Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial.
Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M.  Clin Rheumatol. 2011 May 4. [Epub ahead of print]
Subacromial syndrome is a common cause of shoulder pain and is often managed with nonsteroidal anti-inflammatory drugs (NSAIDs), injections, and rehabilitation. Many clinicians may employ therapeutic modalities to assist in the rehabilitation of subacromial syndrome but more research with modalities is needed. Recently, low-level laser therapy (LLLT) has gained a lot of attention particularly because it has been hypothesized to accelerate tissue repair, improve microcirculation, and generate anti-inflammatory effects. To explore the clinical utility of LLLT, Abrisham SM et al conducted a randomized, double-blind, controlled trial to evaluate the effect of LLLT with exercise among patients with subacromial syndrome (diagnosed based on clinical presentation and physical examination). Eighty participants were treated by exercise therapy programs (e.g., strengthening, stretching, mobilizations) in clinic and at home (10 clinic sessions during 2 weeks).  Patients were randomized so that 40 patients received infrared laser radiation (wavelength 890 nm in pulse mode; 2 to 4 J/cm2) at three points on the shoulder (coracoid process, posterior glenohumeral joint, and lateral rotator cuff tendon)  for 2 minutes at each site (6 minutes total). Among patients with biceps tendonitis a fourth point was treated. The remaining 40 patients received a sham laser treatment from a unit that appeared to be working. Patients were not allowed to take analgesics or NSAIDs during the study period. A blinded physician measured active and passive shoulder range of motion (flexion, abduction, external rotation) with a goniometer. Pain was also recorded. Following treatments both groups had less shoulder pain and improved shoulder range of motion (all measures). Based on change over time, the LLLT with exercise group had more improvement in pain and shoulder range of motion (all measures) compared to the exercise-only group.
The authors suggest that results support the use of LLLT with exercise therapy in relieving shoulder pain and improving range of motion among patients with subacromial syndrome. They note that further studies with larger samples, longer follow-ups, and comparisons to other interventions may be informative. Conducting clinical trials with therapeutic modalities can be a methodological challenge and the authors should be commended on their research design. We need more research to evaluate the safety and efficacy of therapeutic modalities. It would be interesting to know if the treating physiotherapist was blinded because they could bias the results unintentionally by altering their manual therapy. While that bias may influence our evaluation of the efficacy of LLLT it was comforting to see that neither group had any adverse reactions or side effects to the treatments. What’s your experience with LLLT? Are you finding it beneficial? Have you noticed any adverse reactions or side effects?
Written by: Jeffrey Driban
Reviewed by:  Stephen Thomas