Laser Therapy in the Management of Neck Pain

Medical researcher Dr. Roberta Chow, MD, PhD was the lead author of a paper which summarized 16 clinical trials on Low Level Laser Therapy (LLLT) and the management of neck pain.  All the studies used LLLT of varying frequencies, and were double blinded, with either a placebo or control group.  A total of 820 patients were included in the research, which included both acute and chronic neck pain.    

Two trials showed an improvement in acute neck pain with the LLLT group over the placebo group.  Five trials showed an improvement in chronic neck pain with LLLT over the control group.  Eleven trials had a reduction of pain intensity that was statistically significant.  Seven trials involved follow up to 22 weeks after the treatment trial. 

There were mild side effects with LLLT group, but this was no different than with the placebo group. As with any therapy, individual results may vary, but overall the trials showed immediate pain reduction in the acute neck pain patients, and up to 22 weeks of reduced pain in the chronic patients post LLLT treatment.

Citation:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61522-1/fulltext#article-upsell

What a Pain in the Foot!

Summer time is upon us, and so often shoes are exchanged for flip flops.  The problem with flip flops is that they offer little support, and if you have abnormal foot mechanics such as flat feet, you can develop a painful arch, a condition called plantar fasciitis.   

 Plantar Fasciitis is caused by the breakdown and inflammation of collagen fibers in the thick band on the bottom of the foot that maintains the arch.  The pain can develop gradually over time with the most common symptom being pain in the morning or after prolonged sitting, as the band has shortened but limbers up after a few steps. Xrays may identify a heel spur, which is caused by the prolonged pulling of the plantar fascia from the heel. Secondary complications can develop as the difficulty in walking produces abnormal mechanics causing stress to knees, hips and the lower back.

Risk factors in developing plantar fasciitis include:

·         Increasing age as the ligaments are less supportive

·         Flat feet or high arches which causes faulty foot mechanics

·         Runners or ballet dancers who put abnormal stresses on the feet

·         Obesity and pregnancy places increased weight on the feet

·         Occupations which require prolonged standing

·         Improper shoes which lack arch support

Treatment includes:

·         Rest from activities that require being on the feet

·         Ice and oral anti-inflammatory (Aleve) or creams (Voltaren)

·         Laser, acupuncture or other modalities to increase healing

·         Massage therapy to relax and stretch the fascia and increase blood flow

·         Manipulation of a rigid mid foot to return normal function

·         Orthotics to support the arch and distribute weight for better mechanics

·         Exercises to stretch and strengthen the plantar fascia

·         Taping the arch to maintain support

·         Advice to avoid going barefoot, wear supportive shoes, and maintain a healthy weight

·         Severe cases may require steroid injections when unresponsive to conservative treatments but caution should be used as steroids weaken the collagen fibers

Often there is a combination of treatment that is required to be successful at keeping plantar fasciitis under control.  While individual results may vary, I have had success with laser treatments (approximately five), soft tissue stripping of the fascia of the arch, manipulation of the mid foot, and fittings with orthotics.  Home advice of using a 500 ml ice water bottle to offer both inflammation control and massage, as well as doing stretches also complement the therapy. 

So if you are finding you still want to wear your fancy summer shoes, take care of your feet so you don't develop that chronic pain in the foot!

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