Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review.
Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Several treatments are available to treat epicondylitis. Among these are instrumental electrophysical modalities, ranging from ultrasound, extracorporeal shock wave therapy (ESWT), transcutaneous electrical nerve stimulation (TENS) to laser therapy, commonly used to treat epicondylitis.
To present an evidence-based overview of the effectiveness of electrophysical modality treatments for both medial and lateral epicondylitis (LE).
Searches in PubMed, EMBASE, CINAHL and Pedro were performed to identify relevant randomised clinical trials (RCTs) and systematic reviews. Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results.
A total of 2 reviews and 20 RCTs were included, all of which concerned LE. Different electrophysical regimes were evaluated: ultrasound, laser, electrotherapy, ESWT, TENS and pulsed electromagnetic field therapy. Moderate evidence was found for the effectiveness of ultrasound versus placebo on mid-term follow-up. Ultrasound plus friction massage showed moderate evidence of effectiveness versus laser therapy on short-term follow-up. On the contrary, moderate evidence was found in favour of laser therapy over plyometric exercises on short-term follow-up. For all other modalities only limited/conflicting evidence for effectiveness or evidence of no difference in effect was found.
Potential effectiveness of ultrasound and laser for the management of LE was found. To draw more definite conclusions high-quality RCTs examining different intensities are needed as well as studies focusing on long-term follow-up results.
Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment.
Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, 16150, Kelantan, Malaysia, email@example.com.
The need for orthodontic treatment is increasing all the time. As the treatment is time consuming ranging from a year to several years, any method of reducing the period of treatment and increasing the quality of the tissue will be beneficial to patients. The use of non-invasive techniques such as low level laser therapy and low intensity pulsed ultasound in accelerating orthodontic tooth movement are promising. Thus, this overview study will help to generate more understanding about the background information and the possible applications of them in daily orthodontics, depending on previous literature searching for reviews and original research articles.
Photomed Laser Surg. 2012 Jul 10. [Epub ahead of print]
A Comparison of the Low-Level Laser Versus Low Intensity Pulsed Ultrasound on New Bone Formed Through Distraction Osteogenesis.
1 Department of Oral and Maxillofacial Surgery, Kirikkale University Faculty of Dentistry , Kirikkale, Turkey .
Abstract Objective: To assess and compare the effects of low-intensity pulsed ultrasound stimulation (LIPUS) and low-level laser therapy (LLLT) on the bone mineral density (BMD) of bone formed through distraction osteogenesis (DO) using dual energy x-ray absorptiometry (DEXA).
Background data: LIPUS and LLLT are noninvasive supporting treatment concepts used for wound healing. LIPUS has been used to accelerate bone healing through the therapeutic effect arising from piezoelectric and angiogenetic effects on cell membranes. LLLT known as “photobiomodulation” is used in the treatment of soft and hard tissue injuries.
Methods: The study was conducted with 15 New Zealand rabbits randomly divided into three groups of 5 according to treatment, as follows: Group A: DO was performed with no further treatment; Group B: DO was performed followed by 30?mW/cm(2) LIPUS at 1 Mhz for 20?min/day during the distraction period; Group C: DO was performed followed by 25?mW/cm(2) LLLT at 650?nm for 10?min/day during the distraction period. DEXA was used to examine the treated areas prior to surgery and at 30 and 60 days postoperatively.
Results: In the control group, the mean BMD values at both 30 and 60 days postoperatively were below the baseline level, whereas they were above at the same time intervals in the LIPUS group. In the LLLT group, the mean BMD value at 30 days postoperatively was below the baseline level, whereas it was above the baseline level at 60 days postoperatively.
Conclusions: LIPUS and LLLT applied during the distraction period accelerated the DO treatment.
Photomed Laser Surg. 2010 Dec 18. [Epub ahead of print]
Comparative Effects of Low-Intensity Pulsed Ultrasound and Low-Level Laser Therapy on Injured Skeletal Muscle.
Rennó AC, Toma RL, Feitosa SM, Fernandes K, Bossini PS, de Oliveira P, Parizotto N, Ribeiro DA.
1 Department of Biosciences, Federal University of São Paulo (UNIFESP) , Santos, SP, Brazil .
Abstract The main purpose of this study was to compare the effects of low-intensity pulsed ultrasound (US) and low-level laser therapy (LLLT) on injured skeletal muscle after cryolesion by means of histopathological analysis and immunohistochemistry for cyclo-oxygenase-2 (COX-2). Thirty-five male Wistar rats were randomly distributed into four groups: intact control group with uninjured and untreated animals; injured control group with muscle injury and no treatment; LLLT-treated group with muscle injury treated with 830-nm laser; and US-treated group with muscle injury treated with US. Treatments started 24 h postsurgery and were performed during six sessions. LLLT-treated animals presented minor degenerative changes of muscle tissue. Exposure to US reduced tissue injuries induced by cryolesion, but less effectively than LLLT. A large number of COX-2 positive cells were found in untreated injured rats, whereas COX-2 immunoexpression was lower in both LLLT- and US-treated groups. This study revealed that both LLLT and US therapies have positive effects on muscle metabolism after an injury in rats, but LLLT seems to produce a better response.
Lasers Med Sci. 2010 Jun 3. [Epub ahead of print]
Comparative study of the effects of low-intensity pulsed ultrasound and low-level laser therapy on bone defects in tibias in rats.
Fávaro-Pípi E, Feitosa SM, Ribeiro DA, Bossini P, Oliveira P, Parizotto NA, Renno AC.
Department of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luís (SP-310), Km 235, São Carlos, SP, Brazil.
The aim of this study was to investigate and to compare the effects of low intensity ultra-sound (LIPUS) and low-level laser therapy (LLLT) during the process of bone healing by means of histopathological and morphometric analysis. The animals were randomly distributed into three groups of 30 animals each: the control group (bone defect without treatment); the laser-treated group: (bone defect treated with laser), and the LIPUS-treated (bone defect treated with ultrasound). Each group was further divided into three different subgroups (n = 10) and on days 7, 13, and 25 post-injury, rats were killed with an intra-peritoneal injection of general anesthetic. The rats were treated with a 30-mW/cm(2) low-intensity pulsed ultrasound and a 830-nm laser at 50 J/cm(2). The results showed intense new bone formation surrounded by highly vascularized connective tissue presenting a slight osteogenic activity, with primary bone deposition being observed in the group exposed to laser in the intermediary (13 days) and late stages of repair (25 days). This was confirmed by morphometric analysis in which significant statistical differences (p < 0.05) were noticed when compared to the control. No remarkable differences were noticed in the specimens treated with ultrasound with regard to the amount of newly formed bone in comparison to the control group. Taken together, our results indicate that laser therapy improves bone repair in rats as depicted by histopathological and morphometric analysis, mainly at the late stages of recovery. Moreover, it seems that this therapy was more effective than US to accelerate bone healing.
Photomed Laser Surg. 2008 Feb;26(1):6-9.
Comparison between the effect of low-level laser therapy and low-intensity pulsed ultrasonic irradiation in vitro.
Oliveira RF, Oliveira DA, Monteiro W, Zangaro RA, Magini M, Soares CP.
Laboratório de Dinâmica de Compartimento Celular, Instituto de Pesquisa e Desenvolvimento (IP&D), UNIVAP, São José dos Campos, São Paulo, Brazil.
ABSTRACT Objective: The objective of this study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on fibroblast cell culture. Several methods, including ultrasound treatment and LLLT, are being used to facilitate tissue repair and healing processes. Materials and Methods: L929 fibroblast cell cultures were irradiated with low-level laser energy and LIPUS. Cultures irradiated with ultrasound were divided into five groups: group 1: control (did not receive irradiation); group 2: 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 3: 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 4: 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group 5: 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Cultures irradiated with laser energy were divided into three groups: group 1: control (did not receive irradiation); group 2: 6 J/cm(2); and group 3: 50 mJ/cm(2). Each group was irradiated at 24-h intervals, with the following incubation periods post-irradiation: 24, 48, and 72 h; after each irradiation cycle the cultures were analyzed using MTT [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide]. Results: Analysis of results after LLLT and LIPUS demonstrated that the effect of laser therapy on fibroblast cell culture was greater than that of LIPUS (p < 0.05). Conclusion: Results demonstrated that LLLT significantly increased fibroblastic activity more than LIPUS. Therefore, in the first and second phases of tissue repair, laser treatment may be more effective than ultrasound treatment.
J Hand Ther. 2008 Jan-Mar;21(1):63-8.
The Short-term Efficacy of Laser, Brace, and Ultrasound Treatment in Lateral Epicondylitis: A Prospective, Randomized, Controlled Trial.
Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, Oken OF.
Ankara Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Hand Rehabilitation, Ankara, Turkey.
The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.
Clin Tech Small Anim Pract. 2007 Nov;22(4):160-5.
Veterinary Orthopedic and Sports Medicine Group, Ellicott City, MD 21042, USA. firstname.lastname@example.org
Physical rehabilitation modalities such as therapeutic ultrasound (TU), transcutaneous electrical neuromuscular stimulation (TENS), neuromuscular electrical stimulation (NMES), cold or low-level laser therapy (LLLT), and pulsed magnetic field therapy (PMF) can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions brought about by normal aging in our small animal companions. TU uses sound waves to produce both thermal and nonthermal effects that aid in tissue healing, repair, and function. TENS uses different frequencies of electrical current to decrease pain and inflammation. NMES also uses an electrical current to stimulate muscle contraction to assist in normal neuromuscular function in postorthopedic and neurological injuries. LLLT uses light energy to reduce pain, decrease inflammation, and stimulate healing at a cellular level. PMF uses magnetic field to stimulate normal cellular ion exchange and oxygen utilization and promote generalized healing of tissues. These modalities are discussed in detail covering mechanism of action, parameters, settings, and indications/contraindications of use in our small animals. Although these modalities are important in the physical rehabilitation of small animals, they need to be incorporated with a proper diagnosis, manual therapy, and home exercise program into a specific and individualized patient treatment protocol.
Photomed Laser Surg. 2006 Dec;24(6):735-40.
Comparative study of how low-level laser therapy and low-intensity pulsed ultrasound affect bone repair in rats.
Lirani-Galvão AP, Jorgetti V, da Silva OL.
Bioengineering Department, University of São Paulo, São Paulo, Brazil. email@example.com
OBJECTIVE: This study aimed to compare the consequences of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on bone repair. BACKGROUND DATA: Many studies have assessed the effects of LLLT and LIPUS on bone repair, but a comparison of them is rare. METHODS: Male Wistar rats (n = 48) with tibial bone osteotomy were used. One group had the osteotomized limb treated with LLLT (GaAlAs laser, 780 nm, 30 mW, 112.5 J/cm(2)) and the second group with LIPUS (1.5 MHz, 30 mW/cm(2)), both for 12 sessions (five times per week); a third group was the control. After 20 days, rats were sacrificed and had their tibias submitted to a bending test or histomorphometric analysis. RESULTS: In the bending test, maximum load at failure of LLLT group was significantly higher (p < 0.05). Bone histomorphometry revealed a significant increase in osteoblast number and surface, and osteoid volume in the LLLT group, and a significant increase in eroded and osteoclast surfaces in the LIPUS group. CONCLUSION: LIPUS enhanced bone repair by promoting bone resorption in the osteotomy area, while LLLT accelerated this process through bone formation.
Lasers Surg Med. 2004;35(1):84-9.
Comparison of the effects of laser, ultrasound, and combined laser + ultrasound treatments in experimental tendon healing.
Demir H, Menku P, Kirnap M, Calis M, Ikizceli I.
Erciyes University Medical Faculty, Department of Physical Medicine & Rehabilitation, Kayseri, Turkey. firstname.lastname@example.org
BACKGROUND AND OBJECTIVE: Therapeutic ultrasound (US) and laser (L) treatments accelerate and facilitate wound healing, and also have beneficial effects on tendon healing. This randomized control study was designed to evaluate the effects of low-intensity US and low-level laser therapy (LLLT) on tendon healing in rats.
STUDY DESIGN/MATERIALS AND METHODS: Eighty-four healthy male Swiss-Albino rats were divided into three groups consisting of 28 rats, the left Achilles tendons were used as treatment and the right Achilles tendons as controls. The right and left Achilles tendons of rats were traumatized longitudinally. The treatment was started on postinjury day one. We applied the treatment protocols including low-intensity US treatment in Group I (US Group), Sham US in Group II (SUS Group), LLLT in Group III (L Group), Sham L in Group IV (SL Group), US and LLLT in Group V (US + L Group), and Sham US and Sham L in Group VI (SUS + SL Group). The US treatment was applied with a power of 0.5 W/cm2, a frequency of 1 MHz, continuously, 5 minutes daily. A low-level Ga-As laser was applied with a 904 nm wavelength, 6 mW average power, 1 J/ cm2 dosage, 16 Hz frequency, for 1 minute duration, continuously. In the control groups, the similar procedures as in the corresponding treatment groups were applied with no current (Sham method). The treatment duration was planned for 9 days (sessions) in all groups, except the rats used for biochemical evaluation on the 4th day of treatment, which were treated for 4 days. We measured the levels of the tissue hydroxyproline for biochemical evaluation on the 4th, 10th, and 21st days following the beginning of treatment and the tendon breaking strength on the 21st day following the beginning of treatment for biomechanical evaluation. Seven rats in each group were killed on the 4th, 10th, and 21st days for biochemical evaluation and on the 21st day for biomechanical evaluation.
RESULTS: The hydroxyproline levels were found to be significantly increased in the treatment groups on the 10th and 21st days compared to their control groups (P < 0.05). In comparison of the treatment groups on the 4th, 10th, and 21st days of the treatment, the levels of tissue hydroxyproline were found to be more increased in combined US+L Group compared with US Group and L Group, but the difference was not significant (P > 0.05). In comparison of the tendon breaking strengths, it was found as significantly increased in the treatment groups compared with their control groups (P < 0.05), although there was no significant difference between the treatment groups.
CONCLUSIONS: Although US, L, and combined US + L treatments increased tendon healing biochemically and biomechanically more than the control groups, no statistically significant difference was found between them. Also we did not find significantly more cumulative positive effects of combined treatment. As a result, both of these physical modalities can be used successfully in the treatment of tendon healing.
Australas Chiropr Osteopathy. 1998 Jul;7(2):53-67.
A critical review of the current conservative therapies for tennis elbow (lateral epicondylitis).
The pathogenesis, pathology, natural course, and in particular the treatment of lateral epicondylitis (tennis elbow) remains controversial. An extensive review of the scientific literature with respect to the conservative treatment of tennis elbow, revealed that acceptable epidemiological techniques of the prospective randomised control trials or case controlled studies are scarce. While administration of steroid compounds has traditionally been the mainstay of conservative treatment of tennis elbow, the high recurrence rate of side effects and structural tissue changes associated with steroid therapy, leaves this modality as the most controversial approach in the treatment of tennis elbow. In contrast, in some studies evidence in favour of a role for classical acupuncture, ultrasound and low level laser as effective therapeutic means in the treatment of tennis elbow has been provided. As these modalities have not been associated with any side effects, in view of the ease of application, low cost and good curative effects, their increased application has been suggested by some authors. This proposition, however, remains rather conjectural until it could be convincingly substantiated by future studies with appropriate epidemiological design.