Effects of low-intensive laser therapy on tendinopathy of rotator cuff in combination with kinesiotherapeutic methods

Uvod: Kar dve tretjini ljudi, ki jih spremljajo bolečine v ramenskem sklepu, je diagnosticiranih s tendinopatijo rotatorne manšete. Je progresivna bolezen, ki se začne z akutnim tendinitisom in lahko napreduje v degenerativno tendinozo z oslabljeno tetivo, ki se lahko kasneje popolnoma raztrga. Najpogosteje uporabljeni kinezioterapevtski postopki pri tendinopatijah so raztezanje in krepitev mišic rotatorne manšete. Poleg kinezioterapije je med fizioterapevti zelo pogosta uporaba laserske terapije, saj te oblike elektromagnetne energije sodelujejo pri biostimulaciji celic in tako spodbujajo celjenje tkiv. Namen: Namen diplomskega dela je bil na podlagi pregleda strokovne literature predstaviti učinkovitost laserske terapije nizke intenzitete pri zdravljenju tendinopatije rotatorne manšete v kombinaciji s kinezioterapevtskimi postopki. Metode dela: Literatura je bila pridobljena s pomočjo sledečih podatkovnih baz: PEDro, PubMed in CINAHL, knjižna literatura pa je bila pridobljena v knjižnici Zdravstvene fakultete. Iskanje literature je bilo omejeno na slovenski in angleški jezik ter časovno obdobje med letoma 2005 in 2017. Rezultati: V pregled literature je bilo vključenih 8 randomiziranih kontrolnih raziskav. Od izbranih raziskav so v treh primerjali učinkovitost laserske terapije nizke intenzitete s placebo lasersko terapijo, v eni raziskavi so primerjali učinkovitost laserske terapije nizke intenzitete z ultrazvočno terapijo, ostale raziskave pa so primerjale učinkovitost laserske terapije nizke intenzitete z ostalimi instrumentalnimi postopki. Razprava in zaključek: Ugotovili smo, da so bili samo pri treh raziskavah delno pozitivni učinki dodanega laserja nizke intenzitete. V primerjavi z ultrazvočno terapijo smo odkrili, da sta obe terapiji enakovredni pri zdravljenju tendinopatije rotatorne manšete. V štirih raziskavah je bila aplikacija laserja izvedena na bolečih točkah, vendar so delne pozitivne učinke ugotovili samo pri eni raziskavi. V dveh raziskavah niso uporabili priporočenih parametrov laserske terapije. Vse raziskave so uporabile različne parametre, različne terapevtske postopke in tudi različna merilna orodja, kar je lahko vplivalo na rezultat raziskav. Na tako majhnem številu pregledanih raziskav ne moremo zaključiti, ali je laser nizke intenzitete učinkovit ali ne. Povzamemo pa lahko, da je kinezioterapevtska vadba pozitivno učinkovala na rezultat vseh raziskav. Potrebno bi bilo opraviti več naključnih kontrolnih raziskav, ki bi bile enotne in standardizirane, da bi lahko potrdili morebitne učinke laserja nizke intenzitete.Introduction: A diagnosis of tendinopathy of rotator cuff is received by as much as two-thirds of people who are accompanied by pain in the shoulder joint. It is a progressive disease that begins with acute tendinitis and can progress to degenerative tendinosis with a weakened tendon which can later completely tear off. The most commonly used kinesiotherapy procedures in tendinopathy are stretching and strengthening of rotator cuff muscles. In addition to kinesiotherapy, the use of laser therapy is very common among physiotherapists, since these forms of electromagnetic energy are involved in cell biostimulation and thus stimulate tissue healing. Purpose: The purpose of the thesis was to determine the effectiveness of low-intensive laser therapy in the treatment of tendinopathy of rotator cuff in combination with kinesiotherapy procedures, on the basis of a review of professional literature. Methods: Literature was obtained using the following databases: PEDro, PubMed and CINAHL. Book literature was obtained at the library of the Faculty of Health Sciences. Literature search was limited to Slovene and English language and the period between 2005 and 2015. Results: The literature review included 8 randomized control studies. Of the selected studies, three were comparing the effectiveness of low-intensive laser therapy with placebo laser therapy, one study was comparing effectiveness of low-intensive laser therapy with ultrasound therapy, while other studies were comparing effectiveness of low-intensive laser therapy with other instrumental procedures. Discussion and conclusion: After reviewing the literature, we found out that only three studies have partial positive effects due to added low-intensive laser. Compared to ultrasound therapy, both therapies were found to be equivalent in the treatment of tendinopathy of the rotator cuff. In four studies the application of the laser was performed on painful points, but partial positive effects were found only in one study. We found out that two studies did not use the recommended laser parameters. All studies were using different parameters, different therapeutic procedures and also different measuring tools, which may have affected the outcome of the studies. On such a small number of examined studies, we cannot conclude if the low-intensive laser is effective or not. However, we believe that the kinesiotherapy exercise had a positive effect on the outcome of all researches. To verify the potential effects of low-intensity laser, a several randomized, common and standardized control studies should be carried out