Efficiency of low-intensity laser therapy in the treatment of lateral epicondylitis

Abstract

Aim: Lateral epicondylitis is the most common cause of lateral elbow pain and dysfunction, mainly caused by repetitive gripping or wrist extension during various activities. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore poses an important public health concern. The aim of this study was to investigate the efficacy of laser in the treatment of patients diagnosed with lateral epicondylitis. Material and Method: Patients who received low-intensity laser therapy (LILT) treatment and patients who received placebo LILT while waiting for extracorporeal shock wave therapy (ESWT) treatment with the same diagnosis were included in the study. A total of 60 patients in two groups of 30 were included in the study. The patients who received LILT treatment constituted the treatment group (n=30), and the patients receiving placebo LILT constituted the control group (n=30). VAS for resting and resisted wrist extension, HAQ, PRTEE-T pain, function, and total scales were used to measure patients' pain status and response to treatment. Results were compared by analyzing patient files and recorded data. Results: A total of 48 (80%) subjects were female and 12 (20%) were male. The mean age of the control group was 47.8±7.4 years, and the mean age of the treatment group was 45.7±8.5 years. There was no significant difference between the two groups in terms of age, gender, and occupational distribution (p>0.05). In our study, the group treated with LILT showed statistically significant improvement in all parameters (VAS, HAQ, PRTEE) we investigated compared to the control group (p<0.05). Conclusion: We concluded that LILT therapy has positive effects on symptoms and clinical findings in the conservative treatment of lateral epicondylitis. Further research is necessary to solidify the results and determine the optimal use of LILT for this condition.

Keywords

• Lateral epicondylitis
• low-intensity laser therapy
• Elbow

References

1. Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol 2016; 17: 101-12.
2. Sims SE, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a aystematic review of randomized controlled trials. Hand 2014; 9: 419-46.
3. Noteboom T, Cruver R, Keller J, Kellogg B, Nitz AJ. Tennis elbow: a review. J Orthop Sports Phys Ther 1994; 19: 357-66.
4. Cohen MS, Romeo AA, Hennigan SP, Gordon M. Lateral epicondylitis: anatomic relationships of the extensor tendon origins and implications for arthroscopic treatment. J Shoulder Elbow Surg 2008; 17: 954-60.
5. Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil 2004; 85: 308-18.
6. Kochar M, Dogra A. Effectiveness of a specific physiotherapy regimen on patients with tennis elbow: clinical study. Physiotherapy 2002; 88: 333-41.
7. Sevier TL, Wilson JK. Treating lateral epicondylitis. Sports Medicine 1999; 28: 375-80.
8. Shakeri H, Soleimanifar M, Arab A, Behbahani SH. The effects of KinesioTape on the treatment of lateral epicondylitis. J Hand Ther 2018; 31: 35-41.

9. Song HJ, Seo H-J, Lee Y, Kim SK. Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: A systematic review and meta-analysis of randomized controlled trials. Medicine 2018: 97: e13126.
10. Dundar U, Turkmen U, Toktas H, Solak O, Ulasli AM. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study. Lasers Med Sci 2015; 30: 325-32.
11. Fiore P, Panza F, Cassatella G, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med 2011; 47: 367-73.
12. Ezzati K, Laakso E-L, Salari A, Hasannejad A, Fekrazad R, Aris A. The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. J Lasers Med Sci 2020; 11: 81.
13. Fairbank S, Corlett R. The role of the extensor digitorum communis muscle in lateral epicondylitis. J Hand Surg Br 2002; 27: 405-9.
14. Bayat M, Raeissadat SA, Mortazavian Babaki M, Rahimi-Dehgolan S. Is dextrose prolotherapy superior to corticosteroid injection in patients with chronic lateral epicondylitis?: a randomized clinical trial. Orthop Res Rev 2019: 167-75.
15. Hong QN, Durand M-J, Loisel P. Treatment of lateral epicondylitis: where is the evidence? Joint Bone Spine 2004; 71: 369-73.
16. Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther 2005; 18: 411-20.
17. Kaydok E, Ordahan B, Solum S, Karahan AY. Short-term efficacy comparison of high-intensity and low-intensity laser therapy in the treatment of lateral epicondylitis: a randomized double-blind clinical study. Arch Rheumatol 2020; 35: 60.
18. Titchener A, Fakis A, Tambe A, Smith C, Hubbard R, Clark D. Risk factors in lateral epicondylitis (tennis elbow): a case-control study. J Hand Surg Eur Vol 2013; 38: 159-64.
19. Stasinopoulos D, Stasinopoulos I. Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis. Clin Rehabil 2006; 20: 12-23.
20. Ernst E. Conservative therapy for tennis elbow. Br J Clin Pract 1992; 46: 55-7.
21. Toker S, Kilincoglu V, Aksakalli E, Gulcan E, Ozkan K. Short-term results of treatment of tennis elbow with anti-inflammatory drugs alone or in combination with local injection of a corticosteroid and anesthetic mixture. Acta Orthop Traumatol Turc 2008; 42: 184-7.
22. Wadsworth TG. Tennis elbow: conservative, surgical, and manipulative treatment. Br Med J (Clin Res Ed) 1987; 294: 621.
23. Newcomer KL, Laskowski ER, Idank DM, McLean TJ, Egan KS. Corticosteroid injection in early treatment of lateral epicondylitis. Clin J Sport Med 2001; 11: 214-22.
24. Skinner DK, Curwin SL. Assessment of fine motor control in patients with occupation-related lateral epicondylitis. Man Ther 2007; 12: 249-55.
25. Kleinkort J. Clinical use of laser in chronic pain and tissue healing. Stimulus 1982; 7: 7-8.
26. Ailioaie C, Lupusoru-Ailioaie LM. Beneficial effcts of laser therapy in the early stages of rheumatoid arthritis onset. Laser Therapy 1999; 11: 79-87.
27. Fillipin LI, Mauriz JL, Vedovelli K, et al. Low‐level laser therapy (LLLT) prevents oxidative stress and reduces fibrosis in rat traumatized Achilles tendon. Lasers Surg Med 2005; 37: 293-300.
28. Stergioulas A. Effects of low-level laser and plyometric exercises in the treatment of lateral epicondylitis. Photomed Laser Surg 2007; 25: 205-13.
29. Lundeberg T, Haker E, Thomas M. Effect of laser versus placebo in tennis elbow. Effect of laser versus placebo in tennis elbow. ScandinavianJ Rehab Med 1987; 19: 135-8.