By Dava Stewart
Low level laser therapy (LLLT) has been used successfully to treat a number of conditions, and those involving inflammation appear to respond particularly well to the treatment. In addition to functioning as an anti-inflammatory agent, LLLT has analgesic properties.
Though scientists do not yet understand exactly how it works at the cellular level, when administered at the proper intensity for an adequate length of time LLLT relieves pain in a variety of circumstances. One area where researchers are investigating the effectiveness of LLLT is as a treatment for tendinopathy.
Tendinitis is the term used to refer to inflammation of a tendon, and tendinosis describes tiny tears in and around the tendon, usually due to overuse. Thought the two conditions are different, the terms are often used incorrectly. Tendinopathy is the word used to describe both conditions, but for many years tendinitis was the preferred umbrella descriptor. Another possible injury is a tendon rupture, which can result in swelling, bruising, and sudden weakness.1
According to the website UpToDate.com:
“Tendonitis, tendinosis, tendinopathy, paratendonitis, enthesopathy, and insertional tendonitis are among the terms used to characterize acute or chronic tendon pain. The common term tendonitis is confusing because inflammation is often not seen on histopathology.”
Given the confusion surrounding the terms used to discuss injuries to tendons, patients may arrive in the chiropractic office without a clear understanding of which condition they have. Although any tendon can be affected by tendinopathy, the tendons connected to the elbow and ankle are the most frequent.
Recreational athletes, especially runners, suffer tendinopathy at the ankle — Achilles tendinopathy — at far higher rates than the general population. In fact, runners experience the painful condition as much as 10 times more often than others. Without treatment, Achilles tendinopathy is a degenerative condition that eventually makes even walking painful and difficult.2
Multiple studies have shown promising results for LLLT as a treatment for Achilles tendinopathy.3 In most cases, a conservative treatment plan, consisting of rest, ice, compression, and elevation (RICE), along with eccentric exercise and anti-inflammatory pharmaceuticals is followed. However, researchers are finding that combining eccentric exercise and LLLT produces superior results for many patients.4
As with virtually every instance in which LLLT has yielded positive outcomes in studies, the parameters make the difference between an effective treatment and an ineffective one. Treating Achilles tendinopathy with LLLT at too low a power density or for too short a time will not help the patient recover. In fact, one review of 25 studies found that effective dosages were apparent in the 12 positive studies and absent in the 13 inconclusive studies.3 Proper protocols and parameters are vital for effective LLLT treatments.
1WebMD. Tendon Injury (Tendinopathy) – Topic Overview. WebMD.com. http://www.webmd.com/first-aid/tc/tendon-injury-tendinopathy-topic-overview. Last Updated October 2012. Accessed September 2014.
2Luscombe K, Maffulli N, Pankaj Sharma. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004;97(10):472-476.
3Kneebone W. The Treatment of Achilles Tendonitis Using Therapeutic Laser. Practical Pain Management. http://www.practicalpainmanagement.com/treatments/complementary/lasers/treatment-achilles-tendonitis-using-therapeutic-laser. Published June 2010. Accessed September 2014.
4Aarskog R, Bjordal J, Lopes-Martins R, Stergioula M, Stergioulas A. Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy. Am. J. Sports Med. 2008;36(5):881-887.