Low level Laser Therapy versus Ultrasonic therapy for the Treatment of Shoulder Impingement Syndrome A Systematic Review of randomized controlled trials

Background Shoulder impingement syndrome is a common cause of shoulder pain in primary health care settings. Many physical modalities of treatment are available in clinical practice, however there is insufficient evidence on their relative effectiveness. This review compares the effectiveness of Low Level Laser Therapy (LLLT) with ultrasonic therapy. Objectives To assess the effectiveness of LLLT vs. ultrasonic therapy in patients with subacromial impingement syndrome Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE (Pubmed), Embase, Scopus. We searched trials registries on ClinicalTrials.gov (www.ClinicalTrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal (apps.who.int/trialsearch/). We also hand-searched reference lists of all included primary studies, relevant conference proceedings and academic literature, and relevant systematic reviews (both Cochrane and non Cochrane), to identify additional studies missed from the original electronic searches (e.g., unpublished or in press citations). We did not use date or language restrictions. Selection criteria Randomized controlled trials comparing LLLT vs. US therapy in adult patients with subacromial impingement syndrome. Data collection Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected our primary outcomes information from the trials and assessed the quality of evidence for key outcomes using GRADE. Results We included 2 RCTs, contributing 67 participants to our qualitative synthesis. The overall risk of bias is high for both studies. Very low-quality evidence from 1 RCT shows slightly increased mean change in pain severity after LLLT compared to ultrasonic therapy in the short term (3 months) (MD 4.69, 95% CI -5.76 to -3.62).[13]. Very low-quality evidence from 1 RCT shows little to no difference in functional improvement after LLLT compared to ultrasonic therapy in the short term (after 3 months) (MD -0.63, 95% CI -5.53 to 4.27) [13]. No studies investigated Range of Motion in the short term. Verylow certainty evidence showed little to no difference in pain severity and function in the immediate post-treatment phase (up to 1 month). No studies addressed long term follow-up. conclusion There is insufficient evidence regarding the difference in effects between LLLT and Ultrasonic therapy for the treatment of shoulder impingement syndrome.

Comparison of exercise therapy and ultrasonic therapy in the treatment of shoulder impingement syndrome

Background: The shoulder is one of the most frequent sites of musculoskeletal pain, incidence of shoulder pain in primary care patients is estimated to be 11.2 per 1000 per year. a considerable number of people with shoulder pain (41%) show persistent symptoms after 1 year. Comparing the exercise therapy and ultrasound therapy (UST) for impingement syndrome. Methodology: The study was conducted at OPD of MNR Hospital in Sangareddy. The study was conducted for a period of 3 weeks. A total number of 30 subjects were selected by simple random sampling after explained to all the participants and an informed consent was taken from each subject. 30 subjects were randomly divided into 2 Groups. Exercise therapy was given to Group 1 and UST was given to Group 2. Both the Groups received exercise therapy and ultrasonic therapy in shoulder impingement syndrome. Subjects were evaluated pre and post treatment for VAS (Visual Analogue Scale) score, SPADI SCORE (Shoulder Pain and disability index) shoulder ROM. Outcome measures: VAS scale, SPADI score. Results and Discussion: To test the significance of the mean difference of two groups, unpaired t test was done. It is statistically shown that there is some significant impact in the parameters VAS, SPADI and shoulder ROM. The results showed that, group-I had more significant improvement in all parameters than group –II. Conclusion: It is concluded that exercise therapy is better than ultrasonic therapy for subjects with shoulder impingement syndrome. KEY WORDS: Exercise Therapy, Ultrasonic Therapy, Shoulder Pain and disability index, Range of Motion.

Early Stage Rehabilitation for Strain Hamstring : A case report

The purpose of the study. This study's purpose is to report on the early stage physiotherapists' intervention on patients with hamstring strains as recommended in the early stage management of sports injuries. Materials and methods. This study is a case report from of a patient who has a hamstring strain with complaints of pain and decreased range of motion of the knee joint. Physiotherapists provide ultrasonic therapy with isometric contraction exercises on the hamstring muscles for 4 sessions for 2 weeks. Results. Ultrasound therapy and isometric contraction exercises increased the range of motion of the knee joint by 60% (active) and 50% (passive). Pain reduction also occurred by 83% for active motion pain and 80% for passive motion pain. Conclusions. The physiotherapy interventions with ultrasonic therapy and isometric contraction exercise therapy is in accordance with the early stage rehabilitation for the case of hamstring strains. With the interventions, the patient experienced a decrease in pain and an increase in Range of Motion from the knee joint

Ultrasonic therapy modulates the expression of genes related to neovascularization and inflammation in fibroblasts

Introduction: In the rehabilitation of musculoskeletal injuries, ultrasound is widely used in clinical practice. Objective: To evaluate the effects of pulsed ultrasonic therapy on the viability and modulation of genes involved in inflammation (IL-6) and neovascularization (VEGF) processes of L929 fibroblast cells. Methods: For irradiation with ultrasound the cells were subdivided into groups: G1 (without irradiation), G2 (0.3 W/cm2-20%) and G3 (0.6 W/cm2-20%), with periods of treatment at 24, 48 and 72 hours. The cell viability assay was analyzed by the MTT method and gene modulation was analyzed by RT-qPCR method. Results: After the comparative analysis between groups, only G2 and G3 (48-hour) presented statistically significant differences in relation to the control. In relation to the gene expression, the selection of the groups analyzed was delimited according to the comparative analysis of the values obtained by the MTT test. After the achievement of RT-qPCR, it could be observed that in G2 the amount of VEGF gene transcripts increased by 1.125-fold compared to endogenous controls, and increased 1.388-fold in G3. The IL-6 gene, on the other hand, had its transcripts reduced in both G2 (5.64x10-9) and G3 (1.91x10-6). Conclusion: Pulsed ultrasound in L929 fibroblasts showed a significant biostimulatory effect in the 48-hour period, with increased cell viability, and the same effect in the modulation of gene expression related the neovascularization and inflammation, mediating the acceleration of the tissue repair cascade.

Manejo da dor e ação do ultrassom de baixa frequência

Foi objetivo, avaliar a aplicabilidade da terapia ultrassônica para o alívio da dor em pacientes com lesões crônicas. Estudo quase experimental com delineamento antes e depois, com ausência de grupo controle equivalente. A avaliação foi feita de três pontos de corte de temporalidade. Utilizando a escala visual analógica para dor antes, durante e após a intervenção. Efetuada no ano de 2017, entre os meses de abril a outubro e analisada em 2018. A pesquisa respeitou os princípios éticos com CAAE nº 1.049.373. A ação terapêutica teve resultados mais promissores nos pacientes que classificavam a dor como intensa 32% dos participantes. Durante a intervenção mais de 60% dos pacientes relataram alívio da dor logo no início da intervenção. O ultrassom como medida para redução da dor apresenta-se de forma promissora, por promover analgesia sem efeitos adversos e de uma forma não invasiva.Descritores: Terapia por Ultrassom, Manejo da Dor, Ferimentos e Lesões. Management pain and low frequency ultrasoundAbstract: The objective was to evaluate the applicability of ultrasonic therapy for pain relief in patients with chronic injuries. Quasi-experimental study with before and after design, with no equivalent control group. The evaluation was made from three temporality cutoff points. Using the visual analog scale for pain before, during and after the intervention. Carried out in 2017, from April to October and analyzed in 2018. The research complied with the ethical principles with CAAE No. 1,049,373. The therapeutic action had more promising results in patients who classified pain as intense 32% of participants. During the intervention more than 60% of patients reported pain relief early in the intervention. Ultrasound as a measure for pain reduction is promising because it promotes analgesia without adverse effects and in a non-invasive way.Descriptors: Ultrasonic Therapy, Pain Management, Wounds and Injuries. Manejo y acción de dolor ultrasonido de baja frecuenciaResumen: El objetivo fue evaluar la aplicabilidad de la terapia ultrasónica para el alivio del dolor en pacientes con lesiones crónicas. Estudio cuasiexperimental con diseño antes y después, sin grupo de control equivalente. La evaluación se realizó a partir de tres puntos de corte de temporalidad. Usando la escala analógica visual para el dolor antes, durante y después de la intervención. Realizado en 2017, de abril a octubre y analizado en 2018. La investigación cumplió con los principios éticos con CAAE No. 1,049,373. La acción terapéutica tuvo resultados más prometedores en pacientes que clasificaron el dolor como intenso 32% de los participantes. Durante la intervención, más del 60% de los pacientes informaron alivio del dolor temprano en la intervención. El ultrasonido como medida para la reducción del dolor es prometedor porque promueve la analgesia sin efectos adversos y de manera no invasiva.Descriptores: Terapia por Ultrasonido, Manejo del Dolor, Heridas y Traumatismos.