Photobiomodulation as an Adjunctive Treatment to Physiotherapy for Reduction of Anterior Knee Pain in Combat Soldiers: A Prospective, Double‐Blind, Randomized, Pragmatic, Sham‐Controlled Trial

Abstract

Background and ObjectivesAnterior knee pain (AKP) is the most common knee pathology in athletes and occurs in 15% of army recruits of elite units during basic training. Of these, 50% are symptomatic 6 years later. Photobiomodulation (PBM) is a nonthermal red‐to‐near‐infrared irradiation used for pain reduction of a variety of etiologies. This study was designed to determine whether addition of PBM to physiotherapy (PT) for AKP in combat soldiers is superior to PT alone.Study Design/Materials and MethodsIn this prospective, double‐blind, sham‐controlled, randomized clinical trial (NCT02845869), 26 combat soldiers/policemen (male:female, 15:11; body mass index [BMI] = 24.2 ± 3.9,n = 46 knees), with AKP due to overuse/load, received 4 weeks of PT + sham (PT + Sham) or active PBM (wavelength = 660 and 850 nm, pulsing = 2.5 Hz, LED power = 50 mW/cm2[local tissue/regional lymph nodes]; 810 nm continuous beam, laser cluster 6 W/cm2[analgesia] and laser pointer 4.75 W/cm2[trigger points]) (PT + PBM). The main outcome measures were subjective pain by visual analog scale (VAS) (0 [none]–100 [intolerable]) and functional disability by Kujala score (0 [worst]–100 [best]). Evaluations were carried out at baseline, end of treatments, and 3‐month follow‐up.ResultsAll participants completed the treatment protocol without any reported adverse device effects. Post‐treatment pain was significantly reduced in the PT+PBM group, compared with baseline and sham (Δpain, VAS, mean ± SD: PT + PBM = −19 ± 23,P = 0.002; PT + Sham = −6 ± 21,P = 0.16; between groups,P = 0.032). At 3‐month follow‐up, pain reduction was similar between groups; however, the Kujala score was significantly improved only in the PBM‐treated group (ΔKujala: PT + PBM = 11 ± 10,P = 0.003; PT + Sham = 5 ± 7,P = 0.059).ConclusionsAddition of PBM to PT for AKP resulted in earlier reduction in pain and improved functionality, compared with PT alone. This noninvasive, nonpharmacologic, adjunctive therapeutic modality can be easily incorporated into team healthcare frameworks or end units and may lead to earlier return to competition or combat‐level service. Lasers Surg. Med. © 2021 Wiley Periodicals LLC

The Utility of Photobiomodulation as a Supplement to Orthobiologic Interventions

“…The shared benefits of PRP and PBM seem to be in their ability to individually treat soft tissue and joint pathology for conditions including knee osteoarthritis, knee pain, and tendinopathies. 6,[11][12][13][14]17,27,29 Thus, clinicians should consider the appropriate sequencing and timing of these therapies when using them in a care plan. PBM and orthobiologics could potentially promote tissue and wound healing through increasing vasodilation and angiogenesis, which may reduce associated pain through increases in peripheral endogenous opioid production.…”

“…PBM therapy, used with other interventions, such as exercise and electrical stimulation, aids in pain management and inflammatory modulation for conditions such as tendinopathy. 6,7,[11][12][13][14][15][16] Yet, there is a paucity of evidence in human subjects on PBM therapy application as an adjuvant therapy to orthobiological regenerative medicine interventions such as platelet-rich plasma, bone marrow, and fat. Accordingly, this article aims to provide practical guidelines for the use and application of PBM therapy as an adjuvant intervention for orthobiologics.…”

“…Pocai et al 19 showed that PBM treatment produced no meaningful changes in pain (except for pain associated with landing a jump), function, and self-reported outcome measures when used as an independent treatment and compared to a control group in young females. Gavish et al 11 showed that treatment of anterior knee pain in soldiers and police officers with physical therapy and active PBM was superior in shortterm (4 week) outcomes when compared to sham PBM and physical therapy. However, this study also revealed no significant difference in outcomes for anterior knee pain at 3-month follow-up with participants in either group.…”

“…However, this study also revealed no significant difference in outcomes for anterior knee pain at 3-month follow-up with participants in either group. 11 For other lower extremity conditions, PBM therapy lacks clinical utility. Research indicates that PBM and rehabilitation were no better than rehabilitation alone to treat hamstring strain injury.…”

“…Based on how PBM utilization in research and the intended treatment effects of PRP application, PBM and PRP could be combined when treating soft tissue injury, joint pathology, and joint inflammatory conditions including: knee osteoarthritis, knee pain related to soft issue injury or degeneration, and tendinopathies. 6,[11][12][13][14]17,27…”