Following an overwhelming response to a previous topic covered, tendonitis in the knees, I have been asked several questions about treatment options for current and chronic tendonitis. In my last article, I covered proper training and exercise technique to hopefully prevent tendonitis in the knees. Unfortunately, most of us don’t like to take preventative measures and only seek treatment after it becomes a problem. Although I did briefly discuss traditional treatment practices for tendonitis, I have decided to address some of the “newer”, trendier, treatment options for various musculoskeletal ailments including, but not limited to, knee and other types of tendonitis. The first treatment option that I will cover in this article is low-level laser therapy.
Low-level laser therapy gets its more common name of “cold laser therapy” from the type of compressed light of a wavelength from the red part of the light spectrum, or the cold part. It is important to note that this in NOT a heat treatment. The effects are photochemical, and while the patient does not feel cold, it definitely does not have the warming effect on the soft tissue when compared to the more traditional ultrasound modality.
The physiological and scientific theory behind the cold laser process is that the body’s cells are exposed to the light photon energy (either red or infrared), which in turn directly affects the cells metabolism and mitochondrial production of ATP. This, in theory, will aid in several things including muscle tissue and collagen development, as well as improved blood circulation and tissue repair. Advocates of cold laser treatment also add other types of interactions ranging from improvement of the nervous and immune systems to healing of wounds. But for the sake of this article, the build up of the tendon matrix and its recovery is our main focus.
Upon review of the literature, there are over several hundred published laboratory studies of the effects of cold laser treatment on tendonitis and inflammation. Although many are randomized double blind controlled trials, several lack the numbers of participants to draw any statistically significant results. Nonetheless, one fairly large systemic review of the studies by a group out of Australia, did find significant benefit in reduction of inflammation of the tendon. In another study, a group of subjects with chronic tendonitis that had previously tried traditional physical therapy, anti-inflammatories (both pills and injections), and/or surgery, had an 87 percent success rate in pain and symptom reduction following the application of cold laser.
So would I recommend its application? Yes. The studies that support its effectiveness far outweigh the other neutral studies (none reported that the treatment made symptoms worse). And even though the support isn’t overwhelming just yet, new studies are being done every year, and wouldn’t you want to know you have tried all you can before resorting to your 3rd cortisone injection of the year, or even worse, surgery? At the clinic that I work at, I apply the cold laser to almost all cases of tendonitis as an adjunct to other manual therapy techniques and traditional modalities. But let us not forget, prevention of the inflammation is even more critical, and in many cases you will need a comprehensive strengthening program before returning to your activity or sport.