According to WHO (World Health Organization), musculoskeletal (MSK) conditions affect approximately 1.71 billion individuals worldwide and are the leading cause of disability, resulting in restricted mobility, low quality of life, and functional limitations. The most prescribed intervention for most MSK conditions is surgery. However, research has shown that surgery is not only expensive and discomforting but can also result in further complications.
In this case, healthcare practitioners are increasingly recommending alternative treatment methods, such as Low-Level Laser Therapy (LLLT), to address MSK disorders. The efficacy of LLLT for the treatment of MSK complaints is well-documented.
What are MSK Disorders
MSK disorders are injuries that affect the body’s movement. The most commonly known disorders are various forms of arthritis, low back pain, and osteoporosis. These conditions can become chronic and result in disability. According to the results of an internet-based survey, around 116 million Americans are affected by MSK pain annually.[1] Chronic MSK pain can result in dysfunction, impairment, and even disability.
Post-Surgery Syndrome and MSK Disorders
Clinical evidence suggests that MSK surgeries can result in several complications, including degeneration of adjacent muscles, which results in pain and limited mobility.[2] Opioids and steroids are usually used to provide relief from postoperative pain, which often offer short-term relief and are highly costly.[3] [4] Thus, post-surgical care becomes a huge medical and financial burden in most cases where surgical intervention is used to treat MSK complaints.
Studies have strongly suggested a need to limit the use of opioids, steroids, spinal injections, and surgical procedures due to these methods’ limitations in results and long-term side effects.[5] In this context, Laser Therapy has been found to be effective and comparatively risk-free.[6] Research has found that this non-invasive, non-pharmacological procedure is side-effect-free and can help patients regain mobility and functionality, limiting the need for surgery and medications.[7]
Is LLLT an Effective Treatment Modality?
The first major clinical evidence of light radiation was recorded in 1903 when Dr Nils Finsen was awarded Nobel Prize for his contribution to the treatment of lupus vulgaris using concentrated light.[8] This triggered a series of studies in the area of photobiomodulation.
Photobiomodulation works by triggering biochemical activity within cells, resulting in a series of chemical reactions. Low-Level Laser Therapy has been found to be effective for both nociceptive and neuropathic pain.[9] LLLT simulation has been shown to activate various transcription factors, which result in its vasodilatory, analgesic, and anti-inflammatory effects.[10] It can also enhance the production of signaling molecules, such as ATP (adenosine triphosphate), NO (nitric oxide), and ROS (reactive oxygen species).[11] Other benefits of LLLT include increased neovascularization, angiogenesis, and collagen synthesis that aid in healing both chronic and acute wounds.[12]
LLLT for MSK Disorders
Since there are a large number of studies supporting the benefits of LLLT on the musculoskeletal system, it has been established that LLLT could be a more effective, complication-free, and cost-efficient alternative to surgery. Laser Therapy can provide relief from pain, accelerate healing, reduce inflammation, increase angiogenesis, and reduce interleukin 1 activity.
LLLT Reduces MSK Pain: Several human and animal trials have shown that LLLT can reduce pain significantly in various musculoskeletal conditions, including acute conditions such as back pain, post-surgical pain, sprains, and strains, as well as in addressing pain experienced in chronic conditions such as in case of osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain.[13]
LLLT Promotes Healing: LLLT can enhance healing in soft tissue structures such as skin, muscles, ligaments, and tendons, as well as in bony structures.[14] It is also shown to improve contractile force and promote resistance to muscle tear, resulting in increased muscle performance.[15]
LLLT Reduces Inflammation: Inflammatory reactions are at the core of most MSK conditions, such as rheumatoid arthritis and atherosclerosis. Laser Therapy is able to accelerate healing and reduce wound size by decreasing inflammation at the site of injury.[16] This is why it has been shown to be a good alternative to NSAIDs and other conventional treatments for inflammatory musculoskeletal conditions.[17]
LLLT Reduces Interleukin 1 Activity: This is a cytokine that brings about the proliferation of synovitis in musculoskeletal conditions like arthritis. It halts the body’s natural healing process and can enhance cartilage destruction. Laser Therapy has been shown to significantly reduce the activity of Interleukin 1, resulting in increased healing.[18]
Research shows that Laser Therapy can be a better alternative to surgery in the treatment of MSK disorders and can help decrease the medical and economic burden caused by a large number of MSK conditions, including the pain and complications that arise in the aftermath of surgery. Want to get your own FDA-cleared, customizable Laser Device? Check out Berman Partners’ collection of Laser Devices that can be used for a range of problems.
Works Cited
[1] Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010 Nov;11(11):1230-9. doi: 10.1016/j.jpain.2010.07.002. Epub 2010 Aug 25. PMID: 20797916.
[2] Pugazhendi S, Rajamani P, Daniel AS, Pugazhendi K. Non-invasive Complementary Therapies in Managing Musculoskeletal Pains and in Preventing Surgery. Int J Ther Massage Bodywork. 2020 May 29;13(2):9-18. PMID: 32523640; PMCID: PMC7260131.
[3] Manchikanti L, Boswell MV, Datta S, Fellows B, Abdi S, Singh V, Benyamin RM, Falco FJ, Helm S, Hayek SM, Smith HS; ASIPP. Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician. 2009 Jul-Aug;12(4):E123-98. PMID: 19668281.
[4] Axon DR, Patel MJ, Martin JR, Slack MK. Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review. Scand J Pain. 2019 Jan 28;19(1):9-23. doi: 10.1515/sjpain-2018-0306. PMID: 30375350.
[5] Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018 Jun 9;391(10137):2368-2383. doi: 10.1016/S0140-6736(18)30489-6. Epub 2018 Mar 21. PMID: 29573872.
[6] Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012 Feb;40(2):516-33. doi: 10.1007/s10439-011-0454-7. Epub 2011 Nov 2. PMID: 22045511; PMCID: PMC3288797.
[7] Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5):00068. doi: 10.15406/mojor.2015.02.00068. Epub 2015 Jun 9. PMID: 26858986; PMCID: PMC4743666.
[8] Finsen, NEILS RYBERG. Nobel lectures, physiology or medicine 1901–1921. Amsterdam, Netherlands:: Elsevier Publishing Company, 1967.
[9] Wong-Riley MT, Liang HL, Eells JT, Chance B, Henry MM, Buchmann E, Kane M, Whelan HT. Photobiomodulation directly benefits primary neurons functionally inactivated by toxins: role of cytochrome c oxidase. J Biol Chem. 2005 Feb 11;280(6):4761-71. doi: 10.1074/jbc.M409650200. Epub 2004 Nov 22. PMID: 15557336.
[10] Alexandratou E, Yova D, Handris P, Kletsas D, Loukas S. Human fibroblast alterations induced by low power laser irradiation at the single cell level using confocal microscopy. Photochem Photobiol Sci. 2002 Aug;1(8):547-52. doi: 10.1039/b110213n. PMID: 12659495.
[11] Lavi R, Shainberg A, Friedmann H, Shneyvays V, Rickover O, Eichler M, Kaplan D, Lubart R. Low energy visible light induces reactive oxygen species generation and stimulates an increase of intracellular calcium concentration in cardiac cells. J Biol Chem. 2003 Oct 17;278(42):40917-22. doi: 10.1074/jbc.M303034200. Epub 2003 Jul 7. PMID: 12851407.
[12] Lubart R, Wollman Y, Friedmann H, Rochkind S, Laulicht I. Effects of visible and near-infrared lasers on cell cultures. J Photochem Photobiol B. 1992 Feb 28;12(3):305-10. doi: 10.1016/1011-1344(92)85032-p. PMID: 1321905.
[13] Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5):00068. doi: 10.15406/mojor.2015.02.00068. Epub 2015 Jun 9. PMID: 26858986; PMCID: PMC4743666.
[14] Oliveira P, Sperandio E, Fernandes KR, Pastor FA, Nonaka KO, Renno AC. Comparison of the effects of low-level laser therapy and low-intensity pulsed ultrasound on the process of bone repair in the rat tibia. Rev Bras Fisioter. 2011 May-Jun;15(3):200-5. English, Portuguese. PMID: 21829983.
[15] Luo WT, Lee CJ, Tam KW, Huang TW. Effects of Low-Level Laser Therapy on Muscular Performance and Soreness Recovery in Athletes: A Meta-analysis of Randomized Controlled Trials. Sports Health. 2022 Sep-Oct;14(5):687-693. doi: 10.1177/19417381211039766. Epub 2021 Aug 25. PMID: 34428975; PMCID: PMC9460079.
[16] Gupta A, Keshri GK, Yadav A, Gola S, Chauhan S, Salhan AK, Bala Singh S. Superpulsed (Ga-As, 904 nm) low-level laser therapy (LLLT) attenuates inflammatory response and enhances healing of burn wounds. J Biophotonics. 2015 Jun;8(6):489-501. doi: 10.1002/jbio.201400058. Epub 2014 Sep 10. PMID: 25207838.
[17] Alves AC, de Carvalho PT, Parente M, Xavier M, Frigo L, Aimbire F, Leal Junior EC, Albertini R. Low-level laser therapy in different stages of rheumatoid arthritis: a histological study. Lasers Med Sci. 2013 Feb;28(2):529-36. doi: 10.1007/s10103-012-1102-7. Epub 2012 Apr 27. PMID: 22538842.
[18] Hsieh, Y.-L., Chou, L.-W., Chang, P.-L., Yang, C.-C., Kao, M.-J. and Hong, C.-Z. (2012), Low-level laser therapy alleviates neuropathic pain and promotes function recovery in rats with chronic constriction injury: Possible involvements in hypoxia-inducible factor 1α (HIF-1α). J. Comp. Neurol., 520: 2903-2916. https://doi.org/10.1002/cne.23072
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