Stergioulas Apostolos
Faculty of Human Movement & Quality of Life, Peloponnese University, Sparta, Greece.
Photomed Laser Surg. 2007 Jun;25(3):205-13. doi: 10.1089/pho.2007.2041.
This study was undertaken to compare the effectiveness of a protocol of combination of laser with plyometric exercises and a protocol of placebo laser with the same program, in the treatment of tennis elbow.
The use of low-level laser has been recommended for the management of tennis elbow with contradictory results. Also, plyometric exercises was recommended for the treatment of the tendinopathy.
Fifty patients who had tennis elbow participated in the study and were randomised into two groups. Group A (n = 25) was treated with a 904 Ga-As laser CW, frequency 50 Hz, intensity 40 mW and energy density 2.4 J/cm(2), plus plyometric exercises and group B (n = 25) that received placebo laser plus the same plyometric exercises. During eight weeks of treatment, the patients of the two groups received 12 sessions of laser or placebo, two sessions per week (weeks 1-4) and one session per week (weeks 5-8). Pain at rest, at palpation on the lateral epicondyle, during resisted wrist extension, middle finger test, and strength testing was evaluated using Visual Analogue Scales. Also it was evaluated the grip strength, the range of motion and weight test. Parameters were determined before the treatment, at the end of the eighth week course of treatment (week 8), and eighth (week 8) after the end of treatment.
Relative to the group B, the group A had (1) a significant decrease of pain at rest at the end of 8 weeks of the treatment (p < 0.005) and at the end of following up period (p < 0.05), (2) a significant decrease in pain at palpation and pain on isometric testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (3) a significant decrease in pain during middle finger test at the end of 8 weeks of treatment (p < 0.01), and at the end of the follow-up period (p < 0.05), (4) a significant decrease of pain during grip strength testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (5) a significant increase in the wrist range of motion at 8 weeks follow-up (p < 0.01), (6) an increase in grip strength at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.01), and (7) a significant increase in weight-test at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.005).
The results suggested that the combination of laser with plyometric exercises was more effective treatment than placebo laser with the same plyometric exercises at the end of the treatment as well as at the follow-up. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.
本研究旨在比较激光联合增强式训练方案与安慰剂激光联合相同方案在治疗网球肘方面的有效性。
低强度激光已被推荐用于网球肘的治疗，但结果相互矛盾。此外，增强式训练也被推荐用于治疗肌腱病。
50名患有网球肘的患者参与了本研究，并被随机分为两组。A组（n = 25）接受波长904纳米的砷化镓连续波激光治疗，频率50赫兹，强度40毫瓦，能量密度2.4焦/平方厘米，外加增强式训练；B组（n = 25）接受安慰剂激光治疗并进行相同的增强式训练。在为期8周的治疗期间，两组患者均接受12次激光或安慰剂治疗，每周2次（第1 - 4周），每周1次（第5 - 8周）。使用视觉模拟量表评估静息痛、外侧上髁触诊痛、抗阻腕伸展时的疼痛、中指试验时的疼痛以及力量测试时的疼痛。此外，还评估了握力、活动范围和负重测试。在治疗前、治疗第8周疗程结束时（第8周）以及治疗结束后第8周（第8周）测定各项参数。
与B组相比，A组在以下方面有显著改善：（1）治疗8周结束时（p < 0.005）以及随访期结束时（p < 0.05）静息痛显著减轻；（2）治疗8周时（p < 0.05）以及8周随访时（p < 0.001）触诊痛和等长测试时的疼痛显著减轻；（3）治疗8周结束时（p < 0.01）以及随访期结束时（p < 0.05）中指试验时的疼痛显著减轻；（4）治疗8周时（p < 0.05）以及8周随访时（p < 0.001）握力测试时的疼痛显著减轻；（5）8周随访时腕关节活动范围显著增加（p < 0.01）；（6）治疗8周时（p < 0.05）以及8周随访时（p < 0.01）握力增加；（7）治疗8周时（p < 0.05）以及8周随访时（p < 0.005）负重测试显著增加。
结果表明，在治疗结束时以及随访时，激光联合增强式训练比安慰剂激光联合相同的增强式训练更有效。未来需要进一步研究以确定上述方案的相对和绝对有效性。
