Cold Laser and Shockwave Therapy: Going Beyond The Research

When patients present with pain or other debilitation, it’s easy to turn to the tried and true remedies for answers. But what if these don’t work? While literature and best practice tend to deliver the right answers, not every patient sees a benefit. This is where personalized medicine steps in. Vitality Academy recently looked into the research combining shockwave therapy with low-level laser therapy and developed a case study showcasing their results.

It should not come as a surprise that if one gets a good result with shockwave therapy, one can get better results if the same treatment is combined with a Class 4 cold laser. Generating shock waves by accelerating a bullet that hits the applicator and transforming its kinetic energy into radially expanding shockwaves has been shown to be effective in conditions such as plantar faciitis and lateral epicondylosis. Using shockwave therapy has also been studied in treatment of greater trochanter pain pyndrome, chronic plantar fasciitis, chronic medial tibial stress syndrome and Achilles tendinopathy. Low-lever laser therapy (LLLT) is theorized to accelerate the repair of connective tissue and affect fibroblast function. It can also improve healing and reduce pain. A systematic review published in 2009 by Kromer et al. found two studies that investigated the clinical efficacy of LLLT in the treatment of impingement syndrome. They concluded that there is conflicting evidence and that no specific recommendation can be offered. However, Michener et al.’s systematic review on the effectiveness of rehabilitation on patients with shoulder impingement syndrome came to a much different conclusion (Research Review Services).

But do we have to follow research blindly? So if there is no study for shockwave combined with class 4 laser for chronic knee pain, we should not try it?

Well in this report, that is exactly what we did.

A middle-aged woman injured her left knee by getting caught in the GO Train in Toronto.  She attended what we call traditional physiotherapy. There have been some studies showing the efficacy of TENS for knee pain. Many practitioners have also had good results with ultrasound therapy for knee injuries. Exercises for knee pain and injures have been well studied. But in this case, none of the above helped our patient. In fact, according to our patient, these treatments made her worse. I walked in to this patient who was limping around our medical clinic. I told her about our new Shockwave and Apollo laser. A quick physical exam showed lack of ROM in flexion. No swelling was observed. No instability was noted. Pain was reported during the pivot shift test. A meniscus tear was suspected, but this patient was being sent to a specialist and will probably undergo advance imaging.

Regardless, we administered both shockwave (120 mJ, 2000 pulses) and Apollo Class IV laser (350 Jules). Total treatment time was about 5-6 minutes. Following treatment, the patient was able to sleep for the first time in many months pain free. Her knee pain had made her lose sleep night after night.

Now that she is in less pain, therapeutic exercises can be administered. This was a great case, and I was happy to see such good results in one session.

As practitioners, we can always use our common sense, look outside of the box and try new things. In fact, this is how case studies are born, which can lead to randomized double blind studies in future.