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    Effects of High Intensity Laser Therapy

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    of 3

    J. Phys. Ther. Sci.

    29: 1079–1081, 2017

    The Journal of Physical Therapy Science

    Original Article

    Effects of high intensity laser therapy on pain


    and function of patients with chronic back pain

    Hyeun-Woo Choi1), Jongmin Lee, MD1), Sangyong Lee, PhD, PT2), Jioun Choi, PhD, PT3),
    Kwansub Lee, PhD, PT4), Byung-Kon K im, PhD, PT5), Gook-Joo K im, PT6)*
    1) Kyungpook National University Biological Engineering, Kyungpook National University Hospital,
    Republic of Korea
    2) Department of Physical Therapy, U1 University, Republic of Korea
    3) Department of Physical Therapy, Shin Orthopedic Hospital, Republic of Korea
    4) Department of Physical Therapy, The Kang Hospital, Republic of Korea
    5) Department of Physical Therapy, Daegu Health College, Republic of Korea
    6) Department of Physical Therapy, College of Rehabilitation Science, Daegu University:

    12, 15 Jillyang, Republic of Korea

    Abstract. [Purpose] This study examined the effects of High Intensity Laser Therapy on pain and function of
    patients with chronic back pain. [Subjects and Methods] This study evenly divided a total of 20 patients with
    chronic back pain into a conservative physical therapy group that received conservative physical therapy, and a high
    intensity laser therapy group that received High Intensity Laser Therapy after conservative physical therapy. All
    patients received the therapy three times a week for four weeks. For the high intensity laser therapy group, treat-
    ment was applied to the L1–L5 and S1 regions for 10 minutes by using a high intensity laser device while vertically
    maintaining the separation distance from handpiece to skin at approximately 1 cm. A visual analog scale was used
    to measure the pain and Oswestry Disability Index was used for functional evaluation. [Results] In a within-group
    comparison of the conservative physical therapy and high intensity laser therapy groups, both the visual analog
    scale and Oswestry Disability Index significantly decreased. In a between-group comparison after treatment, the
    high intensity laser therapy group showed a significantly lower visual analog scale and Oswestry Disability Index
    than the conservative physical therapy group. [Conclusion] High Intensity Laser Therapy can be an effective non-
    surgical intervention method for reducing pain and helping the performance of daily routines of patients who have
    chronic back pain.
    Key words: Low back pain, High intensity laser therapy, Oswestry disability index
    (This article was submitted Jan. 19, 2017, and was accepted Mar. 30, 2017)

    INTRODUCTION
    Back pain is a frequently observed disease. Statistics tell us that most people have experienced back pain at least once in
    their lifetime. The disease affects almost all age groups, inflicting mental and physical burdens on people1). Risk factors of
    spinal pain include physical characteristics, general medical health, mental condition, and working environmental factors
    where age, weight, injury, occupation, or posture can make people experience the pain2). Back pain resulting from these
    factors causes productivity loss and impairment of quality of life as it limits mobility in people’s daily routines3). Symptoms
    of back pain not only affect sacroiliac articulation and the lumbar region, but also accompany radiating pain that progresses
    to the lower limbs4). Popular treatments for back pain include acupuncture, traction, percutaneous electrical nerve stimula-

    *Corresponding author. Gook-Joo Kim (E-mail: [email protected])


    ©2017 The Society of Physical Therapy Science. Published by IPEC Inc.
    This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd)
    License <https://creativecommons.org/licenses/by-nc-nd/4.0/>.
    Table 1. Comparison of the VAS and ODI within each group at
    the HILT

    Group Pre Post


    VAS (point) CPTG 7.0 ± 1.2 6.2 ± 1.4 aa
    HLTG 7.0 ± 0.8 3.4 ± 0.8 aa,bb
    ODI (%) CPTG 31.6 ± 11.5 29.6 ± 10.7 aa
    HLTG 33.1 ± 13.0 19.0 ± 10.6 aa,b
    VAS: Visual Analog Scale; ODI: Oswestry Disability Index;
    CPTG: Conservative Physical Therapy Group; HLTG: High-
    intensity Laser Therapy Group; aap<0.01, paired t-test; bp<0.05,
    independent sample t-tests; bbp<0.01

    Fig. 1. The high intensity laser therapy

    tion, massage, ultrasonic waves, and low-intensity laser treatment. Surgery is recommended when these treatment methods
    are ineffective or when symptoms are very severe5). High Intensity Laser Therapy (HILT) has photochemistry effects that
    stimulate oxidation of mitochondria and ATP creation by delivering high energy output inside tissues. HILT can cause quick
    absorption of edema and removal of exudates through increased metabolism and blood circulation6). Although many nonsur-
    gical treatments for chronic back pain have been introduced so far, there is a paucity of research on HILT. To help answer this
    shortcoming, this study conducted an experiment to prove the effects of HILT on patients with chronic back pain.

    SUBJECTS AND METHODS


    Among the hospitalized patients and outpatients in S Orthopedics located in Daegu City, Korea, research subjects of this
    study included 20 patients between the ages of 30 and 65 who were diagnosed by their doctors with chronic back pain, based
    on clinical findings and X-ray findings that persisted for more than three months. Excluded from the sample were patients
    who had surgical history in the lumbar region, had a spinal tumor or disc infection, or had inflammatory diseases such as
    rheumatism as well as those who had previous fractures and those who had contraindications for manual therapy. Ethical
    approval for the study was granted by the U1 University institutional review board. All subjects read and signed consent
    forms, in accordance with the ethical standards of the Declaration of Helsinki.
    The patients with chronic back pain were randomly and evenly divided into a Conservative Physical Therapy Group
    (CPTG) that received conservative physical therapy, and a High-intensity Laser Therapy Group (HLTG) that received both
    conservative physical therapy and HILT. The treatment was applied three times a week for a total of four weeks. The CPTG
    subjects had an mean age of 47.1 ± 9.6 years, an mean height of 164.4 ± 10.0 cm, and an mean weight of 62.7 ± 15.6 kg. For
    the HILT subjects, mean age was 48.3 ± 9.0 years, mean height was 160.1.3 ± 5.5 cm, and mean weight was 62.6 ± 10.2 kg.
    CPTG received a 20-minute hot pack treatment, 15-minute interference wave treatment, and 5-minute deep heat injec-
    tion treatment using ultrasonic waves. HLTG received high intensity laser therapy after the identical conservative physical
    therapy was applied. A HILT device (SALUS-Heallaser, Remed Inc.) was applied to the L1–L5 and S1 regions for 10 minutes
    while vertically maintaining the separation distance from handpiece to skin at approximately 1 cm. The laser was applied in
    three phases including initial phase, trigger point, and final phase, with a total energy of 1,378 mJ/cm2 (Fig 1). All patients
    received therapy three times a week for four weeks.
    In this study, a Visual Analogue Scale (VAS) was used to investigate the intensity of pain and the Oswestry Disability
    Index (ODI) was used to evaluate the function of patients with chronic back pain. VAS and ODI of both of CPTG and HLTG
    were measured before and after the four-week treatment using identical methods. As for the statistical analysis in this study,
    paired t-test was conducted to examine the within-group change and independent t-test was conducted for the between-group
    comparison. SPSS/PC Ver. 13.0 was used for statistical treatment in this study where significance level α was set at 0.05.

    RESULTS
    In this study, VAS and ODI significantly decreased in a within-group comparison of CPTG and HLTG (p<0.05). In
    a between-group comparison after the treatment, VAS and ODI of HLTG were significantly lower than CPTG (p<0.05)
    (Table 1).

    1080 J. Phys. Ther. Sci. Vol. 29, No. 6, 2017


    DISCUSSION
    Noninvasive treatment is receiving increasing attention following the widespread recognition of avoiding surgery and
    side effects. This study attempted to find out how high intensity laser therapy affects the pain and function of patients with
    chronic back pain.
    Alayat et al.3) reported that the HLTG included exercise showed increased ROM, reduced pain, and functional disability
    compared to the HLTG, and the Sham Laser Group that included exercise. Alayat et al.3) applied HILT to female patients with
    chronic back pain and reported its effectiveness in pain reduction. In this study, applying HILT to patients with chronic back
    pain for four weeks resulted in statistically significant improvement of VAS in HLTG. It is conjectured that HILT increased
    metabolism and stimulated blood circulation through systemic vasodilatation, causing reabsorption of unnecessary tissue-
    liquid that was accumulated in body and quick removal of exudates6). In this study, function of patients with chronic back
    pain that was measured by ODI showed a statistically significant difference in HLTG. Kheshie et al.7) compared between
    HILT and low-intensity laser treatment using 53 female patients with degenerative knee arthritis as a sample and reported that
    HILT is more effective in pain reduction and functional improvement. Alayat et al.3) applied HILT to 72 female patients with
    chronic back pain and reported its effectiveness in enhancing the range of mobility and function, supporting the results of
    this study. Here, HILT affected homeostasis as it enhanced ATP production by inducing thermal effects through photothermal
    interaction8). It can also be attributed to the fact that HILT relaxed stiffened tissue by increasing expansibility inside collagen
    tissue through a stimulation of metabolism of cells that was caused by decreased infection and increased temperature of the
    local area9, 10).
    This study has several limitations. First, the number of subjects was small. The sample only included patients who visited
    our hospital during one four-week period. Second, we could not perfectly control the daily routine of the subjects. Third, as
    the treatment duration was short, we could not check the long-term effects. We believe that many new studies on the effects
    of HILT will be required in order to complement the limitations of this study.

    REFERENCES

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