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Fábio J. Lanferdini, Rodrigo R. Bini, Bruno M. Baroni, Kelli D. Klein, Felipe P. Carpes and Marco A. Vaz

Low-level laser therapy (LLLT) is a phototherapy modality (ie, the use of light energy for therapeutic purposes) used since the 1960s. 1 LLTT is mainly known to help in healing of skin wounds 2 and regeneration of tendon, 3 muscle, 4 and nerve 5 tissues, as well as by its positive effects on

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Andrew T. Doyle, Christine Lauber and Kendra Sabine

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.

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Aimee L. Thornton, Cailee W. McCarty and Mollie-Jean Burgess

Clinical Scenario:

Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.

Focused Clinical Question:

Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?

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Ian A. Mcleod

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Lindsey E. Eberman, Jesse Moore and Timothy Demchak

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Nathan D. Newman and Katie J. Homan

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Nicole McBrier and Jennifer A. Olczak

Edited by Michael G. Dolan

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Douglas S. Johnson

Column-editor : Jeff Allen

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Justin H. Rigby and Austin M. Hagan

McCarrell, Oscar Perez, and Alexander Pina. References 1. Anders JJ . Nomenclature consensus meeting . Paper presented at: North American Association for Light Therapy and World Association of Laser Therapy Joint Meeting ; May 28, 2015 . Arlington, VA . https://www.naalt.org/whitepapers/2014-naalt

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Stephan R. Fisher, Justin H. Rigby, Joni A. Mettler and Kevin W. McCurdy

Clinical Scenario Photobiomodulation therapy (PBMT) is a promising modality that has gained popularity in different areas of medical practice. Previously referred to as low-level laser therapy or light-emitting diode therapy, PBMT has effectively improved muscle performance by increasing exercise