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Table 1.  

Study by first author Year Method score Laser wavelength Application technique Result Reason for exclusion
Mulcahy [40] 1995 5 904 Not stated No significant differences between active and placebo LLLT Does not satisfy control group criterion: Lacks sufficient patient numbers in placebo control group as only 3 patients had tendinopathy
Simunovic [41] 1998 3 830 Tendon + Trigger Points LLLT significantly better than placebo Does not satisfy criterion for specific endpoint and standard number of treatments: Only bilateral conditions were given placebo treatment, but data for this group were not presented
Vasseljen [42] 1992 5 904 Tendon Traditional physiotherapy significantly better than LLLT Does not satisfy blinding criterion: Neither therapist, patients or observers were blinded in the traditional physiotherapy group

Randomised LLLT-trials Excluded for not Meeting Trial Design Criteria for Diagnosis, Blinding or Specific Endpoints

Trial characteristics by first author, method score, laser wavelength in nanometer, laser application technique, trial results and reason for exclusion.

Table 2.  

Study by first author Method score Wave-length Application technique Result Reason for exclusion
Haker [43] 6 904 Tendon No significant differences Photograph in trial report shows that the laser probe was kept in skin contact and thereby violated the manufacturers' recommendation of a keeping the laser head at a distance of 10 cm. This violation caused a central blind spot of ca 3 cm2 which left the tendon pathology unexposed to LLLT (See Figure 2)
Siebert [44] 6 904 + 632 Tendon No significant differences Active laser treatment to the placebo group received red 632 nm LLLT, which we calculated to be (2.25J), which again is an adequate LLLT dose. Consequently this trials lacks a placebo or non-laser control group

Randomised LLLT-trials Excluded for not Meeting Criteria of Valid Procedures for Active Laser and Placebo Laser Treatment

Trial characteristics given by first author, method score, laser wavelength, laser application technique, trial results and reason for exclusion.

Table 3.  

Study by first author Method score Patient numbers Application technique Control Trial results
Basford [53] 8 47 Tendon Placebo 0
Gudmundsen [51] 6 92 Tendon Placebo ++
Haker [46] 7 49 Acupoints Placebo 0
Haker [50] 6 58 Tendon Placebo +
Krashenninikoff [54] 6 36 Tendon Placebo 0
Lam [55] 7 37 Tendon Placebo ++
Løgdberg-Anderson [49] 7 142 Tendon Placebo ++
Lundeberg [47] 6 57 Acupoints Placebo 0
Oken [56] 7 59 Tendon UL, Brace ++
Palmieri [57] 6 30 Tendon Placebo ++
Papadoupolos [52] 4 31 Tendon Placebo -
Stergioulas [48] 7 62 Tendon Placebo ++
Vasseljen [58] 8 30 Tendon Placebo +
Total 6.5(Mean) 730      

Included Randomised LLLT-trials

Trial characteristics by first author, method score, laser application technique, control group type, trial results. The abbreviations used are determined by the following categories: (-) means a result in favour of the control group, (0) means a non-significant result, (+) means a positive result for LLLT in at least one outcome measure, and (++) means a consistent positive results for more than one outcome measure.

A Systematic Review With Procedural Assessments and Meta-analysis of Low Level Laser Therapy in Lateral Elbow Tendinopathy (Tennis Elbow): Conclusion



The available material suggests that LLLT is safe and effective, and that LLLT acts in a dose-dependent manner by biological mechanisms which modulate both tendon inflammation and tendon repair processes. With the recent discovery that long-term prognosis is significantly worse for corticosteroid injections than placebo in LET, LLLT irradiation with 904 nm wavelength aimed at the tendon insertion at the lateral elbow is emerging as a safe and effective alternative to corticosteroid injections and NSAIDs. LLLT also seems to work well when added to exercise and stretching regimens. There is a need for future trials to compare adjunctive pain treatments such as LLLT with commonly used pharmacological agents.

Authors' Contributions

JMB had the original idea, which was developed through lengthy discussions with contributions from RABL-M, JJ, CC, AEL, AS and MIJ. The literature search, including handsearching, was performed by all members of the author team. The first draft was written by JMB, RABL-M and JJ, and revised by AS and MIJ. Methodological assessments of trials were performed by JMB, AEL, CC, AS. The statistical analysis was performed by JMB, RABL-M, JJ and MIJ. The final linguistic revision was performed by MIJ and all members of the author team read and commented on the manuscript before submission.

Funding Information

The study was funded internally by Bergen University College in providing working hours for the first author, Jan M. Bjordal. The funding body played no role in the study design, the collection, analysis, interpretation of data, in the writing of the manuscript or the decision to submit the manuscript for publication. None of the other authors received any funding for the performance of the study.

Reprint Address

Jan M Bjordal, Institute of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College, Moellendalsvn. 6, 5009 Bergen, Norway; Email:[email protected]


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