Jennifer Boudreault1, François Desmeules1,2*, Jean-Sébastien Roy3,4, Clermont E Dionne3,5, Pierre Frémont3,6 and Joy C MacDermid1
1Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
2School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
3Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
4Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
5Population Health research unit (URESP), Laval University Hospital (CHU) Research Center, Quebec, Quebec, Canada
6Laval University Hospital (CHU) Research Center, Quebec, Quebec, Canada
7School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
Received: 12 January, 2016; Accepted: 06 February, 2016; Published: 08 February, 2016
François Desmeules, PT, PhD, Unité de recherche clinique en orthopédie/ Orthopaedic clinical research unit, Centre de recherche de l’Hôpital Maisonneuve-Rosemont (CRHMR), 5415 Blvd L'Assomption, Pav. Rachel Tourigny, bureau/office 4163, Montréal, QC H1T 2M4, Tel: 514 252-3400, # 5607; Fax: 514 254-7455; E-mail:
Boudreault J, Desmeules F, Roy JS, Dionne CE, Frémont P, et al. (2016) The Efficacy of Laser Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis. J Nov Physiother Phys Rehabil 3(1): 001-015. DOI: 10.17352/2455-5487.000029
© 2016 Boudreault J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Shoulder; Rotator cuf; Tendinopathy; Laser therapy
Objective: To perform a systematic review and meta-analysis on the efficacy of laser therapy (LT) for rotator cuff (RC) tendinopathy in adults.
Methods: A literature search was conducted in four databases for randomized controlled trials (RCTs) published until May 2014, comparing the efficacy of LT to any other intervention. RCTs’ characteristics were extracted using a standardized form and the risk of bias was evaluated using the Cochrane Risk of Bias tool. Data were summarized qualitatively or quantitatively (meta-analysis).
Results: Thirteen RCTs, with moderate mean methodological score (66.4%± 10.0), were included. It was concluded that LT may provide short-term pain relief of minimally significant clinical importance compared to placebo (sham LT), ultrasound therapy, or clinical recommendations alone. In terms of self-reported function and shoulder range of motion (ROM), evidence was inconclusive. When compared to an exercise program, LT was not deemed to have superior effects on pain, function or shoulder ROM. LT in conjunction with exercise was not superior to exercise alone with respect to pain, function and shoulder ROM.
Conclusion: Low to moderate grade evidence supports that LT may reduce pain in the short term in adults with RC tendinopathy, while its effects on function and ROM are not supported. Until more high quality evidence demonstrates clearly the efficacy of LT, clinicians should use LT cautiously and in the sole objective of alleviating pain in the short-term
Shoulder pain is one of the most common reasons for consultation in primary care  and its prevalence varies from 7 to 26% in the general population . Rotator cuff (RC) tendinopathy accounts for 69% to 75% of shoulder pain cases . RC tendinopathy is an inclusive term used to describe a pathology of the RC tendons , that encompasses other diagnostics such as impingement syndrome, subacromial bursitis, and long head of the biceps tendinopathy . It can result in important functional limitations and in time away from work in workers populations . The etiology of RC tendinopathy has been described as multifactorial and may be related to a combination of both intrinsic and extrinsic causes . Intrinsic causes that contribute to rotator cuff tendon degeneration are related to alterations in its biology, mechanical properties, morphology and vascularity . Extrinsic mechanisms that can contribute to the development of RC tendinopathy by reducing the subacromial space include anatomic variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, deficits in the performance of rotator cuff and scapular muscles or decreased flexibility of shoulder soft tissue structures .
Multiple rehabilitations modalities exist to treat RC tendinopathy, such as exercise, manual therapy, or electrotherapy. For many of these interventions commonly used in clinics, evidence regarding their efficacy or the magnitude of treatment effects that may be expected is scarce . Laser therapy (LT) is an electrotherapy modality that has been used for decades by physiotherapists despite scarce evidence regarding its efficacy. Based on indirect evidence from animal tendon studies, LT is believed to decrease inflammation, increase angiogenesis, increase fibroblast activity leading to increased collagen production, increase tensile strength and decrease pain [8,9]. A recent review of systematic reviews was published on the effectiveness of conservative interventions for adults with RC tendinopathy, including LT. The authors concluded that the evidence did not support the effectiveness of LT compared to other interventions . However, this review did not include all the available evidence on the efficacy of LT modality in individuals suffering from RC tendinopathy and its conclusions were only qualitative as it was based on previous systematic reviews evaluating evidence published until 2008. Another systematic review on the efficacy of LT for all types of tendinopathies, that included 3 RCTs specific to RC tendinopathy was recently published and concluded that conflicting evidence exists for the effectiveness of LT in the treatment of all type of tendinopathies; the authors did not make specific conclusions for RC tendinopathy . According to the authors, LT can potentially be effective in terms of pain relief in treating tendinopathy when recommended dosages are used. In fact, one of their conclusions was that adequate recommended laser dosage was not always used in the included studies (low level LT: 8 joules for a wavelength of 780 to 820 nm and 4 joules for a wavelength of 904 nm are recommended) , possibly impeding therapeutic treatment effect. A Cochrane systematic review published in 2003 concluded that LT was effective in individuals suffering from shoulder adhesive capsulitis but not in a population suffering from RC tendinopathy . Since the original publication, this review has not been updated. There is therefore a need to gather and to evaluate new evidence regarding the effectiveness of LT specifically for RC tendinopathy. The aim of the present study was to conduct a systematic review and meta-analysis on the effectiveness of LT to treat adults suffering from RC tendinopathy.
Literature search and study identification
Two evaluators conducted an electronic literature search on Pubmed, CINAHL, Embase and PEDro databases, using a combination of keywords and MESH terms (Figure 1). All databases were searched from their date of inception to May 2014. Reference lists of all retrieved studies and previous reviews on the subject were searched for further relevant studies.