I found an interesting article in the American Journal of Sports Medicine on the effects of low-level laser on the treatment of Achilles tendinopathy. I must admit that I am, and have been, an avid user of laser energy. Over the years I have tried at least 5 different light/laser units, ranging from one the size of a closet (that required cool green goggles) to simplistic infrared light therapy. Lately, my laser of choice has been the Vectra Genisys by my friends at Empi and Chattanooga.
Lasers are definitely one of those modalities that are trendy right now. This is actually funny to me as the technology is certainly not new. While many clinicians may think laser treatments are “gimmicks,” I challenge those next time they whip out an ultrasound or TENs unit to show me such overwhelmingly positive documentation of it’s efficacy. To date, there have been more than 2 dozen studies on the use of laser technology on tendinopathies. I can tell you that lasers are gaining huge popularity in professional sports, where everyone is looking for an edge. The problem may arise from the lack of popularity in the USA, and thus the lack of knowledge regarding how best to use this modality, making clinical studies important.
The authors of this study sought to examine the effects of laser treatment in conjunction with standard treatment (including stretching and eccentric exercises) on chronic tendinosis of the Achilles in athletes over an 8 week period. One group performed exercises with laser treatments 2x a week for the first 4 weeks and then 1x a week for the next 4 weeks. Another group performed the same exercises but received a sham laser of the same frequency.
The results of the study overwhelming support the use of the laser for chronic tendinopathies.
The subjects in the laser group showed significantly less pain at the 4, 8, and 12 week marks. Pain was reduced by almost 50%.
Interestingly, the laser group had less pain at 4 weeks than the control group did at 12 weeks. The laser group also had significant less crepitation during palpation, tenderness during palpation, and morning stiffness and also increased their active dorsiflexion range of motion.
Clinical Implications
Laser energy is an effective modality for the treatment of tendonopathies. According to the authors, laser is effective on producing an anti-inflammatory effect and a stimulating effect of the tissue repair process. With more and more studies showing that NSAIDs and steroid injections actually impair the healing of acute injuries, treatments like laser energy should be considered.
The results may be dependent on the settings of your laser. There are many different lasers on the market and I will be the first to say that it can get confusing. The authors of the study made a specific point to mention that they notice the best results with lower power densities. They used a power density of 30 mW/cm2 and a low energy dose of 1.5 J. In laboratory studies with power densities > 50 mW/cm2, fibroblast activity and collagen production have been shown to be inhibited.
By reducing pain, laser energy may also allow a faster return to more aggressive stages of rehabilitation and eventually functional activities. I use laser daily to rehabilitate injuries but also to help repair tissue on my athlete’s “regen days.” My patients have reported subjective improvements, but I truly became a believer when I tried the laser on an open wound. The wound healed faster than any other wound I have treated.
I still believe that we have a lot to learn about the use of laser energy, but we are taking steps in the right direction. Please share your experience with lasers. What model are you using? What injuries have you seen success with laser energy? What settings do you use?
