Laser

Injury type: Acute/ Chronic

Category: Complementary and Alternative Therapies

Rating: No Research

What is it?

Laser therapy involves the administration of red through to infra-red light to the tissues for the purpose enhancing the healing process and providing pain relief. It is provided by a small hand held device that makes contact with the skin. There are usually no sensations involved with the treatment, other than the light pressure of the device against the skin.

How does it work?

Laser therapy is believed to work on the principle of inducing a biological response through energy transfer. This occurs through the photonic energy delivered into the tissue by the laser which modulates the biological processes within specific tissues. Low dosages of photonic energy may stimulate those biological processes, and higher dosages may inhibit them. Low level laser therapy (LLLT) may be used to enhance wound healing and pain relief. The effect of LLLT is such that it is thought to accelerate remodeling of scar tissue.

Is it effective?

While there is a lack of current evidence specifically examining laser therapy for people with whiplash, several studies have been conducted to evaluate its effectiveness on neck pain in general. For example, an updated systematic review¹ concluded that while LLLT is ‘likely helpful/ worth considering’ for recent and persistent grades I-II neck pain and associated disorders (NAD), it is ‘likely not helpful/ not worth considering’ for recent grade III NAD. Another review² (used for updating a clinical practice guideline) suggested LLLT as a management option, especially for patients with chronic neck pain with mobility deficits or acute neck pain with radiating pain, with weak to moderate level of evidence substantiating this recommendation. More recently, three fair- to good-quality trials comparing LLLT with sham were included in a systematic review³. Collectively, LLLT was associated with a moderately greater improvement in short-term function and pain, when compared to sham.

Are there any disadvantages?

Laser therapy should not be used near the eyes. The treatment may not be suitable for everyone, therefore an appropriate assessment should be carried out prior to its application by a qualified professional.

Where do you get it?

Medical, dental, podiatric, physiotherapy, chiropractic, osteopathic and acupuncture practitioners may provide laser therapy. The portability and diversity of battery and mains-powered diode laser systems allows treatment to be carried out in various clinical, hospital and field locations.

Recommendations

The use of laser therapy following whiplash cannot be recommended because of a lack of current research evidence. More research is required, including studies determining the parameters and investigating the long term effectiveness of laser therapy.

References contributing to the treatment rating

2. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD, Beattie P, Boeglin E. Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83.

Chow, RT, Johnson, MI, Lopes-Martins, RAb & Bjordal, RM 2009, ‘Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials’, Lancet, vol. 374, pp. 1897-1908.

Conforti, M & Fachinetti, GP 2013, ‘High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1° and 2° grade of the Quebec Task Force classification) involving muscles and ligaments’, Muscles, Ligaments and Tendons Journal, vol. 3, no. 2, pp. 106-111.

Guzman, J, Haldeman, S, Carroll, LJ, Carragee, EJ, Hurwitz, EL, Peloso, P, Nordin, M, Cassidy, JD, Holm, LW, Côté, P, Velde, G & Hogg-Johnson, S 2009, ‘Task force on neck pain and its associated disorders’, Journal of Manipulative and Physiological Therapeutics, vol. 32, pp. 227-243.

Guzman, J, Haldeman, S, Carroll, L, Carragee, E, Hurwitz, E Peloso, P, Nordin, M, Cassidy, D, Holm, L, Coˆte, P, Van der Velde, G & Hogg-Johnson, S 2008, ‘Clinical practice implications of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders; from concepts and findings to recommendations’, European Spine Journal, vol. 17, no. 1, pp. 199-213.

Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders’, European Spine Journal, vol. 17, no. 1, pp. 123-152.

Leaver, AM, Refshauge, KM, Maher, CG & McAuley, JH 2010, ‘Conservative interventions provide short-term relief for non-specific neck pain: a systematic review’ , Journal of Physiotherapy, vol. 56, pp, 73-85.

3. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJ. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update.

1. Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal. 2016 Dec 1;16(12):1598-630.