Source

Department of Anatomical sciences and Biology, Medical Faculty, Shahid Beheshti University, MC, PO Box 19395/4719, Tehran, 1985717443, Iran, hamidrr2003@yahoo.com.

Abstract

Diabetes mellitus (DM) is associated with musculoskeletal damage. Investigations have indicated that healing of the surgically tenotomized Achilles tendon was considerably augmented following low-level laser therapy (LLLT) in non-diabetic, healthy animals. The aim of the present study was to evaluate the effect of LLLT on the Achilles tendon healing in streptozotocin-induced diabetic (STZ-D) rats via a biomechanical evaluating method. Thirty-three rats were divided into non-diabetic (n = 18) and diabetic (n = 15) groups. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after STZ injections. The two experimental groups (n = 6 for each group) of non-diabetic rats were irradiated with a helium-neon (He-Ne) laser at 2.9 and 11.5 J/cm(2) for ten consecutive days. The two experimental groups of diabetic rats (n = 5 for each group) were irradiated with a He-Ne laser at 2.9 and 4.3 J/cm(2) for ten consecutive days. The tendons were submitted to a tensiometric test. Significant improvements in the maximum stress (MS) values (Newton per square millimeter) were found following LLLT at 2.9 J/cm(2) in both the non-diabetic (p = 0.031) and diabetic (p = 0.019) experimental groups when compared with their control groups. LLLT at 2.9 J/cm(2) to the tenotomized Achilles tendons in the non-diabetic and diabetic rats significantly increased the strength and MS of repairing Achilles tendons in our study.

Source

Faculty of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran.

Abstract

OBJECTIVES:

A randomized, double-blind, clinical trial study was conducted with the aim of determining the efficacy of adding laser (830 nm) to ultrasound (US) and exercise for the management of shoulder tendonitis.

METHODS:

42 subjects (n=21, in adding laser group and n=21, in US and exercise group) received a course of 10 sessions treatment over one month in the shoulder region. Outcome measures such as Visual Analogue Scale (VAS), Tenderness Severity Scale (TSS), Constant Murley Score (CMS) and Manual Muscle Testing (MMT) were performed before treatment and at the end of 4 weeks treatment. In addition, follow up were performed 2 months after the end of treatment based on the degree of pain improvement.

RESULTS:

VAS, TSS and CMS improved significantly (P=0.001) in both groups, however the muscle strengths only improved significantly in addinglaser group (P< 0.01).

CONCLUSION:

It seems that both protocols of physical therapy interventions were effective in relieving the signs and symptoms of shoulder tendonitis. Furthermore, adding low level laser therapy (LLLT) to the US and exercise was more efficient in improving the muscle strength in patients with shoulder tendonitis over a period of three months. However, it should be emphasized that, the current results might be due to the effects oflaser and exercise instead of laser, us and exercise (as we had no independent group for US).

Source

Unit of Physiotherapy, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar, 28034 Madrid, Spain.

Abstract

BACKGROUND:

Interference is an important feature of the waves. When two or more in phase light waves meet, a new and reinforced wave is generated. Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it.

OBJECTIVE:

To test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of shoulder musculoskeletal pain and associated disability.

DESIGN:

Randomised and single-blind controlled clinical trial.

SETTING:

Physiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital (Madrid).

PARTICIPANTS:

200 patients with shoulder musculoskeletal pain were randomly assigned in two groups, 100 people each.

INTERVENTIONS:

Group I, experimental (n=100) received interferential laser, placing two probes opposite each other over the shoulder joint. Group II, control (n=100) received conventional laser therapy, using a single probe along with a second inactive dummy probe. Lasers used were GaAlAs diode (810 nm, 100 mW), in continuous emission. Laser was applied in contact mode through ten sessions, on 5 shoulder points (7 Joules/point) per session.

MAIN OUTCOME MEASURES:

Visual Analogue Scale (VAS) score and Shoulder Pain Disability index (SPADI), recorded before and after lasertreatment.

RESULTS:

There were no differences between both groups in the reduction of pain, either assessed by VAS scale (median difference=0, 95% CI of the difference =-.6 to .5, p=0.81) or SPADI index (median difference = .4, 95% CI of the difference =-2.9 to 3.8, p=0.80), using the Mann-Whitney U-test. Comparison between the scores recorded before and after the treatment, within each group, showed significant differences for VAS during movement (median difference=3, 95% CI of the difference =2.07 to 4, p<0.001) and SPADI index (median difference=3.5, 95% CI of the difference =2.67 to 3.85, Wilcoxon test, p<0.001), for both groups.

CONCLUSIONS:

In this study, the application of two low level lasers in order to generate interference inside the irradiated tissue showed to be a safe therapy. Both interferential and conventional laser therapy reduced shoulder pain and disability. Nevertheless, differences between them were not detected. Future research in this field could include applying this technique with other laser parameters or application forms.

Copyright © 2011 Chartered Society of Physiotherapy. All rights reserved.

Source

Gnathology Department, School of Dentistry, University of L’Aquila, L’Aquila, Italy. petrucci.ambra@gmail.com

Abstract

AIM:

To assess the scientific evidence on the efficacy of low-level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD).

METHODS:

The databases of PubMed, Science Direct, Cochrane Clinical Trials Register, and PEDro were manually and electronically searched up to February 2010. Two independent reviewers screened, extracted, and assessed the quality of the publications. A meta-analysis- was performed to quantify the pooled effect of LLLT on pain and function in patients with chronic TMD.

RESULTS:

The literature search identified 323 papers without overlap between selected databases, but after the two-phase study selection, only six randomized clinical trials (RCT) were included in the systematic review. The primary outcome of interest was the change in pain from baseline to endpoint. The pooled effect of LLLT on pain, measured through a visual analog scale with a mean difference of 7.77 mm (95% confidence interval [CI]: -2.49 to 18.02), was not statistically significant from placebo. Change from baseline to endpoint of secondary outcomes was 4.04 mm (95% CI 3.06 to 5.02) for mandibular maximum vertical opening; 1.64 mm (95% CI 0.10 to 3.17) for right lateral excursion and 1.90 mm (95% CI: -4.08 to 7.88) for left lateral excursion.

CONCLUSION:

Currently, there is no evidence to support the effectiveness of LLLT in the treatment of TMD.

Source

1 Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University , Prague, Czech Republic .

Abstract

Abstract Objective: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal
disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT. Background data: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients’ lives. Materials and Methods: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of∼0.2 cm(2). Results: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm. Conclusions: Thelaser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of painsymptoms.

Source

Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.

Abstract

Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial.

OBJECTIVE:

To investigate the effectiveness of low-level laser therapy (LLLT) as an adjunct to a program of eccentric exercises for the treatment of Achilles’ tendinopathy.

DESIGN:

Randomized controlled trial with evaluations at baseline and 4, 12, and 52 weeks.

SETTING:

Primary care clinic.

PARTICIPANTS:

Participants with midportion Achilles’ tendinopathy were randomly assigned to 2 groups (LLLT n=20: mean age ± SD, 45.6±9.1y; placebo n=20: mean age ± SD, 46.5±6.4y). The 12-week evaluation was completed by 36 participants (90%), and 33 participants (82.5%) completed the 52-week evaluation.

INTERVENTION:

Both groups of participants performed eccentric exercises over a 3-month period. In addition, they received either an active or placebo application of LLLT 3 times per week for the first 4 weeks; the dose was 3J per point.

MAIN OUTCOME MEASURES:

The primary outcome was the Victorian Institute of Sport Assessment-Achilles’ questionnaire (VISA-A) score at 12 weeks; secondary outcome was a visual analog scale for pain. Outcomes were measured at baseline and 4, 12, and 52 weeks.

RESULTS:

Baseline characteristics exhibited no differences between groups. At the primary outcome point, there was no statistically significant difference in VISA-A scores between groups (P>.05). The difference in VISA-A scores at the 4-week point significantly favored the placebo group (F(1)=6.411, sum of squares 783.839; P=.016); all other outcome scores showed no significant difference between the groups at any time point. Observers were blinded to groupings.

CONCLUSIONS:

The clinical effectiveness of adding LLLT to eccentric exercises for the treatment of Achilles’ tendinopathy has not been demonstrated using the parameters in this study.

Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Source

Dental School, University of Pernambuco, Pernambuco, Brazil, janainasalmos@hotmail.com.

Abstract

The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), doeslow-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

Source

Unit of Physiotherapy, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar, 28034 Madrid, Spain.

Abstract

BACKGROUND:

Interference is an important feature of the waves. When two or more in phase light waves meet, a new and reinforced wave is generated. Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it.

OBJECTIVE:

To test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of shoulder musculoskeletal pain and associated disability.

DESIGN:

Randomised and single-blind controlled clinical trial.

SETTING:

Physiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital (Madrid).

PARTICIPANTS:

200 patients with shoulder musculoskeletal pain were randomly assigned in two groups, 100 people each.

INTERVENTIONS:

Group I, experimental (n=100) received interferential laser, placing two probes opposite each other over the shoulder joint. Group II, control (n=100) received conventional laser therapy, using a single probe along with a second inactive dummy probe. Lasers used were GaAlAs diode (810 nm, 100 mW), in continuous emission. Laser was applied in contact mode through ten sessions, on 5 shoulder points (7 Joules/point) per session.

MAIN OUTCOME MEASURES:

Visual Analogue Scale (VAS) score and Shoulder Pain Disability index (SPADI), recorded before and after lasertreatment.

RESULTS:

There were no differences between both groups in the reduction of pain, either assessed by VAS scale (median difference=0, 95% CI of the difference =-.6 to .5, p=0.81) or SPADI index (median difference = .4, 95% CI of the difference =-2.9 to 3.8, p=0.80), using the Mann-Whitney U-test. Comparison between the scores recorded before and after the treatment, within each group, showed significant differences for VAS during movement (median difference=3, 95% CI of the difference =2.07 to 4, p<0.001) and SPADI index (median difference=3.5, 95% CI of the difference =2.67 to 3.85, Wilcoxon test, p<0.001), for both groups.

CONCLUSIONS:

In this study, the application of two low level lasers in order to generate interference inside the irradiated tissue showed to be a safe therapy. Both interferential and conventional laser therapy reduced shoulder pain and disability. Nevertheless, differences between them were not detected. Future research in this field could include applying this technique with other laser parameters or application forms.

Copyright © 2011 Chartered Society of Physiotherapy. All rights reserved.

 Pubblicato su PubMed a http://www.ncbi.nlm.nih.gov/pubmed/22507365

Source

Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. n.smidt.emgo@med.vu.nl

Abstract

AIM:

To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow.

METHOD:

Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power.

RESULTS:

23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis.

CONCLUSIONS:

Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.

Source

University of Utah School of Medicine, Salt Lake City, Utah.

Abstract

OBJECTIVE:

To systematically review the evidence for the effectiveness of nonoperative interventions in the management of frozen shoulder (adhesive capsulitis).

DATA SOURCES:

The Cochrane Library, PubMed, EMBASE, CINAHL, and Pedro were searched for randomized controlled trials (RCTs) and systematic reviews of interventions for primary adhesive capsulitis (search words included frozen shoulder, shoulder pain, and periarthritis) up to April 2008.

STUDY SELECTION:

Selection criteria required that studies included patients with frozen shoulder; the disorder was not caused by acute trauma or systemic disease; an intervention for treating adhesive capsulitis was evaluated; the outcome measures included pain, function, or recovery and were reported separately for patients in the study with adhesive capsulitis; and the article was written in English, French, German, or Dutch. Two reviewers independently selected relevant studies from the search results and resolved disagreements by consensus. The findings from 5 Cochrane reviews and 18 recent additional RCTs were included.

DATA EXTRACTION:

Information on the study population, interventions, outcome measures, and results was extracted by 1 reviewer and checked by a second. Methodologic quality was assessed independently by 2 reviewers. Heterogeneity of the studies was such that the data could not be quantitatively assessed. The level of evidence was ranked as strong, moderate, limited, or conflicting, depending on the consistency of positive findings and the quality of the RCTs; as no differences in effectiveness found; and as no evidence for the intervention from reviews or RCTs.

MAIN RESULTS:

There was strong evidence in the short term for the effectiveness of intra-articular steroid injections for pain but not range of motion and moderate evidence for steroid injections for pain in the medium term. No differences were found on range of motion between steroid injections and manipulation. There was moderate evidence in favor of arthrographic distension compared with steroid injections in the short term. Among physiotherapy interventions, there was strong evidence in favor of laser therapy compared with placebo in producing a good outcome and some evidence for reduced pain and disability. There was moderate evidence for several mobilization techniques in the short and long term and in combination with exercise. There was moderate evidence in the short term for the effectiveness of oral steroids compared with placebo or no treatment for pain relief and range of motion and for suprascapular nerve block compared with acupuncture, placebo, or steroid injections for painrelief.

CONCLUSIONS:

Pain, range of motion, and overall outcome in adhesive capsulitis were most effectively improved by steroid injections, laser therapy, some mobilization techniques, arthrographic distension, and suprascapular nerve block. Most effects were shown in the short term, although physiotherapy did show effects in the longer term.