Shoulder impingement and low level laser therapy

Low level laser therapy (LLLT) has been shown to have anti-inflammatory and analgesic effects. There are also no known side effects of the treatment, making it an effective option for relieving pain in a wide variety of situations.^1,2

For some injuries and conditions, exercise is the best treatment, but what about the patients who are in too much pain to exercise? If LLLT can decrease the pain so that patients can exercise, it can accelerate the pace of healing.

The shoulder is one of the most complex joints in the body, and shoulder impingement is the most common cause of pain and loss of range of motion.³ Shoulder impingement occurs when the movement of the joint is restricted in any way. The most common reasons for impingement are tendonitis and bursitis. When movement is impinged, the tissues surrounding the rotator cuff often become inflamed, can wear thin, and may tear.

Treating impingement syndrome before there is a rotator cuff tear is by far the best option. Inflamed tissue is easier to heal than torn tissue. However, early scientific research was inconclusive. In fact, one study concluded that physiotherapy and surgery are equally effective. Researchers found that physiotherapist-lead exercise, home exercise, and surgery were all equally effective long term. That study did not address LLLT, however. It seems to make sense that a side-effect free treatment that lessens inflammation would make the exercises less painful, and therefore easier to do.⁴

Another study addressed the question of whether LLLT treatments impacted recovery from impingement syndrome. The conclusion was that it did not. The researchers wrote, “The low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability.”⁵

However, a more recent study, published in 2014, found that both corticosteriod injections (a widely-used treatment for impingement syndrome) and LLLT were more effective than placebo or sham treatments.⁶ Along the same lines, researchers found that LLLT and ultrasound therapy are equally effective treatments for impingement syndrome.⁷

Scientific research does not provide a clear answer to the question “Is LLLT an effective treatment option for patients with shoulder impingement syndrome?” More studies are necessary, but that is not surprising. LLLT is a relatively new treatment, and researchers are only beginning to understand why and how it works. However, for patients who are in pain and prefer a conservative treatment plan, there is not a good reason (barring any contraindications such as pregnancy) to not offer LLLT as a treatment for impingement syndrome. If the analgesic effects of LLLT lessen the pain, and cause no harm, the patient’s quality of life will be improved.

References

¹Bonjardim L, Conti P, Maia L, Maia M, Quintans J, Ribeiro M. “Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review.” National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881861/. Published 2012. Accessed August 2014.

²Demchak T, Kingsley J, Mathis R. “Low-level laser therapy as a treatment for chronic pain.” Frontiers in Physiology. http://journal.frontiersin.org/Journal/10.3389/fphys.2014.00306/full. Published August 2014. Accessed August 2014.

³Hains G. “Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques.” Journal of the Canadian Chiropractic Association. http://www.jcca-online.org/ecms.ashx/PDF/2002/2002-3/ChiropracticManagementofShoulderPain.pdf. Published 2002. Accessed August 2014.

⁴Bastiaenen C, de Bie R, Staal J, Kromer T, Tautenhahn U. “Effects of Physiotherapy in Patients with Shoulder Impingement Syndrome: A Systematic Review of the Literature.” Journal of Rehabilitation Medicine. http://www.ingentaconnect.com/content/mjl/sreh/2009/00000041/00000011/art00003. Published October 2009. Accessed August 2014.

⁵Ay S, Dogan S, Evcik D. “The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study.” Clinics. http://www.scielo.br/scielo.php?pid=S1807-59322010001000016&script=sci_arttext. Published 2010. Accessed August 2014.

⁶Kelle B, Kozanoglu E. “Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial.” Clinical Rehabilitation. http://cre.sagepub.com/content/28/8/762. Published February 2014. Accessed August 2014.

⁷Duman I, Tan A, Taskaynatan M, Yavuz F. “Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: A randomized clinical trial.” Journal of Back and Musculoskeletal Rehabilitation. http://iospress.metapress.com/content/n3p56h2t70g83894/. Published December 2013. Accessed August 2014.