Mobile Physio In-Home Rehabilitation Specialist in the Greater Toronto Area
Ask a physiotherapist (647) 390-6998

by Max Kovler, PT Reg. (ON) for Mobile Physio:

Lateral elbow tendinopathy is a common disorder which commonly results from overstrain of the tendons of the muscles of the lateral elbow, typically during activities involving strong gripping such as tennis; hence the term ‘tennis elbow’.  The condition is largely self-limiting, but symptoms can take a long time to resolve (often between 6 and 24 months) [1].Exercise therapy and stretching exercises are a mainstay of physiotherapy, but physical interventions such as laser therapy are also commonly used.  Although the sparse evidence makes it difficult to assess the separate effect of strengthening exercises or stretching [2], studies have found that either exercises alone [3], or in conjunction with physiotherapy are more effective than wait-and-see controls. Also exercise therapy, particularly eccentric exercises, have been found effective in tendon disorders in other body parts [4-7].

LLLT is a non-invasive treatment and refers to the use of low-power levelor “cold” lasers; this in contrast to traditional lasers that are used surgically for making incisions in tissue.  The low absorption of laser light by human skin allows deep penetration of the light energy.  Many lab studies have been published indicating that LLLT can stimulate healing in soft tissue injuries and wounds as well asreduce pain.  However, while it is widely accepted that light has a positive effect on the function of cells, the translation of the results fromlaboratory trials to real patients has been more difficult, with many experiments showing benefits and others showing little or no effect. Studies have used an extensive variety of both types of equipment as well as many different treatment parameters.   Currently there is a lack of standardization regarding the dose, number of treatments or the length of treatment. For these reasons a number of insurance carriers (e.g. Aetna) have published guidelines which consider treatment with LLLT to be experimental or investigational.

Bjordal et al. (2008) conducted a systematic review of the use of LLLT in lateral elbow pain which included 13 randomized controlled trials, with a total of 730 patients (8-20). Out of 13 published trials, four found that LLLT was not effective, but nine trials did find that LLT made a difference.  However, the treatment parameters were important, with studies using specific wavelengths (820, 830, and 1064 nm), and those irradiating acupuncture points tending to get negative results.  Studies that used the 904 nm lasers, in which the tendons were directly irradiated, and where the dose was between 0.5 and 7.2 J had better results.  However, the improvement of the laser treated groups over-and-above those that received sham-therapy was quite small (e.g. 10-20% better, on average) and thus of questionable clinical value.  Generally, the treatment was very well tolerated, with no adverse effects reported.

The positive results for combining LLLT of 904 nm wavelength with an exercise regimen were also encouraging.  The results showed an added value in terms of a more rapid recovery.  Adding LLLT to regimens with eccentric and stretching exercises reduced recovery time by 4 and 8 weeks in two trials (10, 16).

Reach Max at max.kovler@mobilephysio.ca or (647) 390-6998.

REFERENCES

1. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M: Prevalence anddeterminants of lateral and medial epicondylitis: a population study. Am J Epidemiol2006, 164(11):1065-74.

2. Smidt N, Assendelft WJ, Arola H, Malmivaara A, Greens S, Buchbinder R, et al.: Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med 2003, 35(1):51-62.

3. Pienimäki TT, Tarvainen TK, Siira PT, Vanharanta H: Progressive Strengthening and Stretching Exercises and Ultrasound for Chronic Lateral Epicondylitis. Physiotherapy 1996, 82(9):522-530.

4. Visnes H, Bahr R: The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med 2007, 41(4):217-23.

5. van Tulder M, Malmivaara A, Koes B: Repetitive strain injury. Lancet 2007, 369(9575):1815-22.

6. Woodley BL, Newsham-West RJ, Baxter GD: Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med 2007, 41(4):188-98. discussion 199.

7. Kingma JJ, de Knikker R, Wittink HM, Takken T: Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2007, 41(6):e3

8. Haker E, Lundeberg T: Laser treatment applied to acupuncture points in lateral humeral epicondylagia: a double – blind study. Pain 1990, 43:243-247.

9. Lundeberg T, Haker E, Thomas M: Effect of laser versus placebo in tennis elbow. Scand J Rehabil Med 1987, 19:135-8.

10. Stergioulas A: Effects of low-level laser and plyometric exercises in the treatment of lateral epicondylitis. Photomed Laser Surg2007, 25(3):205-13.

11. Haker E, Lundeberg T: Is low-energy laser treatment effective in lateral epicondylalgia ?Journal of Pain and Symptom Management 1991, 6(4):241-246.

12. Løgdberg-Andersson M, Mutzell S, Hazel Å: Low level laser therapy of tendinitis and myofascial pain. A randomiseddoubleblind controlled study. Laser Therapy 1997, 9:79-86.

13. Gudmundsen J, Vikne J: Laserbehandlingavepicondylitishumeriogrotatorcuffsyndrom. Nor TidskrIdrettsmed1987,2:6-15.

14. Papadopoulos ES, Smith RW, Cawley MID, Mani R: Low-level laser therapy does not aid the management of tennis elbow. ClinRehabil1996, 10:9-11.

15. Palmieri B: Stratified double blind crossover study on tennis elbow in young amateur athletes using infrared lasertherapy. Medical Laser Report 1984, 1:1.

16. Lam LK, Cheing GL: Effects of 904-nm Low-Level Laser Therapy in the Management of Lateral Epicondylitis: A Randomized Controlled Trial. Photomed Laser Surg2007, 25(2):65-71.

17. Vasseljen O Jr, Hoeg N, Kjeldstad B, Johnsson A, Larsen S: Low level laser versus placebo in the treatment of tennis elbow. Scand J Rehabil Med 1992, 24(1):37-42.

18. Krasheninnikoff M, Ellitsgaard N, Rogvi-Hansen B, Zeuthen A, Harder K, Larsen R, et al.: No effect of low power laser in lateral epicondylitis. Scandinavian Journal of Rhematology1994, 23:260-263.

19. Basford JR, Sheffield CG, Cieslak KR: Laser therapy: a randomized, controlled trial of the effects of low intensity

Nd:YAG laser irradiation on lateral epicondylitis. Arch Phys Med Rehabil2000, 81(11):1504-1.

20. Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, Oken OF: The Short-term Efficacy of Laser, Brace, and Ultrasound Treatment in Lateral Epicondylitis: A Prospective, Randomized, Controlled Trial. J Hand Ther2008, 21(1):63-8.

If you enjoyed this post, please consider leaving a comment or subscribing to the RSS feed to have future articles delivered to your feed reader.
Follow us

mobilephysio

Home Healt Care at Toronto, Canada
Mobile Physio Home Health Care is dedicated to providing immediate access to rehabilitation services in your own home or office. Your very own Physiotherapist tailors an exercise program that keeps you motivated to ensure the best possible recovery in the shortest time.
Follow us

No Comments

Leave a Reply