Improving Extracorporeal Shock Wave Therapy With 904 or 905 NM Pulsed, High Power Laser Pretreatment

Abstract

Extracorporeal shock wave therapy (ESWT) is a well investigated and widely used treatment modality for a number of musculoskeletal disorders. A limitation of ESWT is its potential painfulness at higher, clinically relevant energy flux density (EFD), which may limit its applicability and, thus, effectiveness. Various studies in the literature demonstrated that neither application of a higher number of extracorporeal shock waves with lower EFD nor use of local anesthesia may solve this problem. Based on the results of several other studies in the literature it is hypothesized here that in patients suffering from musculoskeletal disorders that can be treated with ESWT, pretreatment with a pulsed, high power laser with a wavelength of 904 or 905 nanometers (hereafter: "laser pretreatment") does not only allow to apply higher EFDs in subsequent ESWT but actually results in faster and/or better treatment outcome than ESWT without laser pretreatment. Accordingly, it is hypothesized here that combining ESWT with laser pretreatment leads to synergistic effects and, thus, is superior to either treatment modality alone. Confirming this hypothesis in preclinical and clinical research may raise significance and increase the use of ESWT in physical and rehabilitation medicine, with immediate benefit for patients.

More than Ninety Percent of the Light Energy Emitted by Near-Infrared Laser Therapy Devices Used to Treat Musculoskeletal Disorders Is Absorbed within the First Ten Millimeters of Biological Tissue

“…There is increasing interest in the application of near-infrared (NIR) light for the treatment of various musculoskeletal disorders, where the NIR light is used to reduce pain and inflammation and to stimulate tissue healing [ 1 , 2 , 3 , 4 , 5 ]. A number of studies showed that high power laser therapy alone can effectively be applied to treat various musculoskeletal disorders (for examples and references, see [ 6 ]).…”

“…Another potential application of NIR laser light in medicine is the augmentation of extracorporeal shock wave therapy (ESWT) [ 6 ]. ESWT is a non-pharmacological and non-surgical treatment modality for a variety of musculoskeletal disorders [ 12 ].…”

“…This has led to the general recommendation not to use local anesthetics to increase the pain threshold during ESWT [ 12 , 18 ]. On the other hand, due to the aforementioned mechanisms of action, a pretreatment with a high power NIR laser may locally and temporarily reduce the sensation of pain and, therefore, allow the application of ESWs with higher EFD in subsequent ESWT [ 6 ]. Additionally, the combination of high power NIR laser treatment with ESWT may lead to synergistic effects [ 6 ].…”

More Than Ninety Percent of the Light Energy Emitted by Near-Infrared Laser Therapy Devices Used to Treat Musculoskeletal Disorders Is Absorbed Within the First Ten Millimeters of Biological Tissue

“…Another potential application of NIR laser light in medicine is the augmentation of extracorporeal shock wave therapy (ESWT) [6]. ESWT is a non-pharmacological and nonsurgical treatment modality for a variety of musculoskeletal disorders [12].…”

Why and How to Use the Body’s Own Stem Cells for Regeneration in Musculoskeletal Disorders: A Primer

“…As long as the aforementioned local self-healing power of the body is sufficient to restore physiological body structures and functions in the event of trauma or disease, all treatment efforts should primarily focus on this. A variety of methods, including but not limited to physiotherapy, osteopathy, extracorporeal shock wave therapy (ESWT) [7], laser therapy [8] and the injection of platelet-rich plasma (PRP) [9], can make valuable contributions through stimulation of local regeneration.…”