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Achilles Tendinopathy

Low level laser therapy reduces : Inflammation in activated achilles tendinitis

BJORDAL Jan Magnus ; IVERSEN Vegard ; BRANDAO MARTINS-LOPES Rodrigo Alvaro;
Progress in biomedical optics and imaging ISSN 1605-7422
2006, vol. 7, no26, [Note(s): 31400G.1-61400G.8]
Society of Photo-Optical Instrumentation Engineers, Belligham, ETATS-UNIS (2001) (Revue)

Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon.

Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE2 in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test.

Results: PGE2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT.

Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy

Apostolos Stergioulas, PT, PhD*, Marianna Stergioula, PT*, Reidar Aarskog, PT, MSc , Rodrigo A. B. Lopes-Martins, MPharm, PhD and Jan M. Bjordal, PT, PhD ,||, From the * Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Laconia, Greece, the Institute of Physical Therapy, Bergen University College, Bergen, Norway, the Laboratory of Pharmacology and Phototherapy of Inflammation, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, and the || Section of Physiotherapy Science, Department of Public Health and Primary Care, University of Bergen, Bergen, Norway Address correspondence to Jan M. Bjordal, PT, PhD, Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway (e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.

Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy ( = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session.

Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.

Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

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