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Research from the LZR7 website & US National Library of Medicine…
The Clinical Efficacy of Low-Power Laser Therapy on Arthritis

The clinical efficacy of low-power laser therapy (lllt) on pain and function in cervical osteoarthritis.Ozdemir F, Birtane M, Kokino S. Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.

Clin Rheumatol 2001;20(3):181-4

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LLLT) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

Laser Therapy Efficacy on Pain and Inflammation

Action of 904 NM Diode Laser in Orthopedics and TraumatologyGiuseppe Tam, M. D. Specialist in Legal/Insurance Medicine, Laser Center Tolmezzo – Italy

Objective: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy.

Summary Background Data: Low power density laser acts on the Prostaglandins synthesis, increasing the change of PGG2 and PGH2 Periossidos into PGI2 (also called Prostaciclyn or Endoprostol). The last one is the main product of the Arachidonic acid into the endothelial cells and into the smooth muscular cells of the vessel walls having a vasodilating and anti-inflammatory action.

Methods: Treatment was carried out on 447 cases and 435 patients (250 women and 185 men) in the period between 20.05.1987 and 31.12.1999. The patients, whose age ranged from 25 to 70, with a mean age of 45 years, were suffering from rheumatic, degenerative and traumatic pathologies as well as cutaneous ulcers. The majority of the patients had been seen by orthopaedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy, with poor results. Two thirds were experiencing acute symptomatic pain, while the others presented a chronic pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength. Frequency of treatment: 1 application per day for 5 consecutive days, followed by a 2-day interval. In the evaluation of the results the following parameters have been considered: disappearance of spontaneous and induced pain, anatomic and functional evaluation of the joints, muscular growth, verbal rating scales, hand dinamometer, patient’s pain diary.

Results: Very good results were achieved especially with cases of symptomatic osteoarthritis of the cervical vertebrae, with sport-related injuries, with epicondylitis, and with cutaneous ulcers; also, last but not of least importance, with cases of osteoarthritis of the coxa.

Conclusions: Treatment with 904 nm diode laser has substantially reduced the symptoms as well as improved the quality of life of the patient, thus postponing the need for surgery.

Fibromyalgia

Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E.Lasers Med Sci. 2002;17(1):57-61

Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomised, single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo laser treatment daily for two weeks except weekends. Both the laser and placebo laser groups were evaluated for the improvement in pain, number of tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In both groups, significant improvements were achieved in all parameters (p < 0.05) except sleep disturbance, fatigue and skinfold tenderness in the placebo laser group (p > 0.05). It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain, muscle spasm, morning stiffness and tender point numbers in favour of laser group after therapy (p < 0.05). None of the participants reported any side effects. Our study suggests that laser therapy is effective on pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia.

Acute Low Back Pain with Radiculopathy

Acute Low Back Pain with Radiculopathy: A Double-Blind, Randomized, Placebo-Controlled StudyKonstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND, Clinic for Rehabilitation, Medical School, Belgrade, Serbia.

Objective: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).

Conclusions: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.

In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial.

Efficiency of laser therapy applied in labial traumatism of patients with spastic cerebral palsy

Moreira LA, Santos MT, Campos VF, Genovese WJ.Laser Disciplines in Dentistry, Implantodontics and Integrated Dentistry Clinic, University of Cruzeiro do Sul (UNICSUL), Sao Paulo, SP, Brazil. lam@apcd.org.br

The aim of this study was to report the effectiveness of laser therapy applied to traumatic labial injury of patients with spastic cerebral palsy. We report two cases of patients with internal mucosa and lower lip traumatism caused by oral reflex automatism with spastic tonic bite and lower lip interposition. One patient presented extensive lower lip ulceration, loss of tissue, crusty and hemorrhagic areas, with increasing pain and spasticity. The other patient presented local congestion signs, extremely enlarged tissue growth and increased labial volume. Laser therapy was applied to all injured areas, with a low-potency diode InGaAlP laser [685 nm Quasar (Dentoflex), 190 J/ cm2, with a 24-h interval between the first and second administration, and a 7-day interval between the two subsequent ones. At first re-evaluation, 24 h later, there was a striking reduction in inflammation, a decrease in vascular congestion, and a reduction of the ulcerated area with spasticity and pain reduction. At the 14-day re-evaluation, significant clinical differences in the advanced healing process were seen. Low-intensity laser showed to be effective in traumatic soft tissue treatment in cerebral palsy patients by accelerating the healing process, reducing secondary contamination, promoting analgesia; thus, it can be an important tool in the treatment of these patients.

Laser Brain Treatment

Vopr Kurotol Fizioter Lech Fiz Kult 2009 Nov-Dec;(6):3-11There is a lot of interest about using low level lasers for the treatment of various types of brain dysfunction and damage. In this Russian study, a combination of low level laser and electrical stimulation was applied to the treatment of 576 patients with neurosurgical problems including the loss of brain function, nervous system lesions of traumatic origin, and vascular problems.

Their approach, they claim, allows brain function to be completely restored, creating normal function in the nervous system. Because there are now a number of well controlled studies documenting brain regeneration with low level laser, it is intriguing to see this continuing steady stream of studies from around the world that demonstrate the safety and efficacy of regenerating brain function with low level laser.

Treating Traumatic Brain Injuries

Photomed Laser Surg 2010 Dec 23It is well known that laser therapy is helpful for all types of pain and soft tissue problems. However, one of the most exciting trends in laser therapy is the use of lasers to heal the brain, nervous system, heart, lungs, and liver. The following two studies demonstrate the value of laser therapy in treating the brain.

In the first study, patient 1 had a traumatic brain injury for 7 years following a motor vehicle accident. 500 milliwatts of Infrared light was applied directly to the patient’s skull. Initially, the patient was only able to work for 20 min. on her computer. After eight weekly treatments, her ability increased to 3 hours! The patient continues to perform nightly home treatments because if she stops treatment for more than 2 weeks, she regresses.

Patient 2 had a history of traumatic brain injuries following a sports accident, a fall and military service. An MRI showed frontal lobe atrophy. Before treatment to her skull, she was on medical disability for 5 months. After 4 months of treatment, medical disability was discontinued and she returned to working full-time as an executive! After 9 months of treatment, tests showed dramatically improved brain function.

At the time of this report, both patients were continuing treatment. The scientists who performed these studies concluded that light therapy to the brain can improve cognition and reduce costs of traumatic brain injury treatment

Can Laser Help a Crushed Sciatic Nerve?

Lasers Med Sci. 2009 Feb 6This study looked at the influence of laser on functional recovery of the sciatic nerve in rats following crushing lesion. With the aim of accelerating the regenerative processes, the objective was to study the influence of gallium-aluminum-arsenide (GaAlAs) laser on functional and histomorphological recovery of the sciatic nerve in rats. The sciatic nerves of 12 Wistar rats were crushed divided into two groups: control and laser therapy. For the latter, GaAlAs laser was utilized, at three equidistant points on the lesion, for 20 days. Comparison of the sciatic functional index (SFI) showed that there was a significant difference only between the pre-lesion value of the laser therapy group and that after the 21st day in the control group. It was concluded that the parameters and methods utilized demonstrated positive results regarding the sciatic nerve improvement over the time period evaluated.

Herniated Discs

Many practitioners use lasers over herniated and inflamed discs. However, there has never been a scientific study that demonstrated accelerated disc healing with LLLT (low level laser therapy). In this study (Biomed Sci Instrument 2008;44:34-40) done at University of Mississippi Medical Center, the researchers investigated the effects of low power laser on the healing process of a traumatized disc in an animal model.The rats received 830 nm wavelength laser treatment for a period of 4 weeks. The results of this study indicated that the discs of the laser treated animals healed more effectively than the sham group. Image analysis revealed that there was more disc formation in the laser irradiated animals than the sham.

increase in discs regeneration and healing following trauma. When researchers describe the results as “remarkable” it is worth watching. This is especially true in light of the research that shows that photons do penetrate deeply into the disc and spinal cord.

Is Laser More Effective Than Splinting with Carpal Tunnel?
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2009 Sep;28(9):1059-65This study published in Clinical Rheumatology (2009 Sep;28(9):1059-65) compared LLLT to splinting. The patients with unilateral, mild, or moderate idiopathic carpal tunnel syndrome (CTS) who experienced symptoms over 3 months were included in the study. The LLLT (low level laser therapy) group received ten sessions of laser therapy and splinting while S group was given only splints.

The grip strength of splinting group was decreased significantly! 23% of the LLLT had full recovery and 57% had partial recovery, while only 4% of the splint group had full recovery. It was concluded that laser therapy was more effective at stimulating nerve recovery than splinting.

The Use of Laser Therapy and Additional Therapeutic Modalities After Arthroscopy of the Knee at Alpine Ski Team

Lilic Alen, physiotherapist; Kozlevcar _ivec Maja, dr. med. spec.fiz.reh.med.; Marcan Radoslav, dr.med., spec.ortop.In the present article we will review different kind of injuries in the alpine ski sport and we will concentrate on the injuries of the ligamentar part of the knees and meniscs in slovenian ski team. After the description of the injuries follows detailed presentation of the rehabilitational procedures from the first day of the injury till the return in to the competition arena. We will try to explain the modalities of the rehabilitational procedures and their influence in the tissues, their main and side effects. Our main attention will be focused to the use of the biostimulative laser of higher power – 1,2 W and wave length of 830 nm and it’s influence on the velocity of recovery in the patients and their success in following competitions.

Laser Can Help Neck and Arm Pain

Pain Med. 2010 Aug;11(8):1169-78There have been a lot of studies showing that laser helps neck pain, but this is the first that shows that it can help neck pain that radiates down the arm.

The objective of this study was to investigate clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain and radiculopathy. Sixty subjects received 15 treatments over 3 weeks with LLLT or placebo. LLLT was applied to the anatomical site of the spinal segment involved. Statistically significant differences between groups were found for intensity of arm pain and for neck range of motion.

Since it has been shown that low level lasers can help regenerate spinal discs and almost all connective tissues, it makes sense that it would help radiculopathy, sciatica, etc.

Laser therapy – a new modality in the treatment of peripheral nerve injuries.

Low-level laser treatment can reduce edema in second degree ankle sprains.

Stergioulas A. Faculty of Human Motion, University of Peloponnese, Attica, Greece. asterg@uop.grJ Clin Laser Med Surg. 2004 Apr;22(2):125-8. PMID: 15165387 [PubMed – indexed for MEDLINE]

OBJECTIVE: Low-level laser therapy (LLLT) has been used for the last few years to treat sports injuries. The purpose of this study was to compare three therapeutic protocols in treating edema in second degree ankle sprains that did not require immobilization with a splint, under placebo-controlled conditions.

MATERIALS AND METHODS: Forty-seven soccer players with second degree ankle sprains, selected at random, were divided into the following groups: The first group (n = 16) was treated with the conventional initial treatment (RICE, rest, ice, compression, elevation), the second group (n = 16) was treated with the RICE method plus placebo laser, and the third group (n = 15) was treated with the RICE method plus an 820-nm GaA1As diode laser with a radiant power output of 40 mW at 16 Hz. Before the treatment, and 24, 48, and 72 h later, the volume of the edema was measured.

RESULTS: A three by three repeated measures ANOVA with a follow up post hoc test revealed that the group treated with the RICE and an 820-nm GaA1As diode laser presented a statistically significant reduction in the volume of the edema after 24 h (40.3 ± 2.4 mL, p < 0.01), 48 h (56.4 ± 3.1 mL, p < 0.002), and 72 h (65.1 ± 4.4 mL, p < 0.001).

CONCLUSIONS: LLLT combined with RICE can reduce edema in second-degree ankle sprains.

Low-power laser treatment in patients with frozen shoulder: preliminary results

Stergioulas A., Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Humam Movement and Quality of Life, Peloponnese University, Sparta, Greece. asterg@uop.grPhotomed Laser Surg. 2008 Apr;26(2):99-105 PMID: 18341417 [PubMed – indexed for MEDLINE]

OBJECTIVE: In this study I sought to test the efficacy of low-power laser therapy (LLLT) in patients with frozen shoulder.

Background Data: The use of low-level laser energy has been recommended for the management of a variety of musculoskeletal disorders.

MATERIALS AND METHODS: Sixty-three patients with frozen shoulder were randomly assigned into one of two groups. In the active laser group (n = 31), patients were treated with a 810-nm Ga-Al-As laser with a continuous output of 60 mW applied to eight points on the shoulder for 30 sec each, for a total dose of 1.8 J per point and 14.4 J per session. In the placebo group (n = 32), patients received placebo laser treatment. During 8 wk of treatment, the patients in each group received 12 sessions of laser or placebo, two sessions per week (for weeks 1-4), and one session per week (for weeks 5-8).

RESULTS: Relative to the placebo group, the active laser group had: (1) a significant decrease in overall, night, and activity pain scores at the end of 4 wk and 8 wk of treatment, and at the end of 8 wk additional follow-up (16 wk post-randomization); (2) a significant decrease in shoulder pain and disability index (SPADI) scores and Croft shoulder disability questionnaire scores at those same intervals; (3) a significant decrease in disability of arm, shoulder, and hand questionnaire (DASH) scores at the end of 8 wk of treatment, and at 16 wk posttreatment; and (4) a significant decrease in health-assessment questionnaire (HAQ) scores at the end of 4 wk and 8 wk of treatment. There was some improvement in range of motion, but this did not reach statistical significance.

CONCLUSIONS: The results suggested that laser treatment was more effective in reducing pain and disability scores than placebo at the end of the treatment period, as well as at follow-up.

Role of Low-Level Laser Therapy in Neurorehabilitation

Javad T. Hashmi, MD, Ying-Ying Huang, MD, Bushra Z. Osmani, MD, Sulbha K. Sharma, PhD, Margaret A. Naeser, PhD, LAc, and Michael R. Hamblin, PhDABSTRACT: This year marks the 50th anniversary of the discovery of the laser. The development of lasers for medical use, which became known as low-level laser therapy (LLLT) or photobiomodulation, followed in 1967. In recent years, LLLT has become an increasingly mainstream modality, especially in the areas of physical medicine and rehabilitation. At first used mainly for wound healing and pain relief, the medical applications of LLLT have broadened to include diseases such as stroke, myocardial infarction, and degenerative or traumatic brain disorders. This review will cover the mechanisms of LLLT that operate both on a cellular and a tissue level. Mitochondria are thought to be the principal photoreceptors, and increased adenosine triphosphate, reactive oxygen species, intracellular calcium, and release of nitric oxide are the initial events. Activation of transcription factors then leads to expression of many protective, anti-apoptotic, anti-oxidant, and pro-proliferation gene products. Animal studies and human clinical trials of LLLT for indications with relevance to neurology, such as stroke, traumatic brain injury, degenerative brain disease, spinal cord injury, and peripheral nerve regeneration, will be covered.

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