), Zlatko Trobonjaca, M.D. (3). (1)
Pain Clinic, Laser Center, Locarno, Switzerland; (2) Laser Center, Opatija, Croatia; (3) Department
of Physiology and Immunology, Faculty of Medicine, University of Rijeka, Croatia.
Among the other treatment modalities of medial and lateral epicondylitis, Low Level Laser
Therapy (LLLT) has been promoted as highly successful method. The aim of this clinical study
was to determine the efficacy of LLLT on medial and lateral epicondylitis using Trigger Points
(TPs) and scanning application technique under placebo - controlled conditions in two
independent Laser Centers located at Locarno, Switzerland and Opatija, Croatia. Unilateral cases
of either type of epicondylitis (n=283) were randomly allocated to one of three treatment groups
according to the LLLT technique applied: (1) TPs; (2) scanning; (3) combination of TPs and
scanning. Bilateral cases of either type of epicondylitis (n=41) were subject to crossover,
placebo-controlled conditions. Laser devices used in all groups of patients were infrared diode
laser (GaAlAs) 830 nm continuous wave for treatment of TPs and HeNe 632,8 nm combined with
infrared diode laser 904 nm. Pulsed wave for scanning technique. Treatment outcome was
observed and measured according to the following methods: (1) short form McGill's Pain
Questionnaire; (2) Visual Analogue Scales; (3) Verbal Rating Scales; (4) Patient's pain diary; and
(5) hand dynamometer. The result have demonstrated that total relief of pain with consequently
improved functional ability was achieved in 82% of chronic cases all of which were treated by
combination of TPs and scanning technique. The current clinical study provides further evidence
of the efficacy of LLLT in the management of lateral and medial epicondylitis.
____________________________________________________________________________
LOW LEVEL LASER THERAPY OF SOFT TISSUE INJURIES UPON SPORT ACTIVITIES AND TRAFFIC
ACCIDENTS: A MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL STUDY ON
132 PATIENTS.
Zlatko Simunovic, M.D., F.M.H. (1), Tatjana Trobonjaca, M.D. (2) (1) Pain Clinic-Laser Center,
Locarno, Switzerland; (2) 2 Laser Center, Opatija, Croatia. (3)
The aim of current multicenter clinical study was to assess to efficacy of Low Level Laser Therapy
(LLLT) in the treatment of sport- and traffic-related soft tissue injuries compared to the placebo
and classical physiotherapeutic procedures. This study was conducted in two centers located in
Locarno, Switzerland (n=94) and Opatija, Croatia (n=38). Two types of irradiation techniques were
used: (1) direct, skin contact technique for treatment of Trigger Points (TPs) where infrared diode
laser (GaAIAs) 830 nm continuous wave was applied; and (2) scanning technique for irradiation of
larger surface area with use of Helium Neon (HeNe) laser 632.8 nm combined with infrared diode
laser 904 nm pulsed wave. Control group of patients was treated with classical physiotherapeutic
procedures. Results were evaluated according to the clinical parameters like: hematoma, edema,
heat, pain and loss of function. All findings were scored and statistically analyzed according to the
chi-square test. The results have demonstrated that the recovery process was accelerated
(35-50%) in 85% of patients treated with LLLT compared to the control group of patients, what is
especially important by professional athletes. The advantages of LLLT observed in this study
appear to be efficient withdrawal of all clinical symptoms, functional recovery, no risks or side
effects, painlessness, good toleration by any age and sex, cost benefit, etc. The results and
advantages obtained proved once again the efficacy of LLLT as new as successful way in the
treatment of soft tissue injuries.
____________________________________________________________________________
Biostimulation of human chondrocytes with Ga-Al-As diode laser: 'In vitro' research. Artificial
Cells, Blood Substitutes, and Immobilization Biotechnology.
2000; 28(2):193-201. Morrone G, Guzzardella G A, Tigani D et al.
The aim of the study was to verify the effects of lllt performed with GaAlAs (780 nm, 2500 mW) on
human cartilage cells in vitro. The cartilage sample used for the biostimulation treatment was
taken from the right knee of a 19-year-old patient. After the chondrocytes were isolated and
suspended for cultivation, the cultures were incubated for 10 days. The cultures were divided into
four groups. Groups I, II, III were subject to biostimulation with the following laser parameters:
300J, 1W, 100Hz,10 min. exposure, pulsating emission; 300J, 1W, 300Hz, 10 min. exposure,
pulsating emission; and 300J, 1W, 500Hz, 10 min. exposure, pulsating emission, respectively.
Group IV did not receive any treatment. The laser biostimulation was conducted for five
consecutive days. The data showed good results in terms of cell viability and levels of Ca and
Alkaline Phosphate in the groups treated with laser compared to the untreated group. The results
obtained confirm our previous positive in vitro results that the GaAlAs Laser provides
biostimulation without cell damage.
___________________________________________________________________________
LOW LEVEL LASER THERAPY IN TENDON INJURIES? - A REVIEW OF IN VITRO AND IN VIVO
TRIALS
J.M. Bjordal, C. Couppe University of Bergen, Dept. Physiotherapy Science, Bergen, Norway
Purpose: To investigate the effect of different laser treatment parameters on fibroblast
inflammation and production of collagen fibers.
Material : Controlled in vitro or in vivo trials with low level laser therapy (LLLT) 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. Optimal treatment
parameters regarding timing, treatment frequency, dose and power density at target tissue were
synthesized.
Results : The literature search identified 31 controlled trials with LLLT on collagen tissue. Three in
vitro trials were performed on stretch-induced and inflammation in fibroblast cultures and five in
vitro trials were performed on collagen production. Optimal dose and power density for inhibition
of prostaglandin PGE2 and interleukin 1- beta production was found to be 3.2-6.3 J/cm2 and 5.3
mW/cm2 measured at the target fibroblast cells after 5 days of irradiation. Data on upper range
limits for anti-inflammatory treatment were inconclusive. Optimal dose and power density for
collagen production was found to be in the range 0.2-2.0 J/cm2 and 2 .20 mW/cm2 measured at
the target fibroblast cells. Daily treatment for 2 weeks with optimal parameters yielded a maximum
increase in collagen production of 37%. The results from three in vivo trials showed similar
increase in collagen production. Doses in excess of 4.5 J/cm2 and power densities higher than
30 mW/cm2 inhibited fibroblast metabolism and decreased collagen production.
Conclusion : There is evidence of a dose-response pattern for LLLT in the treatment of tendon
injuries during the proliferative phase of regeneration.
____________________________________________________________________________
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
parameters 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 parameters 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/parameters can be effective
in the treatment of tendinitis.
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THE USE OF LASER THERAPY AND ADDITIONAL THERAPEUTIC MODALITIES AFTER
ARTHROSCOPY OF THE KNEE AT ALPINE SKI TEAM
Lilic Alen, physiotherapist; 2Kozlevcar _ivec Maja, dr. med. spec.fiz.reh.med.; 3Marcan Radoslav,
dr.med., spec.ortop 1FIZIO, Ilirska Bistrica, Slovenija, 2Iskra Medical, Ljubljana, Slovenija,
3Ortopedska bolni_nica Valdoltra, Slovenija
In the present article we will review different kind of injuries in the alpine ski sport and we will
concentrate on the injuries of the ligamentar part of the knees and meniscs in slovenian ski team.
After the description of the injuries follows detailed presentation of the rehabilitational procedures
from the first day of the injury till the return in to the competition arena. We will try to explain the
modalities of the rehabilitational procedures and their influence in the tissues, their main and side
effects. Our main attention will be focused to the use of the biostimulative laser of higher power -
1,2 W and wave length of 830 nm and it's influence on the velocity of recovery in the patients and
their success in following competitions.
____________________________________________________________________________
Asagai reports on the use of GaAlAs (100 mW) laser treatment in a group of 1000 patients with
cerebral palsy.
The laser reduces muscle spasm and increases the mobility of the muscles. Although the
duration of the LLLT effect was limited to one to several hours, it can be applied in conjunction
with conventional functional therapies, thereby enhancing the effects of the latter. Asagai Y et al.
Application of low reactive-level laser therapy (LLLT) in the functional training of cerebral palsy
patients. Proc. 2nd Congress World Assn for Laser Therapy, Kansas City, September 1998; p.
99-100.
____________________________________________________________________________
Bjordal J M. Low level laser therapy can be effective for tendinitis: a meta-analysis.
A literature search identified 77 randomized clinical trials with LLLT, of which 18 included
tendinitis. Three trials were excluded for lack of placebo control, of which one 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 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
29.5% (19.5-39.0). LLLT with optimal treatment procedure/parameters can be effective in the
treatment of tendinitis.
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Laser's effect on bone and cartilage change induced by joint immobilization: an experiment
with animal model.
Akai M, Usuba M, Maeshima T, Shirasaki Y, Yasuoka S. Lasers Surg Med. 1997. 21(5): 480-4.
The influence of low-level (810 nm)) laser on bone and cartilage during joint immobilization was
examined with rats' knee model. The hind limbs of 42 young Wistar rats were operated on in order
to immobilize the knee joint. They were assigned to three groups 1 wk after operation; irradiance
3.9 W/cm2, 5.8 W/cm2, and sham treatment. After 6 times of treatment for another 2 wk both hind
legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss
tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused
regions. The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8
W/cm2 therapy. Soft laser treatment may possibly prevent biomechanical changes by
immobilization.
____________________________________________________________________________
LLLT is as well documented as NSAIDs and steroid injections for shoulder tendinitis/bursitis
and epicondylaglia.
The Norwegian physiotherapist Jan M Bjordal published his thesis .Low level laser therapy in
shoulder tendinitis/bursitis, epicondylalgia and ankle sprain. in 1997, at the Division of
Physiotherapy Science, University of Bergen. It has also been published in Physical Therapy
Reviews. 1998; 3: 121-132.
Here is the Conclusion of the thesis: .A systematic review has been performed on the effect of
LLLT for three diagnoses. LLLT was evaluated on similar criteria for methodological
assessments of trials as previously established for medical interventions. No evidence was found
to indicate that randomized controlled trials on LLLT for tendinitis/bursitis of the shoulder, lateral
epicondylalgia and ankle sprains were methodologically inferior to RCTs on medical
interventions. The clinical effects of LLLT were found to be supported by scientific evidence
regarding short (0-4 weeks) and medium term (<3 months) efficacy for subacute or chronic lateral
epicondylitis, and short term efficacy (>3 months) for subacute or chronic lateral epicondylitis, and
short term efficacy (> 3 months) for subacute or chronic shoulder tendinitis/bursitis. The evidence
of effect from LLLT for acute ankle sprain in inconclusive, although there seems to be a slight
tendency in favor of LLLT. Adverse effects of LLLT are rarely seen and only in minor forms
(nausea, headache) compared to medication, where more serious gastrointestinal discomfort or
ulcers are not uncommon. It has also been shown that trials in favor of active treatment had more
treatments per week than the trials showing no difference in effect. In short one could say that
LLLT should be used much in the same way as NSAID are used for short periods of time. Most
trials showing significant effects used an IR 904 nm laser, but some results in favor of IR lasers
with wavelengths of 780, 820 and 830 nm were also observed. Clinical effects of LLLT were best
in subacute conditions. In chronic conditions a higher dosage and more treatments seem to be
needed. The results of the high quality LLLT trials were all in favor of treatment with confidence
intervals not including zero, and the trials came from several different research groups. Evidence
was found to be at the highest or the second highest level depending on what level of clinical
significance is decided according to the classification of Oxman (1994) and McQuay (1997). The
review found little support for the alleged large placebo effects of LLLT. In chronic cases the
placebo effect is probably less that 10%, after the natural history of the complaints is taken into
account..
In the .Summary of discussion on clinical effect estimates for LLLT. the author writes:
.The majority of the included LLLT-trials found significant clinical effect from LLLT. Seven of the
eleven LLLT-trials with acceptable methods included calculations of 95% confidence limits above
zero, and one LLLT-trial on ankle sprain included zero (Axelsen & Bjerno 1993). The clinical effect
estimates from LLLT-trials for shoulder tendinitis/bursitis are similar or higher than for NSAID or
steroid injections. For lateral epicondylalgia estimates for short term clinical effects are similar or
lower for LLLT than for steroid injections, but medium clinical effect estimates are similar or
higher for LLLT. Recurrence of symptoms in lateral epicondylalgia is less likely after LLLT than
after steroid injections. Evidence of clinical effects from ankle sprain is inconclusive. Adverse
effects from LLLT are seldom seen and they appear less serious than for patients treated with
NSAID and steroid injections..
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