To Your Health September, 2024 (Vol. 18, Issue 09)

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Laser for Knee Pain

By Dr. Phil Harrington

Knee pain is a common orthopedic condition affecting millions of individuals worldwide.¹ Traditional treatments such as over-the-counter or prescription medication may not always provide satisfactory results and can have undesirable side effects.¹ Photobiomodulation treatments with a class 4 therapeutic laser have gained attention as a potential clinical solution for managing knee pain.²

This case study presents the effectiveness of class 4 laser therapy in alleviating knee pain in a 55-year-old female patient with chronic knee pain due to osteoarthritis. The study highlights the patient's progress and outcomes over a six-week treatment period, demonstrating the potential benefits of laser therapy in pain management.

Issues With Conventional Care

Knee pain is a prevalent musculoskeletal condition that can significantly impact an individual's quality of life. Osteoarthritis, the most common cause of knee pain, is characterized by the degeneration of joint cartilage and surrounding tissues.³

Conventional treatments for knee pain often include medication, physical therapy, and in some cases, surgical intervention. However, these treatments may not always provide lasting relief and may be associated with potential side effects.

Laser Therapy: Mechanisms of Action

Class 4 laser therapy is a non-invasive modality with potential benefits for pain management and tissue healing. This therapy involves the application of red and infrared laser light to the affected area, stimulating cellular processes and promoting tissue repair.

Class 4 therapeutic lasers use deeply penetrating infrared wavelengths and have sufficient power to deliver adequate dosages to effective treatment of deeper tissues. As Anders, et al., wrote, "An important advance in photobiomodulation therapy (PBMT) was the recognition that optimization of transcutaneous therapeutic parameters should be based on the photonic dose reaching the target tissue, and that often requires higher doses of light at the skin surface to reach deeper tissues."⁴

The Clinical Case

A 55-year-old female patient presented with chronic knee pain in both knees. The patient had a history of osteoarthritis, which was confirmed through medical imaging. She reported persistent pain, stiffness, and limited range of motion in her knees. The pain significantly impacted her daily activities, including walking, climbing stairs, and even sitting for extended periods.

The patient had previously tried oral pain medication and physical therapy, with limited success in managing her symptoms.

Upon assessment, the patient's pain level was rated as eight on a scale of 0 to 10 (with 10 being the highest pain intensity). Physical examination revealed swelling and tenderness around the knee joints, as well as reduced joint flexibility. Based on the patient's history and clinical presentation, a treatment plan involving class 4 laser therapy was proposed.

The treatment plan consisted of 12 sessions of class 4 laser therapy, scheduled three times a week for four weeks. The laser therapy device utilized wavelengths of 650, 810, 915 and 980 nanometers (nm), an average power output of 7.6 watts, with a treatment time of six minutes. The total dose was 2,736 joules (J), applied to an area of roughly 600 square centimeters (cm²), for a surface dosage of about 4.5 J/cm².

The laser technician ran the treatment wand around the knee joint from all angles and asked the patient to occasionally perform simple flexion-extension exercises during laser treatment.

Follow-Up / Outcome

During the initial two weeks of treatment, the patient reported a mild improvement in pain levels. Her pain rating decreased from eight to six on the pain scale. Additionally, the patient mentioned a reduction in morning stiffness and an increase in joint flexibility. The patient was able to walk longer distances without experiencing severe discomfort. Swelling around the knee joints also appeared to decrease slightly.

During the final two weeks of treatment, the patient's pain level continued to decrease, reaching a rating of two on the pain scale. The patient reported being able to engage in activities that were previously challenging, such as kneeling and squatting. Her joint flexibility had improved to a point that she could bend her knees without experiencing sharp pain.

The patient's overall satisfaction with the treatment was high, as she felt a marked improvement in her quality of life.

A follow-up assessment was conducted six weeks after conclusion of class 4 laser therapy. The patient's pain level remained at two on the pain scale, indicating a sustained reduction in pain intensity.

The patient reported that she no longer required regular use of oral pain medication for daily activities.

Her joint flexibility and range of motion had further improved, and she continued to engage in exercises and stretches to maintain her progress.

Discussion

This case study demonstrates the potential efficacy of class 4 laser therapy in managing chronic knee pain, particularly pain due to osteoarthritis. The gradual reduction in pain levels, improved joint flexibility, and enhanced range of motion suggest that class 4 laser therapy may offer benefits beyond traditional treatment modalities. The therapy's non-invasive nature and absence of reported side effects make it an appealing option for patients who seek alternative approaches to pain management.

The mechanism of action underlying class 4 laser therapy involves the stimulation of cellular metabolism and the promotion of tissue repair. The therapy's ability to penetrate deep tissues may contribute to its effectiveness in addressing knee pain associated with osteoarthritis, in which degenerative changes occur within the joint structures.

Editor's Note: Ask your doctor about the benefits of laser therapy and whether it's right for you.

References

1. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective. Biochem Pharmacol, 2020 Oct;180:114147.
2. Ahmad MA, A Hamid MS, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiother, 2022 Mar;114:85-95.
3. Giorgino R, Albano D, Fusco S, et al. Knee osteoarthritis: epidemiology, pathogenesis, and mesenchymal stem cells: what else is new? An update. Int J Mol Sci, 2023 Mar 29;24(7):6405.
4. Anders JJ, Arany PR, Baxter GD, Lanzafame RJ. Light-emitting diode therapy and low-level light therapy are photobiomodulation therapy. Photobiomodul Photomed Laser Surg, 2019 Feb;37(2):63-65.

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Phil Harrington, DC, CMLSO, FASLMS, is a 1996 Palmer College of Chiropractic graduate and also holds a bachelor's degree in physics.