Effectiveness of High Power Laser Therapy on Pain and Isokinetic Peak Torque in Athletes with Proximal Hamstring Tendinopathy: A Randomized Trial

Extracorporeal Shock Wave Therapy versus laser therapy in treating musculoskeletal disorders: a systematic review and meta-analysis

This systematic review aimed to compare the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) versus Laser therapy (Low-Level Laser Therapy (LLLT) and High-Intensity Laser Therapy (HILT) in treating musculoskeletal disorders (MSKDs). Systematic searches of randomized clinical trials (RCTs) were performed in six databases from inception till February 2025. Two researchers independently screened titles, abstracts, and full-text articles. Eligible studies had to report at least one of the following outcomes: pain, functionality, strength, range of motion (ROM), and quality of life (Qol). Risk of bias was assessed using the revised Cochrane Collaboration tool (RoB 2.0). Meta-analysis was conducted using Review Manager software version 5.4.1, and quality of evidence was evaluated using the GRADE approach. Twenty-eight RCTs involving 1,460 patients were included. The findings indicated that neither LLLT nor HILT showed a significant difference from ESWT in pain, strength, ROM, or quality of life. However, ESWT demonstrated a marginal statistically significant functional advantage over LLLT, but not over HILT. The GRADE certainty rating was rated as very low to moderate. According to GRDAE certainty rating, ESWT and laser therapies (LLLT and/or HILT) had equivalent effect in improving pain, strength, ROM, and Qol in patients with MSKDs, while ESWT had some short-term effects in improving functions more than LLLT but not than HILT. Large RCTs with higher methodological quality are needed to draw more incisive conclusions.

Effectiveness of high-power laser therapy on partial tears of the supraspinatus tendon: A randomized controlled trial

BACKGROUND

High-power laser therapy (HPLT) has potential in treating shoulder disorders. However, the impact of HPLT on supraspinatus partial thickness tear (SS-PTT) remains unexplored.

OBJECTIVE

To evaluate the effects of HPLT on pain, function, and musculoskeletal ultrasound (MSK-US) parameters in SS-PTT.

METHODS

A randomized, assessor-blinded, placebo-controlled clinical trial was conducted. Thirty-six patients with SS-PTT were randomized into the HPLT+ exercise (Exs) group or the sham+ Exs group. Eighteen age-matched healthy subjects were evaluated for MSK-US parameters as the control group. Ten treatment sessions were administered three times per week. The HPLT was used with a maximum power of 20 watts (W), 2478 joules (J), and 24.78 J/cm2 for the first three sessions, followed by 4678 J and 46.78 J/cm2 for the subsequent seven sessions. Musculoskeletal parameters, visual analog scale (VAS), and shoulder pain and disability index (SPADI) were measured before and 48 hours after the final treatment session.

RESULTS

At baseline, short-axis (SAX) thickness (p = .027, η2 p = .13), echogenicity (p = .014, η2 p = .16), and occupation ratio (OR) (p = .003, η2 p = .2) were different between patient groups with control. All measured parameters significantly improved in the HPLT, except for echogenicity (p = .447, η2 p = .02) and the disability subscale of the SPADI (p = .131, η2 p = .07). After treatment, sham + Exs still showed significant differences in SAX thickness (p = .047, η2 p = .11), echogenicity (p = .001, η2 p = .25) and OR (p = .015, η2 p = .15) with control.

CONCLUSION

High-power laser therapy was an effective modality for patients with SS-PTT. Its ability to decrease pain and improve MSK-US parameters, especially tear size, enhances its value as part of conservative treatments.

Efficacy of pulsed electromagnetic field therapy on pain and physical function in patients with non-specific low back pain: a systematic review

INTRODUCTION

Non-specific low back pain is a common and clinically significant condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy has shown benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this study was to assess the effects of PEMF on pain and function on patients with non-specific low back pain.

METHODS

A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function.

RESULTS

Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale.

CONCLUSION

PEMF therapy seems to be a safe and beneficial treatment option for non-specific low back pain, particularly if used as an addition to conventional physical therapy modalities. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

Challenges and opportunities of medicines for treating tendon inflammation and fibrosis: A comprehensive and mechanistic review

BACKGROUND

Tendinopathy refers to conditions characterized by collagen degeneration within tendon tissue, accompanied by the proliferation of capillaries and arteries, resulting in reduced mechanical function, pain, and swelling. While inflammation in tendinopathy can play a role in preventing infection, uncontrolled inflammation can hinder tissue regeneration and lead to fibrosis and impaired movement.

OBJECTIVES

The inability to regulate inflammation poses a significant limitation in tendinopathy treatment. Therefore, an ideal treatment strategy should involve modulation of the inflammatory process while promoting tissue regeneration.

METHODS

The current review article was prepared by searching PubMed, Scopus, Web of Science, and Google Scholar databases. Several treatment approaches based on biomaterials have been developed.

RESULTS

This review examines various treatment methods utilizing small molecules, biological compounds, herbal medicine-inspired approaches, immunotherapy, gene therapy, cell-based therapy, tissue engineering, nanotechnology, and phototherapy.

CONCLUSION

These treatments work through mechanisms of action involving signaling pathways such as transforming growth factor-beta (TGF-β), mitogen-activated protein kinases (MAPKs), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), all of which contribute to the repair of injured tendons.

Magnetic Resonance Imaging With a Novel Hip Flexion Scanning Position for Diagnosing Proximal Hamstring Tendinopathy

Background

Making a diagnosis of proximal hamstring tendinopathy (PHT) may be challenging, as patients with correlating clinical symptoms may have normal or minimal findings on magnetic resonance imaging (MRI) scans.

Purpose/Hypothesis

The purpose of this study was to assess the effect of a novel hip flexion (HF) scanning position on the MRI diagnosis of PHT. It was hypothesized that the HF position, which simulates the symptom-provoking sitting position, would reveal PHT pathology more accurately than the standard scanning position.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

Patients with chronic PHT symptoms were included. Chronicity was defined as symptoms that were present for >3 months. Each patient underwent an MRI in 2 parts: (1) the standard pelvic examination in the supine position and (2) the novel HF position in which the patient lays on his or her side with the hip at 90° of flexion. Tendon insertion areas of the semimembranosus and the biceps femoris were analyzed independently by 2 experienced musculoskeletal radiologists, and the findings were classified as normal, tendinosis, or rupture. The MRI findings for both the standard and HF positions were compared in every patient, and the percentage of different diagnoses between the 2 MRI positions was reported.

Results

In total, 38 patients (67 tendons) were analyzed. In 71% of the patients, the HF position revealed more severe injury than the standard position. The HF position showed a rupture in 16% of the tendons, with findings classified as tendinosis in the standard position. Of the tendons diagnosed as normal in the standard position, 6% were classified as rupture and 11% as tendinosis in the HF position.

Conclusion

The novel HF scanning position offered additional value in the diagnosis of PHT in symptomatic patients when compared with the standard hip-in-neutral position. This position can improve the diagnostics of PHT, especially if an athlete or an active patient with gluteal area pain has normal or minimal MRI findings in the standard position.

A Practical Guide to Injection Therapy in Hand Tendinopathies: A Systematic Review of Randomized Controlled Trials

Hand tendinopathies represent a pathological condition associated with significant disability. However, due to this high heterogeneity of the treatments and their efficacy, there is still a lack of consensus on the infiltrative therapy of the hand. This systematic review aimed to investigate the efficacy of injection techniques in the treatment of pain related to the main hand tendinopathies. We searched online medical databases (PubMed, Pedro, Cochrane Library, Scopus, and WoS). Only RCTs published in the last 10 years (up to 5 August 2024), written in English, and related to infiltrative treatment in wrist and hand tendinopathies were evaluated. The risk of bias in RCTs was assessed with Version 2 of the Cochrane Risk of Bias tool for randomized trials (RoB 2). Out of 641 articles identified, 23 were included in the final synthesis: 14 RCTs on trigger finger, and 9 RCTs on de Quervain's tenosynovitis. The present systematic review showed that infiltrative therapy of trigger finger and de Quervain's tenosynovitis constitutes a fundamental element in the treatment of these pathological conditions, in terms of pain reduction and improvement in the functionality of the hand.

Effects of Photobiomodulation on Pain and Return to Play of Injured Athletes: A Systematic Review and Meta-analysis

ABSTRACT

Morgan, RM, Wheeler, TD, Poolman, MA, Haugen, ENJ, LeMire, SD, and Fitzgerald, JS. Effects of photobiomodulation on pain and return to play of injured athletes: A systematic review and meta-analysis. J Strength Cond Res 38(6): e310-e319, 2024-The aims of this systematic review and meta-analysis were to evaluate the effect of photobiomodulation (PBM) on musculoskeletal pain in injured athletes and to determine if the effects of PBM allowed injured athletes to return to play faster. Electronic databases (MEDLINE Complete, CINAHL, and SPORTDiscus, PubMed, Web of Science, and Embase) were systematically searched (up to and including November 7, 2023) for peer-reviewed randomized controlled trials (RCTs) meeting criteria. Six RCTs, representing 205 competitive and recreational athletes with a mean age of 24 years, were included in the analysis. There were 6 intervention groups using standard physical therapy (n = 1), placebo PBM (n = 4), and aloe gel (n = 1) lasting between 10 minutes and 8 weeks in duration. The level of significance set for the study was p < 0.05. Overall, the use of PBM indicated a positive effect on pain reduction for PBM vs. control groups, standardized mean differences = 1.03, SE = 0.22, 95% confidence intervals = [0.43-1.63], p = 0.0089, but the 2 RCTs found evaluating the effect of PBM on time to return to play after injury in athletes do not support a benefit. Allied healthcare professionals may use PBM to reduce pain, thus allowing an athlete to return to their normal biomechanical movement faster; however, limited evidence suggests that PBM does not reduce time to return to play after an injury.

Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study

Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p <  0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p <  0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.

Hamstring Injury Treatments and Management in Athletes: A Systematic Review of the Current Literature

BACKGROUND

The field of sports medicine presents a varied landscape of research on hamstring injuries in athletes, characterized by inconclusive and sometimes conflicting findings on effective treatment and rehabilitation strategies. This discordance prompted the current systematic investigation.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for conducting the systematic review. Multiple international bibliometric databases (Scopus, PubMed, Web of Science, and Embase) were searched to identify studies evaluating any treatment option for the management of hamstring injuries in athletes. Eligible studies were appraised for quality using Joanna Briggs Institute and Risk of Bias 2 tools.

RESULTS

A total of 30 studies with 1,195 participants were included. Of the reviewed studies, treatments varied from aggressive rehabilitation, platelet-rich plasma (PRP) injections, manual techniques, various exercise protocols to modalities like high-power laser and nonsteroidal anti-inflammatory drugs. Evidence suggested benefits from treatments like extensive muscle lengthening during eccentric actions, progressive agility, and trunk stabilization. PRP injections produced mixed results regarding return to sport and reinjury rates. Stretching exercises, sometimes combined with cryotherapy, showed benefits.

CONCLUSION

Treatments for hamstring injuries exhibit varied efficacy. Although rest, ice, compression, and elevation remains essential for acute management, rehabilitation focusing on muscle strengthening and flexibility is crucial. The potential benefits of PRP injections, especially for chronic cases, require more conclusive research. A comprehensive approach, combining evidence-based practices and patient-centric factors, is vital for effective management and recovery.

LEVEL OF EVIDENCE

Level IV. See Instructions for Authors for a complete description of levels of evidence.