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Three Part Question

IN [adults with chronic tendonitis] IS [laser beneficial] AT [decreasing pain and improving function]?

Clinical Scenario

A 29 year old patient presents with a 3 month history of supraspinatus tendonitis. You are planning to use a form of electrotherapy but the patient mentions that he had laser for a similar problem in his tendo Achilles that seemed to help. You wonder if it will apply to a tendon in another part of the body.

Search Strategy

MEDLINE 1966-10/04, CINAHL 1982 –10/04, AMED 1985-09/04, SPORTDiscus 1830-09/04, EMBASE 1996-09/04, via the OVID interface. In addition the Cochrane Library Issue 4, 2004 and the PEDro database were also searched.
Medline, CINHAL, AMED, SPORTDiscus, EMBASE: [{(exp tendonitis OR tendinosis.mp OR tendinopathy.mp)} OR "jumper's knee".mp] AND [(low level laser.mp OR low level laser therapy.mp OR laser therapy.mp OR therapeutic laser.mp) LIMIT to human AND English language.
Cochrane: (Laser therapy OR therapeutic laser) AND (exercise therapy OR therapeutic exercise) AND (musculoskeletal injury).

Search Outcome

Altogether 5 papers including 1 systematic review were found. A further paper was also found in conference proceedings via a personal communication making a total of 7 papers. Of the 6, one was a commentary on the systematic review. The conference proceedings paper was laser therapy to shoulder trigger points, not tendonitis and so was considered irrelevant. All the papers found predated the systematic review so this is presented in the table only.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Bjordal JM et al, 2001, Norway	12 placebo controlled RCTs with subacute/chronic tendonitis. N = 687	Systematic review (1a)	% improvement in pain over placebo. Effect v size plots. Laser v placebo plots	Including 3 trials with no or worse effect of laser over placebo (n=12) pooled mean effect = 21% (95% CI, 5.9-36.1) in favour of laser over placebo. Excluding these 3 trials (n=9) Pooled mean effect 32% (95% CI 23-41) in favour of laser v placebo	Only analyses pain as outcome, but states this in methods

Comment(s)

The systematic review is the most recent paper concerning low level laser therapy on tendinopathy and seems to favour its use over placebo in decreasing the pain associated with tendonitis. It comments that the use of laser therapy is dependent on power density and dose applied and the pooled mean effects will alter when studies do not meet optimal irradiation doses.

Clinical Bottom Line

Laser therapy is superior to placebo in reducing pain of chronic tendinopathy by about 32%.

References

1. Bjordal JM, Couppe,C, Ljunggren AE. Low level laser therapy for tendinopathy. evidence of a dose response pattern. Phys Ther Reviews 2001;6:91-99.