High-intensity laser therapy may reduce patellofemoral pain, improve function
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Key takeaways:
- High-intensity laser therapy may reduce pain and improve function for patients with patellofemoral pain syndrome.
- Laser therapy improved outcomes compared with other electrophysical stimulation techniques.
For patients with patellofemoral pain syndrome, high-intensity laser therapy was associated with reduced pain and improved lower extremity function compared with ultrasound and nerve stimulation, according to published results.
To assess the efficacy of high-intensity laser therapy for patients with patellofemoral pain syndrome (PFPS), Ozge Ozlu and Esra Atilgan, from the Institute of Health Sciences at Istanbul Medipol University in Turkey, performed a single-blinded randomized controlled trial of 45 patients with PFPS.
Researchers randomly assigned patients to receive high-intensity laser therapy combined with exercise (n = 15), ultrasound transcutaneous electrical nerve stimulation (TENS) with exercise (n = 15) or ultrasound interferential current stimulation with exercise (n = 15) for 2 weeks.
Outcomes included VAS pain scores, knee flexion range of motion, quadriceps and hamstring muscle strength, Kujala scores, the lower extremity functional scale and the timed-up-and-go test.
Researchers found patients who received high-intensity laser therapy had greater reductions in pain, increases in knee flexion angle, improvements in Kujala scores and overall lower extremity function at 3 months compared with patients who received TENS and interferential current stimulation.
Researchers concluded high-intensity laser therapy may be effective for the treatment of PFPS, especially in combination with exercise such as vastus medialis strengthening, to reduce pain and improve function.
Perspective
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The purpose of this study was to compare treatment of patients with so-called “patellofemoral pain syndrome” using exercise therapy with three different combinations of modalities including laser, ultrasound and interferential current. Patients and the treating physical therapist were not blinded to the treatment.
The authors concluded that the group treated with high-intensity laser therapy was superior. From a scientific perspective, this study is less than ideal given the lack of blinding of both the treating therapist and the patient. It is unclear in the manuscript who did the outcome measurements and whether they were blinded.
Treatment of patients with anterior knee pain is most effective when a specific diagnosis of the cause of the pain can be discerned. “Patellofemoral pain syndrome” does not allow patient-specific treatment. Proven nonoperative management of patients with anterior knee pain includes an exercise program focused on the patient's specific evaluation. Published evidence and experience show this must include hip and quadriceps strengthening, as well as stretching of muscles in the lower extremity.
An excellent consensus statement was published by Collins and colleagues, which does not endorse the use of electrophysical modalities and emphasizes the success of appropriate exercise. Until high-quality studies document the effectiveness of laser treatment, I believe this must be considered unproven.
Reference:
Collins NJ, et al. Br J Sports Med. 2018;doi:10.1136/bjsports-2018-099397.
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