Laser Therapy for Chronic Achilles Tendinopathy

Achilles Tendinopathy is common in many athletes following injury, and can lead to tendon degeneration, pain, loss of performance and eventual tendon rupture.  A study published in the American Journal of Sports Medicine investigated whether the addition of low level laser therapy (LLLT) for 8 weeks in addition to an eccentric exercise (EE) program would speed recovery and improve outcomes in recreational athletes with chronic Achilles Tendinopathy.

52 athletes with symptoms of at least 6 months of unilateral, activity limiting pain in the Achilles tendon were included.  They were randomized into two groups, the first group having EE and LLLT and the second group having EE with placebo LLLT.  LLLT and placebo LLLT were administered twice a week for 4 weeks, than weekly for 4 weeks.  EE were performed 4 times a week, consisting of unilateral calf raises performed on a step which started with body weight only, and progressed with weight in a back pack, beginning with 1 set of 15 reps and progressing to 12 sets of 12 reps.  Static stretching of the Achilles tendon was included.

 Outcomes were measured at 4, 8 and 12 weeks.  Pain intensity during physical activity was significantly better in the true LLLT group at every stage of assessment, and all secondary outcomes were also significantly better.  This study provides evidence that adding LLLT to an EE program may speed recovery and improve outcomes, up to 4 weeks following treatment.

Citation: American Journal of Sports Medicine 2008; 36(5):881-887.

Spinal Manipulation for Chronic Cervicogenic Headaches

Headache symptoms are very common, effecting approximately 16% of the population, and can be divided into three main categories:  migraine, tension and cervicogenic headaches.  Cervicogenic headaches are associated with neck pain and mechanical dysfunction of the cervical spine and therefore in theory should respond to spinal manipulation therapy (SMT) to restore normal neck movement. 

A 2010 pilot study looked at patients with chronic cervicogenic headaches.  The criteria included: at least 5 headaches a month for over 3 months; pain which started at the base of the skull and radiated over the top of the head to the front: and pain/reduced range of motion in the cervical spine.  The patients were randomly assigned to 4 treatment groups for the 8 week study:

·         High dose SMT (manipulation twice a week, totally 16 treatments)

·          Low dose SMT (manipulation once a week, with the second session per week for information only, totally 8 treatments)

·          High dose light massage (twice a week treatments, totally 16 treatments)

·         Low dose light massage (weekly treatments with a second session per week for information only, totally 8 treatments)

The results of the study were:

• There was no difference in the high or low dose SMT groups, but SMT was more effective than light massage.  At 8 weeks, the number of weekly headaches had decreased by 50% in the patients who received SMT.
• This difference was both statistically and clinically significant.  Overall there was a decrease in intensity/pain of the cervicogenic headaches, decrease in headache frequency; and decrease in medication intake which was sustained with the SMT groups.

This study supports that SMT can work as an additional intervention with cervicogenic headaches, best  in combination with soft tissue treatment, exercise and education.

Citation:  The Spine Journal 2010; 10:117-128