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Therapeutic Modalities

Low level laser therapy for tendinopathy: evidence of a dose-response pattern

Summary:

This review assessed the effects of low-level laser therapy (LLLT) on pain from tendinopathy. The authors concluded that LLLT can reduce pain in subacute and chronic tendinopathy if a valid treatment procedure and location-specific dose is used. Differences among the studies were not examined and only the short-term outcomes were assessed. The authors’ conclusions may not be reliable.

Conclusion:

Thirteen RCTs with sixteen treatment comparisons were included (n approximately 789).

Nine RCTs using optimal laser treatment dose and power density found that LLLT reduced pain in patients with sub-acute and chronic tendinopathy compared with control (WMD 32%, 95% CI: 23, 41).

Nine RCTs using optimal laser treatment dose and power density and 4 RCTs not using optimal treatment parameters found that LLLT reduced pain compared with control (WMD 22%, 95% CI: 5.9, 36.1). There was a statistically significant difference between RCTs using optimal laser treatment dose and power density and those RCTs not using optimal treatment parameters (P<0.001).

The funnel plots suggested there was potential for some publication bias.

Author & Journal:Bjordal JM, et al, Phys Therapy Rev 2001;6:91-99
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The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs.

Summary:

Extracorporeal shockwave therapy (ESWT) has expanded from the original uses of human urinary calculi treatment to veterinary orthopaedic applications. This paper investigates the feasibility and efficacy of treating dogs with osteoarthritis of the stifle joint with ESWT.

Conclusion:

The subjective data provided by client questionnaire did not show significant difference between groups.

Author & Journal:Dahlberg J, et al, Vet Comp Orthop Traumatol 18(3): 147-52, 2005
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In vivo tissue temperature comparison of cryotherapy with and without external compression.

Summary:

To compare the tissue-cooling efficiency of external cryotherapy with and without adjunctive compression.

Conclusion:

Externally applied instant cold packs in a dog model caused local tissue hypothermia that peaked by 20 minutes, persisted for at least 1 hour, and was significantly augmented by adjunctive compression. Further research is needed to evaluate the clinical efficacy and safety of these interventions in the management of acute soft-tissue injuries.

Author & Journal:Barlas D, et al, Ann Emerg Med 28:436-439, 1996
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Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts.

Summary:

It has been reported that lipopolysaccharide (LPS) from periodontal pathogens can penetrate gingival tissues and stimulate the production of prostaglandin E2 (PGE2), which is known as a potent stimulator of inflammation and bone resorption. Although biostimulatory effects of low-level laser irradiation such as anti-inflammatory results have been reported, the physiological mechanism is not yet clarified. The purpose of the present study was to determine the effect of laser irradiation on PGE2 production and cyclooxygenase (COX)-1 and COX-2 gene expression in LPS-challenged human gingival fibroblast (hGF) cells in vitro.

Conclusion:

In conclusion, low-level laser irradiation inhibited PGE2 by LPS in hGF cells through a reduction of COX-2 mRNA level. The findings suggest that low-level laser irradiation may be of therapeutic benefit against the aggravation of gingivitis and periodontitis by bacterial infection.

Author & Journal:Sakurai Y, et al, Eur J Oral Sci 2000;108: 29-34
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The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy.

Summary:

To determine if shock wave therapy (SWT) after tibial plateau leveling osteotomy (TPLO) has a beneficial effect on patellar ligament inflammation assessed by thickening of the ligament and ligament fiber disruption.

Conclusion:

Based on these results, SWT decreases the radiographic signs of patellar ligament desmitis.

Author & Journal:Gallagher A, et al, Vet Surg 41(4):482-485, 2012
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The effect of ice on intra-articular temperature in the knee of the dog.

Summary:

The effect of surface cooling on intra-articular temperature was examined in dogs’ knees.

Conclusion:

We conclude that brief periods of topical cold application to a dog’s knee can induce significant and long lasting depression of intra-articular temperatures and that this is a local effect not dependent on core temperature cooling.

Author & Journal:Bocobo C, et al, Am J Phys Med Rehabil 70(4):181-185, 1991
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Low-level laser therapy induces dose-dependent reduction of TNFalpha levels in acute inflammation.

Summary:

The aim of this study was to investigate if low-level laser therapy (LLLT) can modulate acute inflammation and tumor necrosis factor (TNFalpha) levels.

Conclusion:

LLLT can reduce TNFalpha expression after acute immunocomplex lung injury in rats, but LLLT dose appears to be critical for reducing TNFalpha release.

Author & Journal:Aimbiro F, et al, Photomed Laser Surg 2006;24:33-37
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High energy focused shock wave therapy accelerates bone healing. A blinded, prospective, randomized canine clinical trial.

Summary:

To evaluate the influence of shock wave therapy (SWT) on radiographic evidence of bone healing after tibial plateau leveling osteotomy (TPLO).

Conclusion:

Forty-two dogs (50 stifles) were included in the statistical analysis. No major complications were observed and all osteotomies healed uneventfully. The median healing scores were significantly higher at eight weeks postoperatively for the SWT group compared to the SHAM group for the 10-point (p <0.0002) and 5-point scoring systems (p <0.0001).

Author & Journal:Kieves NR, et al, VCOT. 2015:28:425-432
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Ice reduces edema. A study of microvascular permeability in rats.

Summary:

Ice is applied following a soft-tissue injury on the basis of clinical information. This study investigates the relationship between ice therapy (cryotherapy) and edema by determining microvascular permeability before and after contusion with and without icetherapy and provides data supporting a reduction in edema following cryotherapy.

Conclusion:

The application of ice significantly decreased microvascular permeability following striated muscle contusion. The results of this study demonstrated that microvascular permeability is increased following a contusion coincident with significant leukocyte-endothelial interactions. However, microvascular permeability was significantly reduced following cryotherapy, a treatment demonstrated to reduce the number of rolling and adherent leukocytes. This association suggests that the reduction in edema in injured skeletal muscle following cryotherapy may be due to a reduction in leukocyte-endothelial interactions.

Author & Journal:Deal DN, et al, J Bone Joint Surg 84(9):1573-1578, 2002
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A meta-analysis of the efficacy of laser phototherapy on pain relief.

Summary:

Laser phototherapy has been widely used to relieve pain for more than 30 years, but its efficacy remains controversial. To ascertain the overall effect of phototherapy on pain, we aggregated the literature and subjected the studies to statistical meta-analysis.

Conclusion:

Fifty-two effect sizes were computed from the 22 articles that met the inclusion criteria. The resulting overall mean effect size was highly significant; d = +0.84 (95% confidence interval = 0.44-1.23). The effect size remained significant even when a high outlying d value was conservatively excluded from the analysis; d = +0.66 (95% confidence interval = 0.46-0.86). The fail-safe number associated with the overall treatment effect, that is, the number of additional studies in which phototherapy has negative or no effect on pain needed to negate the overall large effect size of +0.84, was 348.

Author & Journal:Fulop AM, et al, Clin J Pain 2010;26:729-736
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