The Effects of Low-Level Laser Therapy on Pain Associated With Tendinopathy: A Critically Appraised Topic

Abstract

Clinical Scenario: Tendinopathies plague many active individuals, causing pain and reducing sport activity by decreasing range of motion and strength. There are many modalities that have been used to treat pain associated with chronic inflammation, such as ultrasound, moist heat packs, and electrical stimulation. Low-level laser therapy (LLLT) is one such modality. Potential benefits of managing pain associated with tendinopathies have been investigated using LLLT. Cellular respiration and metabolism are thought to be increased by LLLT acting on the mitochondrial cytochromes. The effects LLLT may have on cellular activity could increase blood flow to progress the healing process by reducing the pain-spasm cycle. The purpose of this critically appraised topic is to identify the clinical effectiveness of LLLT on pain associated with tendinopathy and to identify the parameters used to achieve statistically and clinically relevant pain outcomes. Focused Clinical Question: What is the effect of LLLT on pain associated with tendinopathy? Clinical Bottom Line: Although LLLT significantly decreases pain from baseline, its use may be no better than placebo or traditional treatments such as ultrasound, moist heat packs, electrical stimulation, or therapeutic exercise to reduce pain associated with tendinopathy. Total accumulated joules across the treatment sessions may need to be taken into account as a parameter.

Photobiomodulation effects on Achilles tendon pain: a systematic review and meta-analysis of randomized clinical trials

“…A recent review of the photobiomodulation effect on tendinopathies 19 showed a beneficial effect for the tendinopathies' treatment. However, although they showed a significant decrease in pain from baseline, its use is no better than placebo or traditional treatments such as ultrasound, moist heat packs, electrical stimulation, or therapeutic exercise to reduce pain associated with tendinopathy 19 .…”

“…Two recent systematic reviews verified the photobiomodulation effect on pain in patients with tendinopathies 19,20 . Doyle et al 19 found five relevant studies indicating that photobiomodulation decreases pain from baseline measurements.…”

“…Two recent systematic reviews verified the photobiomodulation effect on pain in patients with tendinopathies 19,20 . Doyle et al 19 found five relevant studies indicating that photobiomodulation decreases pain from baseline measurements. However, from their five included studies, only two studies 21,22 indicated clinical effectiveness in pain when comparing photobiomodulation with placebo treatment.…”

“…However, from their five included studies, only two studies 21,22 indicated clinical effectiveness in pain when comparing photobiomodulation with placebo treatment. Therefore, the inconsistent findings on the photobiomodulation clinical effects to decrease tendinopathy pain may not be warranted 19 . Nevertheless, this systematic review did not perform a meta-analysis and quality of evidence evaluation.…”

Photobiomodulation with low-level laser therapy for treating Achilles tendinopathy: a systematic review and meta-analysis

“…However, the effect of low-level laser therapy appears to be dependent on the use of optimal laser doses, as recommended by the World Association for Laser Therapy. 6,[9][10][11][12] In tendon lesions, inflammation process indicates the start of tissue repair, stimulating cell proliferation and the remodeling of the extracellular matrix. As low-level laser therapy has been reported as a treatment modality that induces tissue restoration, it could help to accelerate the repair process and enhance the tendon healing response.…”