Low-Level Laser Therapy for the Treatment of Chronic Tendinopathy

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?

9 replies
  1. mark
    mark says:

    Hi Mike

    I want to buy a laser but am not sure which brand or whether spending an enormous amount is any different from buying a fairly cheap one. Can you recommend any please?

  2. Jeff
    Jeff says:

    I have been using the k-laser for some time now and love the results it provides as a modality. I too find it hard to believe that it can still be viewed as a sham treatment when the research on photobiomodulation and its benefits are significant and many.

  3. Coach Kevin Gendron MS, CSCS
    Coach Kevin Gendron MS, CSCS says:

    Kudos to you Mike for incorporating 3LT into your program/practice….we’ve been using 3LT since 1996 with alarming results with our doc/PT treating everything from shingles to AC separation to other musculoskeletal issues. We recently healed a fractured clavicle returning a star hockey player to the ice in 13 days after twice a day treatments for roughly 12 minutes each session using Erchonia’s Performance Laser. This laser is a helium/neon gas duodiode set at 636 nanometers which appears to be optimal in the literature. We’ve attended workshops through Erchonia with Dr. Donald Chu and Dr. Jeff Spencer (lance armstrongs chiro) who have been lecturing on laser in the US for over a dozen years. Erchonia is a great resource for those interested in Low Level Light. Congrats to you and keep the information coming!!!

    Coach K

  4. Mike Reinold
    Mike Reinold says:

    @Jen, man that sounds like a tough one. The only two things I can think of would be to 1) look away from the Achilles and see if there are biomechanical implications from the kinetic chain that may be causing the true problem, that is why not getting better, just treating symptoms vs treating the problem, this can be anything ranging from weakness/tightness somewhere to even a disc bulge that is causing decreased innervation to the gastroc, or 2) send back to doc!

  5. Anonymous
    Anonymous says:

    Please help! I don't have access to laser tx and I have a patient with achilles tendonopathy who keeps getting worse! I have tried multiple other modalities and exercises, eccentric strengthening, proximal strengthening, manual therapy; every attempt at increasing function result in increased pain and antalgic gait! please advise!!
    Jen Johndrow PT, Northampton MA

  6. Anonymous
    Anonymous says:

    On walt.nu (World assosiation for laser therapy)there are only recomandation for treatment to be under 100 mW/cm2 on certain tendinopathies, including the achilles tendon. Is the recomandations from these studiesonly including other tendinopathies such as for example patellar tendinopathy?

  7. Mike Reinold
    Mike Reinold says:

    @Ravi – you are correct. I was confusing the parameters of this study with another that showed good results in Achilles Tendinosis (Meier JL, Kerkour K. Traitement laser de la tendinite. Med Hyg. 1988;46:907–911.). The authors of the review study stressed that settings should be less than 100 mW/cm2. Others have questioned if it should be below 50 mW/cm2. Treatment time is just an equation based on your settings, so basically irrelevant.

  8. Ravi Lescher
    Ravi Lescher says:

    I'm new to using LLLT (just began working in a clinic with infrared) but wanted to be clear on effective parameters: your synopsis of the study stated 30mW/cm2 and 1.5 joules but the abstract stated they used 60mW/cm2 and 5.4 joules. Which is it? And do you know treatment time in the study? Thanks.

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