Low level laser therapy in tennis elbow

Tennis elbow, or lateral epicondylitis, is a common pain condition found in 1 to 2 percent of the adult Swedish population. Low level laser therapy is sometimes used as a treatment modality in tennis elbow.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What systematic reviews are published regarding low level laser therapy for tennis elbow?

Identified literature

Nine relevant systematic reviews were identified. One of them had moderate risk for bias and is presented below [1]. Eight had high risk of bias and is not presented further [2-9].

Table 1. Systematic reviews with low/medium risk of bias
CCT = Controlled clinical trial; CI = Confidence Interval; LLLT = Lowlevel laser therapy; n = Number of studies; WMD = Weighted mean difference
Included studies Population/Intervention Outcome and Results
Tumilty et al. 2010, [1] Low level laser treatment of tendinopathy: a systematic review with meta-analysis
13 CCTs, 536 subjects Population: Epicondylitis

Intervention: LLLT Wavelength: 632.8 to 1060 nm Power density: 60 to 400 mW/cm2 Energy density: 1.8 to 150 J/cm2

Control: Placebo (n=8) or other active control (n=5) such as other electrotherapy modalities, ultrasound, and corticosteroid injection.		 Meta-analysis:

Grip strength (n = 4): WMD: 9.59 kg (95% CI, 5.90 to 13.27) Average grip strength in intervention groups was between 29.57 and 56.30 kg after treatment.

Average grip strength in control groups was between 21.61 and 43.60 kg after placebo.

Pain scores (n=5):
Data could not be pooled
Authors' conclusion:
“This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy.”
“LLLT can potentially be effective in treating tendinopathy when recommended dosages are used.”
“Poor blinding procedures, lack of randomization, and lack of intention to treat analysis may have increased potential biases and weakened the scientific merit of the works reviewed. “

References

  1. Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28(1):3-16. Available from: https://doi.org/10.1089/pho.2008.2470.
  2. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, et al. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008;9:75. Available from: https://doi.org/10.1186/1471-2474-9-75.
  3. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39(7):411-22; discussion -22. Available from: https://doi.org/10.1136/bjsm.2004.016170.
  4. Sims SE, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y). 2014;9(4):419-46. Available from: https://doi.org/10.1007/s11552-014-9642-x.
  5. Smidt N, Assendelft WJ, Arola H, Malmivaara A, Greens S, Buchbinder R, et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003;35(1):51-62. Available from: https://doi.org/10.1080/07853890310004138.
  6. Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med. 2014;48(12):957-65. Available from: https://doi.org/10.1136/bjsports-2012-091513.
  7. Wood SM, Yoon AP, Tseng HJ, Yang LY, Chung KC. Comparative Effectiveness of Physical Therapy and Electrophysiotherapy for the Treatment of Lateral Epicondylitis: A Network Meta-Analysis. Plast Reconstr Surg. 2022;150(3):594e-607e. Available from: https://doi.org/10.1097/PRS.0000000000009437.
  8. Trudel D, Duley J, Zastrow I, Kerr EW, Davidson R, MacDermid JC. Rehabilitation for patients with lateral epicondylitis: a systematic review. J Hand Ther. 2004;17(2):243-66. Available from: https://doi.org/10.1197/j.jht.2004.02.011.
  9. Chang WD, Wu JH, Yang WJ, Jiang JA. Therapeutic effects of low-level laser on lateral epicondylitis from differential interventions of Chinese-Western medicine: systematic review. Photomed Laser Surg. 2010;28(3):327-36. Available from: https://doi.org/10.1089/pho.2009.2558.
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Published: Report no: ut202303 Registration no: SBU 2022/752
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Literature search

Medline via OvidSP 16 November 22

Title: LLLT for tennis elbow
/ = Term from the MeSH controlled vocabulary;.sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy;.ti,ab = Title or abstract;.tw = Title or abstract;.kf = Keywords;.kw = Keywords, exact;.bt = Book title. NLM Bookshelf;.pt = Publication type;.ja = Journal abbreviation;.af = All fields;adjn= Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other;* or $ = Truncation;“ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. exp Elbow Tendinopathy/ 1 887
2. (lateral epicondyl* or medial epicondyl* or lateral humeral epicondyl* or medial humeral epicondyl* or Golfer's elbow* or Golfers elbow* or tennis elbow* or tendinopath* or tendinosis or tendinitis).mp 14 904
3. 1 OR 2 14 904
Study types: systematic reviews and meta-analysis / randomized controlled trials 1
4. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 403 643
Final result
5. 3 AND 4 727

1.Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.

Scopus via scopus.com 16 November 22

Title: LLLT for tennis elbow
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords);ALL = All fields;W/n= Within. Proximity operator retrieving terms withinnwords from each other;PRE/n= Precedes by. Proximity operator, the first term in the search must precede the second bynwords;LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range;DOCTYPE = Publication type;“re” = review;“le” = letter;“ed” = editorial;“ch” = book chapter;“cp” = conference proceedings:* = Truncation;“ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ( "lateral epicondyl*" OR "medial epicondyl*" OR "lateral humeral epicondyl*" OR "medial humeral epicondyl*" OR "golfer's elbow*" OR "golfers elbow*" OR "tennis elbow*" OR tendinopath* OR tendinosis OR tendinitis ) 22 905
Study types: systematic reviews and meta-analysis / randomized controlled trials
2. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND ( EXCLUDE ( DOCTYPE , "le" ) OR EXCLUDE ( DOCTYPE , "ed" ) OR EXCLUDE ( DOCTYPE , "ch" ) OR EXCLUDE ( DOCTYPE , "cp" ) ) 583 745
Final result
3. 1 AND 2 1 126

Embase via Elsevier 16 November 22

Title: LLLT for tennis elbow
/de = Term from the EMTREE controlled vocabulary; /exp = Term from the EMTREE controlled vocabulary, including all narrower terms in the hierarchy; ti = Title; ab = Abstract; kw = Author keywords; it = Publication type; NEAR/n= Near. Proximity operator retrieving terms within; nwords from each other; * = Truncation; ‘ ‘ = Citation Marks, searches for an exact phrase
Search terms Items found
Population:
1. 'epicondylitis'/exp AND [embase]/lim 3 619
2. ('lateral epicondyl*':ti,ab OR 'medial epicondyl*':ti,ab OR 'lateral humeral epicondyl*':ti,ab OR 'medial humeral epicondyl*':ti,ab OR 'golfers elbow*':ti,ab OR 'tennis elbow*':ti,ab OR tendinopath*:ti,ab OR tendinosis:ti,ab OR tendinitis:ti,ab) AND [embase]/lim 11 687
3. 1 OR 2 13 076
Study types: systematic reviews and meta-analysis / randomized controlled trials
4. ('systematic review'/de OR 'meta analysis'/de OR [cochrane review]/lim OR (((systematic NEAR/4 review) OR 'meta analys*' OR metaanalys*):ti,ab)) NOT ('case report'/de OR 'editorial'/it OR 'letter'/it OR 'note'/it) 596 615
Final result
5. 3 AND 4 657
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