Clinical Efficiency of High-Intensity Laser Therapy in Patients With Cervical Radiculopathy: A 12-Week Follow-up, Randomized, Placebo-Controlled Trial

Exploring the Influence of Physiotherapeutic Interventions in Alleviating Clinical and Psychosocial Symptoms in Patients With Cervical Radiculopathy-A Systematic Review

BACKGROUND

Cervical radiculopathy is a painful condition affecting the upper extremities, including the shoulder girdle, characterised by pain, disability, and limited range of motion. Common in individuals in their fifties, its annual incidence is 83 per 100,000 people. Psychosocial factors such as anxiety, depression, and fear avoidance further influence its severity and impact. Modern musculoskeletal issues, such as prolonged computer use and poor posture, also contribute to cervical problems.

OBJECTIVES

To evaluate the effectiveness of physiotherapy interventions on clinical and psychosocial outcomes in patients with cervical radiculopathy.

DESIGN

Systematic review (PROSPERO ID: CRD42025614571).

METHODS

Literature was sourced from PubMed and Google Scholar. Titles, abstracts, and full texts were screened based on inclusion criteria. Methodological quality was assessed using the 11-point PEDro scale, and risk of bias was evaluated using the Cochrane RoB 2 tool.

RESULTS

A total of 49 studies met the inclusion criteria. Findings indicate that physiotherapy interventions-such as exercise therapy, manual therapy, and electrotherapy-significantly reduce pain, enhance range of motion, and improve functional capacity. These interventions also positively impact psychosocial outcomes by reducing anxiety, depression, and fear avoidance. However, evidence comparing their effectiveness against standard rehabilitation remains inconclusive.

CONCLUSION

This review highlights the beneficial effects of physiotherapy interventions on both clinical and psychosocial health in cervical radiculopathy patients. They contribute to improved pain management, mobility, function, and mental well-being. Further studies are needed to validate long-term outcomes and establish superiority over conventional treatments.

Comparative effectiveness of six biophysical agents on neck pain rehabilitation: a systematic review and network meta-analysis

PURPOSE

This systematic review and network meta-analysis aims to investigate the comparative effectiveness of six biophysical agents, including Transcutaneous electrical nerve stimulation (TENS), interferential current (IFC), extracorporeal shockwave therapy (ESWT), therapeutic ultrasound, low-level laser therapy (LLLT), and high-intensity laser therapy (HILT) on neck pain rehabilitation.

METHODS

Three bibliographic databases, PubMed, Embase, and Scopus were searched from inception to July 30, 2024. Randomized controlled trials comparing a single biophysical agent with placebo control or another biophysical agent on neck pain intensity as an outcome were selected. Two independent reviewers independently conducted study selection, data extraction, and quality assessment. The methodological quality of included randomized controlled trials was assessed using the Physiotherapy Evidence Database scale.

RESULTS

A total of 34 randomized controlled trials with 2141 patients with neck pain were included, and all included studies had good or above quality. A random-effects frequentist network meta-analysis, assuming a common random-effects standard deviation for all comparisons in the network. Effects of biophysical agents on neck pain intensity were estimated as mean differences with 95% confidence intervals. League tables were created to display the relative degree of neck pain for all comparisons among the six biophysical agents.

CONCLUSION

This study suggests that rehabilitation of neck pain using biophysical agents should be prioritized in the following ranks: HILT, ESWT, IFC, TENS, LLLT, and therapeutic ultrasound. The results clarified how different biophysical agents may influence neck pain outcomes and provided proper evidence to inform clinicians to select biophysical agents prudently for neck pain management.

The Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined With Platelet-Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study

OBJECTIVES

To evaluate the combined effect of 2 different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE).

DESIGN

Prospective, randomized, sham-controlled trial.

SETTINGS

Outpatient clinic.

PARTICIPANTS

Ninety-one patients (N=91) with LE for >3 months were randomly allocated into 3 groups.

INTERVENTIONS

Participants were assigned to PRP+ESWT, Sham PRP+ESWT, or ESWT only treatment group. All groups received exercise therapy.

MAIN OUTCOME MEASURES

The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36, ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated 3 times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2).

RESULTS

The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week.

CONCLUSIONS

The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.

High-frequency laser therapy: a new alternative to physiotherapy in the treatment of cervical disk hernia

Introduction

High-frequency laser therapy has been increasingly used in several musculoskeletal disorders, but there is still a lack of evidence for the usage of the device in neck pain. This study aimed to compare the effectiveness of physiotherapy, high-frequency laser, and exercise therapy methods in the treatment of pain in cervical disk herniation.

Methods

It was a multicenter, randomized, controlled clinical trial. Patients aged between 18 and 65 with neck pain and a diagnosis of cervical disk hernia were included in the study. Patients with a history of cervical surgery, rheumatism, cancer, or pacemaker were excluded from the study. The patients were randomized into 15 sessions of physiotherapy, high-frequency laser, or exercise therapy groups and evaluated with a range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 before treatment, after treatment, and in 1st and 3rd months. p < 0.05 was considered statistically significant.

Results

In total, 150 patients were analyzed. There was a significant improvement in range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 scores in three groups after 3-month follow-up (p < 0.05). The improvement was statistically greater in the physiotherapy and high-frequency laser therapy groups (p < 0.05), but there was no significant difference between these two groups (p > 0.05).

Discussion

The results in the physiotherapy and high-frequency laser therapy groups were better than the exercise group. They may be alternatives to each other in cervical disk hernia treatment.

The Effectiveness of High Intensity Laser in Improving Motor Deficits in Patients with Lumbar Disc Herniation

BACKGROUND

High-Intensity Laser (HIL) therapy, known for its biostimulatory effects on nerve cell growth and repair, shows promise for improving motor deficits caused by morphopathological changes. This research study aimed to comprehensively assess muscle strength changes through muscle testing, complemented by functional tests evaluating factors contributing to disability in patients with Lumbar Disc Herniation (LDH) and associated motor impairment, following a complex rehabilitation protocol incorporating HIL therapy.

METHODS

A total of 133 individuals with LDH and motor deficits were divided into two groups. Group 1 (n = 66) received HIL therapy followed by standard rehabilitation, while Group 2 (n = 67) underwent only the standard rehabilitation program. Functional parameters, including muscle strength, the ability to walk on tiptoes or heels, and self-assessed fall risk, were monitored.

RESULTS

Both groups showed statistically significant improvements in all monitored parameters. A comparative analysis revealed a significant result for the HIL therapy regimen across all indicators.

CONCLUSIONS

The group undergoing a rehabilitation program with integrated HIL therapy displayed significantly greater improvement in motor deficits, affirming the positive impact of HIL therapy on functional parameters among LDH patients.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).