slide 1: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
216
IJAMSCR |Volume 4 | Issue 2 | April - June - 2016
www.ijamscr.com
Research article Medical research
Effect of low level laser therapy in acute low back pain with
radiculopathy: A single blinded randomized control study
Akhil Mathew
1
Dr. Dhanesh Kumar K U
2
Dr. Ajith S
3
and Subash Chandra Rai
4
1
Musculoskeletal and Sports Physiotherapy PG Nitte Institute of Physiotherapy Nitte University
Mangalore Karnataka India.
2
Principal and Professor. Musculoskeletal and Sports Physiotherapy Nitte Institute of Physiotherapy
Nitte University Mangalore Karnataka India.
3
Associate prof. Musculoskeletal and Sports Physiotherapy Nitte Institute of Physiotherapy Nitte
University Mangalore Karnataka India.
4
Assistant prof. Musculoskeletal and Sports Physiotherapy Nitte Institute of Physiotherapy Nitte
University Mangalore Karnataka India.
Corresponding author: Dr. Dhanesh Kumar K U
Email: dhaneshphysioyahoo.co.in
ABSTRACT
Background
The lifetime prevalence of low back pain is reported as over 70 in industrialized countries. Peak prevalence
occurs between ages 35 and 55. There is increasing evidence that inflammation in association with root
compression is the main pathological factor of radiculopathy. LLLT can be advantageous because its
therapeutic window for anti-inflammatory actions overlaps with its ability to promote tissue repair in a dose
dependent manner.
Objective
The aim of the study was to compare the effectiveness of low level laser therapy and conventional therapy in
acute low back pain with radiculopathy.
Methodology
Study proceeded after ethical clearance from the central ethical committee of Nitte University. The subjects
diagnosed with acute low back pain with radiculopathy by an orthopaedician fulfilling the inclusion criteria will
be included in the study. An informed written consent will be collected from all the subjects included in the
study.
A total of 100 patients will be included in the study and they will be randomly assigned into two groups using
convenience sampling. One group will receive conventional therapy and the other group LLLT.
Visual Analogue Scale Oswestry Low Back Pain Disability Questionnaire Modified Schober’s test will be
measured pre and post following treatment for a duration of 5 days.
Results
Both groups have shown significant improvement but low level laser therapy group have shown more
significant results p value 0.001 compared to control group managed with conventional therapy.
ISSN:2347-6567
International Journal of Allied Medical Sciences
and Clinical Research IJAMSCR
slide 2: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
217
Conclusion
Based on the above results we conclude that low level laser therapy is having a remarkable effect on pain
control and tissue repair in acute back pain with radiculopathy. Further research in dosiometry and also with
large sample seize is recommended.
Keywords: Acute Low Back Pain Laser Radiculopathy.
INTRODUCTION
Low back pain with radiculopathy is defined as
pain and discomfort localized below the costal
margin and above the inferior gluteal folds with
leg pain
1
. Acute low back pain is usually defined as
the duration of an episode of low back pain
persisting for less than 6 weeks
2
. Pain is a
subjective experience and acute pain is a warning
signal which expresses that body tissue is about to
be injured. If injury actually occurs then a cascade
of patho physiological events will take place in a
well mapped simultaneous and chronological
order
2
. Pain intensity is usually most prevalent in
the inflammatory phase during the first hours and
days after injury and in most cases pain decreases
as the tissue re pair processes get under way. In
peripheral nerve injury pain may occur from
persisting mechanical pressure neurogenic
inflammation or damage to the nerve structure
leading to a state of persistent central sensitization
within the central nervous system
34
.
The lifetime prevalence of low back pain is
reported as over 70 in industrialized countries
one-year prevalence 15 to 45 adult incidence
5 per year. Peak prevalence occurs between ages
35 and 55
2
. Specific low back pain represents 15
of low back pain problems. About 50 of specific
back pain is due to prolapsed intervertebral disc
PID in which the nucleus pulposus herniates
through a tear in the annulus fibrosis resulting in
irritation of the adjacent nerve root and causing a
typical radiculopathy pain. It is commonly seen in
the age group of 15- 45 years of age.
3
Majority of
the spinal disc herniation occurs in the lumbar
region 95 in the L
4
-L
5
or L
5
-S
1
1
.
The clinical phenomena in acute LBP are pain
and neurological disorders that affect activities of
daily living. The symptoms range from mild to
severe that radiate into the regions served by the
affected nerve root that are irritated or impinged by
the herniated material. Other symptoms may
include motor and sensory changes such as
muscular weakness numbness paralysis
paresthesia and altered reflexes
4
.
There is expanding proof that aggravation in
relationship with root pressure is the fundamental
neurotic element of radiculopathy. Disturbance of
the annulus fibrosis causes spilling of the core
pulposus into the spinal channel which contains
different aggravations to tissues including
glycoproteins nitric oxide and phospholipase A2
which cause an incendiary reaction in and around
the torment touchy nerve tissues
5
.
Hazard variables most much of the time
reported are substantial physical work regular
bowing winding lifting pulling and pushing
monotonous work static stances and vibrations.
Psychosocial hazard variables incorporate anxiety
trouble tension wretchedness intellectual
brokenness torment conduct work disappointment
and mental anxiety at work. Representing 75 to
85 of aggregate labourers non-appearance
2
. Two
deliberate audits found that guidance to stay
dynamic with or without different medicines
diminished incapacity agony and discovered
quicker rates prompting less time went through off
work contrasted and bed rest. In a few rules back
particular activities e.g. fortifying flexion
expansion extending are considered not valuable
amid the main weeks of a scene. Different rules
express that low push oxygen consuming activities
are a remedial alternative in intense low back
pain
25
.
LASER
The expression "laser" started as an acronym for
light intensification by invigorated outflow of
radiation. Low-level laser treatment LLLT is a
treatment procedure which utilizes a solitary
wavelength light source. Laser has the
accompanying qualities: collimation – it has little
bar dissimilarity over separation union – the light
waves are all in stage and monochromicity – it has
a solitary or tight band of a specific wavelength of
light. The radiated laser light is noted for its high
level of spatial and worldly coherence. Laser
radiation and monochromatic light might adjust cell
and tissue capacity
6
.
slide 3: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
218
To the extent discogenic back agony is
concerned most orthopedic specialists use non-
steroidal calming drugs and customary exercise
based recuperation comprising of ultrasonic
treatment footing treatment Tran’s cutaneous
electrical treatment and short-wave treatment.
These types of moderate treatment modalities speak
to symptomatic treatment just without the
biomodulation impacts offered by low-level
lasers
78
.
In spite of the fact that LLLT is presently used
to treat a wide assortment of diseases. A not
exactly ideal decision of parameters can bring
about lessened viability of the treatment or even a
negative restorative result
9
. Thus a large number of
the distributed results on LLLT incorporate
negative results just in view of an improper
decision of light source and measurements. This
decision is especially vital as there is an ideal
measurement of light for a specific application and
dosages higher or lower than this ideal quality
might have no restorative impact. Indeed LLLT is
described by a biphasic measurements reaction:
lower dosages of light are frequently more
advantageous than high doses
10
.
CELLULAR AND TISSULAR MECHANISMS OF LLLT
Local LLLT effects occurring in less than 24
hours after first irradiation. LLLT has an extensive
variety of impacts at the atomic cell and tissue
levels. The three fundamental components by
which laser produce pain relieving impacts are
accepted to be: animating endogenous opoids
discharge lifting torment limits and adjusting the
arrival of harmful go betweens for example
bradykinin and histamine. Torment balance might
likewise happen because of changes in nerve
conduction speed and change in the limit for
myelin creation
12
. LLLT backs off the
transmission of agony signs through the autonomic
sensory system manages serotonin and nor
epinephrine and expansions the torment edge.
Inside of the cell there is solid proof to propose
that LLLT follows up on the mitochondria to build
adenosine tri phosphate ATP creation adjustment
of responsive oxygen species ROS and the
affectation of interpretation elements. These
interpretation variables cause protein union that
triggers an expanded cell multiplication and
movement balance in the levels of cytokines
development elements and incendiary middle
people and expanded tissue oxygenation
12
.
LLLT is additionally utilized for irritation
edema swelling and tissue mending. LLLT
application is accepted to restrict the arrival of
incendiary arbiters for example bradykinin and
histamine diminishing the provocative reaction.
Notwithstanding it has been unequivocally
conjectured that a lessening in prostaglandin action
amid the provocative procedure is the principle
mitigating impact of laser incitement.
Prostaglandins cause vasodilation at the site of
aggravation encouraging invasion of incendiary
cells to the encompassing tissue. Concentrates on
have demonstrated that an abatement in
prostaglandin movement because of laser
incitement might advance healing.
1213
LLLT causes
vasodilatation by setting off the unwinding of
smooth muscle connected with endothelium which
is very pertinent to the treatment of joint irritation.
This vasodilatation expands the accessibility of
oxygen to treated cells furthermore takes into
account more noteworthy activity of safe cells into
tissue. These two impacts add to quickened
mending
14
.
At the most fundamental level LLLT acts by
prompting a photochemical response in the cell a
procedure alluded to as biostimulation or
photobiomodulation. At the point when a photon of
light is consumed by a chromophore in the treated
cells an electron in the chromophore can get to be
energized and hop from a low-vitality circle to a
higher-vitality circle. This put away vitality can
Reduced PGE2
levels
Reduced IL1
levels
Reduced TNF
levels
Reduceplasminogen
activator
Redced
neutrophil
influx
Reduced
hemorrhagic
formation
Reduced COX-
2 expression
Effects on
inflammatory
mediators
Reduced cell aptosis
improved micro circulation
Reduced edema
formation
slide 4: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
219
then be utilized by the framework to perform
different cell assignments. There are a few bits of
proof that indicate a chromophore inside
mitochondria being the underlying focus of LLLT.
Radiation of tissue with light causes an expansion
in mitochondrial items for example ATP NADH
protein and RNA and additionally an equal growth
in oxygen utilization and different in vitro tests
have affirmed that cell breath is up regulated on
treatment with LLLT
12
.
Cytochrome c oxidase CCO is the pivotal
chromophore in the cell reaction to LLLT. CCO is
an extensive transmembrane protein complex
comprising of two copper focuses and two heme
iron focuses which is a segment of the respiratory
electron transport chain. The electron transport
chain passes high-vitality electrons from electron
bearers through a progression of transmembrane
buildings counting CCO to the last electron
acceptor creating a proton angle that is utilized to
deliver ATP. Consequently the utilization of light
straightforwardly impacts ATP generation by
influencing one of the transmembrane buildings in
the chain: specifically LLLT results in expanded
ATP creation and electron transport
1214.
LLLT has
prompted theory that CCO and NO discharge are
connected by two conceivable pathways. It is
conceivable that LLLT might bring about
photodissociation of NO from CCO. Cell breath is
down regulated by the creation of NO by
mitochondrial NO synthase mtNOS a NOS
isoform particular to mitochondria that ties to
CCO and represses it. The NO uproots oxygen from
CCO repressing cell breath and accordingly
diminishing the creation of ATP. By separating NO
from CCO LLLT keeps this procedure from
occurring and results in expanded ATP creation
12
15
.
The wavelengths of light utilized for LLLT fall
into an "optical window" at red and NIR
wavelengths 600–1070 nm. Wavelengths in the
reach 600–700 nm are utilized to treat shallow
tissue and more wavelengths in the extent 780–950
nm which infiltrate further are utilized to treat
more profound situated tissues
12
.
MATERIALS AND METHOD
The objective of the study was to compare the
effectiveness of laser therapy and conventional
treatment in acute low back pain with
radiculopathy. A sample seize of 100 patients were
selected from Justice K. S Hegde Charitable
Hospital Department of physiotherapy having
acute back pain with radiculopathy. Patients who
met the inclusion criteria were included in the
study and were divided into 2 groups by computer
generated random numbers. One group will receive
conventional therapy and the other group LLLT.
Hot pack will be given for both groups prior to
treatment session for 10 minutes. Visual analogue
scale VAS Oswestry back pain disability
questionnaire OWQ and Schober’s test SCT to
document pain disability and lumbar range of
motion respectively will be measured pre and post
following treatment for duration of 5 days.
Laser unit of wavelength 905nmred frequency
5000HZ power output 100mW spot seize 1cm
power density 20 mW/cm
2
energy density 3J and
treatment time of 150 second in each points. Laser
probe is held in contact with skin over local
transforaminal region 2.5cm and 3.5 cm laterally
of the of the involved nerve root and on distal level
segment. Conservative group will be receiving
TENS for 10 minutes. TENS- VectroStim bipolar
100 HZ 30mA.
Inclusion Criteria Exclusion Criteria
Age – 18 to 60 years Previous history of spinal surgery
Sex – Male and Female Sub-acute and chronic LBP
Patients with acute low back pain and radiculopathy
diagnosed with or without the help of radiographs
Formal therapeutic or medical intervention
within the last three months eg: steroid injections
Both single and multiple levels lumbar disc protrusion
and prolapse
Co-existing conditions like ankylosing
spondylitis rheumatoid arthritis spinal stenosis
VAS score more than 6 Spinal tumors or patients where secondary
metastases was suspected
slide 5: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
220
Figure 1: Intervention group receiving LASER therapy Figure 2: Control group receiving TENS.
RESULTS
Statistical analysis was performed with the
SPSS Version. 21.0 programs. A .05 of
probability was adopted as the level for statistical
significance. Descriptive statistics of Age Gender
was done by using Mean and Standard Deviation.
Comparison within group A and B was done by
using Paired t test. Between group comparison was
done by Independent t test. Since the VAS score
was following the normal distribution curve
Wilcoxon Signed Rank Test was not performed.
Instead comparison was done by independent t test.
VAS OWQ SCT was evaluated in this study as
outcome measures. A total number of 90 patients
completed the study out of which each group
contains 45 subjects. There were10 dropouts in this
study who had taken discharge early.
In group A intervention mean age was
40.98±10.04. Group Bcontrol mean value
were43.38±9.73.. There is no difference in the
age between the groups which means subjects are
equally distributed according to age. In Paired
sample statistics results of VAS test for pain had
an initial mean value of control group was 1.96 ±
.47 and that of intervention group was 3.96 ±
.96.This data clearly shows that both the group
having significant change in reduction of the pain
after the treatment session. The result of OWQ test
had an initial mean value of control group was
4.35±4.65 and that of intervention group was
9.97±3.73. Available data clearly shows that both
the group is having significant change in reduction
of the disability after the treatment session. Result
of SCT test had an initial mean value of control
group was Flexion0.81±0.63Extension
0.26±0.44and that of intervention group was
Flexion 1.42±0.49 Extension 0.84±0.47.
Available data clearly shows that both the group is
having significant change in reduction of the
lumbar range of motion after the treatment session.
Table 2: shows the significance of p 0.05 0.001.
In Independent sample statistics Pain
difference PD at the end of 5 days of treatment
shows differences in both group Control 1.96 ±
.47 and Intervention 3.97 ± .96 and statistically
stating that there is a difference existing between
the group treatment p 0.001 hence LASER is
effective in reducing acute pain than conservative
treatment. Low back Disability difference OWD
at the end of 5 days of treatment shows differences
in both group control group 4.35±4.65 and that of
intervention group was 9.97±3.73 and statistically
stating that there is a difference existing between
the group treatment p 0.001 hence LASER is
effective in reducing pain and disability than
conservative treatment. Schobers test difference
STD at the end of 5 days of treatment shows
differences in both group control group was
Flexion0.81±0.63 Extension 0.26±0.44 and that
of intervention group was Flexion 1.42±0.49
Extension 0.84±0.47 statistically stating that
there is a difference existing between the group
treatment p 0.001 hence LASER is effective in
improving lumbar flexibility than conservative
treatment.
slide 6: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
221
Table 1: Descriptive statistics of the subjects
Table 2: Paired t test within group comparison
Group Variables PAIRED DIFFERENCES t value Sig.2-tailed
Mean ± SD 95 Confidence Interval of the Difference
Lower Upper
ContrControl
VAS pre -post 1.95 ± 0.47 1.81 2.09 27.64 .001
OWQ pre - post 4.35 ± 4.65 2.95 5.77 6.27 .001
SCT Flex pre- post 0.81 ± 0.63 1.00 0.62 8.59 .001
SCT Ext pre-post 0.26 ± 0.44 0.40 0.13 4.00 .001
I Intervention VAS pre - post 3.97 ± 0.96 3.68 4.26 27.65 .001
OWQ pre - post 9.97 ± 3.73 8.85 11.10 17.90 .001
SCT Flex pre- post 1.42 ± 0.49 1.57 1.27 19.10 .001
SCT Ext pre-post 0.84 ± 0.47 0.98 0.70 11.93 .001
Group Mean Std.
Deviation
Control Age 43.38 9.733
VAS pre 7.60 .751
VAS post 5.64 .645
OWQ pre 32.18 6.840
OWQ post 27.82 6.936
SCT pre
Flexion
3.09 1.104
SCT pre
Extension
2.24 .679
SCT post
Flexion
3.900 .8367
SCT post
Extension
2.51 .626
Intervention
Sex 1.33 .477
Age 40.98 10.042
VAS pre 7.89 .859
VAS post 3.91 .557
OWQ pre 33.42 5.061
OWQ post 23.44 3.461
SCT pre
Flexion
2.78 .765
SCT pre
Extension
1.93 .688
SCT post
Flexion
4.200 .7261
SCT post
Extension
2.78 .420
slide 7: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
222
Table 3: Independent t test between group comparisons
DISCUSSION
Although low back pain is prevalent and is
having a very high chance of chronicity and
recurrence there is lack of evidence on effective
treatment in acute phase patients. The requirement
for an effective and optimal treatment is
emphasized by the fact that optimal treatment in
acute phase will reduce the prevalence and prevent
the chronicity and recurrence
5
. In clinical practice a
broad spectrum of therapy approaches is being
used ranging from pharmacological physical
agents to exercise and manual therapy practice.
Various types of physical agents are not
sufficiently supported. The general
recommendation is that further studies are required
or it can be used to manage patients for whom no
improvement has been achieved by previous
treatments
16
.
This study included patients with severe pain
VAS≥6 and moderate to minimal disability during
V Variable Differences
t-test for Equality of Means
Mean ± SD t
Sig.2-
tailed
95 Confidence Interval of the
Difference
Lower Upper
PD
CONTROL 1.96 ± .47
-
12.614
.001 -2.34082 -1.70363
INTERVENTION
3.97 ± .96
OWD
CONTROL 4.35 ± 4.65
-6.315
.001
-7.39144 -3.85301
INTERVENTION
9.97 ± 3.73
SFD
CONTROL 0.81 ± .63
-5.083 .001 -.85005 -.37218
INTERVENTION
1.42 ± .49
STD
CONTROL 0.26 ± .44
-5.944 .001 -.77097
-.38459
INTERVENTION 0.84 ± .47
0
2
4
6
8
10
12
VAS OWQ SCT flxn SCT extn
control
intrvntn
Independent t test between group comparison
slide 8: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
223
daily activities on screening associated with acute
radiculopathy and disc herniation. Results show
statistically significant improvement in all groups
with better result for all parameters measured in
group Aintervention group with other group p
value 0.001. The analysis of parameters with
more specified clinical meaning has shown
significant differences between Group A and Group
B with better reduction in pain intensity and
disability. The main problems in comparing the
results of this study with others are the differences
in the included patients and applied parameters.
Metaanalysis by Yousefi-Nooraie and
colleagues considered nonspecific LBP and there
were no consistent conclusions
4
. Many other
clinical studies have used LLLT for nonspecific
chronic LBP however a group of patients with
nonspecific chronic LBP is very heterogenic and
the reasons of their pain caused not only by
pathological changes in the spinal and paraspinal
structures but also by complex neurophysiologic
and psychosomatic and psychosocial mechanisms
4
.
Hypothetically the biological actions of LLLT are
multiple the reduction of inflammation is the
primary effect with consecutive improvement in
neurophysiologic features of the affected nerve.
The direct effect on nerve which accelerates
recovery of the conduction block changes in
endorphin level the results of clinical and
experimental study has shown that the anti-
inflammatory effects are more significant
16
.
Various studies have documented changes in
biochemical markers of inflammation distribution
of inflammatory cells and the reduction in
formation edema hemorrhage and necrosis after
local LASER beams ranging from 660-905nm
5
.
Comparison with anti-inflammatory drugs like
Meloxicam and Indomethacin has shown similar
anti-inflammatory effects. The direct action or
effect of LLLT on neural structures that are
damaged by compression or inflammation should
be considered as an important additional effect.
This additional effect is beneficial in acute lesions
of neural structures such as acute lumbar
radiculopathy. A less than optimal choice of
parameters can result in reduced effectiveness of
treatment or even a negative therapeutic outcome.
As a result many of the published results on LLLT
include negative results simply because of an on
appropriate choice of light source and dosage.
LLLT is characterized by a biphasic dose response:
lower doses of light are more beneficial than high
doses
5
.
Evidence from this study suggests only the short
term effects of LASER. Further studies could
include patients randomized by levels of baseline
disability and duration of symptoms. Studies which
state the long term effect of LLLT should be
emphasized. Further studies should evaluate many
factors such as psychosocial aspect and dosiometry
that may reflect on treatment response and
recovery. The complete substitution of anti-
inflammatory drugs by LLLT in patients that are at
high risk should also be targeted in future studies.
CONCLUSION
Treatment of acute low back pain with
radiculopathy at 905-nm LLLT of a dose of
3J/point proposed as an additional therapy in acute
care setup has shown better short term
improvement in pain disability and quality of life
compared with patients treated with conventional
physiotherapy TENS.No side effects were noticed
for LLLT throughout the study period. Hence
LLLT is a viable option to treat acute radicular pain
and there by arresting the promotion towards
chronicity. LLLT reduces pain and disability in
acute state and delay or prevents progression.
REFERENCES
1. Djavid G Mehrdad R Ghasemi M Hasan-Zadeh H Sotoodeh-Manesh A Pouryaghoub G. In chronic low
back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the
long term: a randomised trial. Australian Journal of Physiotherapy. 2007 533:155-160.
2. Van Tulder M Becker A Bekkering T Breen A Gil Del Real M Hutchinson a et al. Chapter 3 European
guidelines for the management of acute nonspecific low back pain in primary care. European Spine
Journal. 2006 15S2:s169-s191.
slide 9: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
224
3. Carey T Garrett J Jackman A McLaughlin C Fryer J Smucker D. The Outcomes and Costs of Care for
Acute Low Back Pain among Patients Seen by Primary Care Practitioners Chiropractors and Orthopedic
Surgeons. New England Journal of Medicine. 1995 33314:913-917.
4. Bjordal J Johnson M Iversen V Aimbire F Lopes-Martins R. Low-Level Laser Therapy in Acute Pain:
A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo -
Controlled Trials. Photomedicine and Laser Surgery.
5. Konstantinovic L Kanjuh Z Milovanovic A Cutovic M Djurovic A Savic V et al. Acute Low Back Pain
with Radiculopathy: A Double-Blind Randomized Placebo-Controlled Study. Photomedicine and Laser
Surgery. 2010 284:553-560.2006 242:158-168.
6. Gur A Karakoc M Cevik R Nas K Sarac A Karakoc M. Efficacy of low power laser therapy and
exercise on pain and functions in chronic low back pain. Lasers Surg Med. 2003 323:233 -238.
7. Hayden J. Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain. Annals of Internal Medicine.
2005 1429:765.
8. Artus M van der Windt D Jordan K Croft P. The clinical course of low back pain: a meta-analysis
comparing outcomes in randomised clinical trials RCTs and observational studies. BMC Musculo skeletal
Disorders. 2014 151:68.
9. Glazov G Yelland M Emery J. Low-dose laser acupuncture for non-specific chronic low back pain: a
double-blind randomised controlled trial. Acupuncture in Medicine. 2013 322:116-123.
10. Gur A Karakoc M Cevik R Nas K Sarac A. Efficacy of low power laser therapy and exercise on pain
and functions in chronic low back pain. Lasers Surg Med. 2003 323:233-238.
11. Bekkering G Hendriks H Koes B Oostendorp R Ostelo R Thomassen J et al. Dutch Physiotherapy
Guidelines for Low Back Pain. Physiotherapy. 2003 892:82-96.
12. Chung H Dai T Sharma S Huang Y Carroll J Hamblin M. The Nuts and Bolts of Low-level Laser
Light Therapy. Annals of Biomedical Engineering. 2011 402:516-533.
13. Ohkuni I Ushigome N Harada T Ohshiro T Mizutani K Musya Y et al. low level laser therapy for
patients with sacroilitis. Hall H McIntosh G Boyle C.
14. Effectiveness of a low back pain classification system. The Spine Journal. 2009 98:648 -657.AC JOINT
PAIN. LASER THERAPY. 2011 202:117-121.
15. Fritz J Cleland J Childs J. Subgrouping Patients with Low Back Pain: Evolution of a Classification
Approach to Physical Therapy. J Orthop Sports Phys Ther. 2007 376:290-302.
16. Ip D Fu N. Can intractable discogenic back pain be managed by low-level laser therapy without recourse
to operative intervention JPR. 2015:253.
17. Chou R. Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence
for an American Pain Society/American College of Physicians Clinical Practice Guideline. Annals of
Internal Medicine. 2007 1477:492.
18. Fairbank JCT Pynsent PB 2000 “The Oswestry Disability Index”. Spine 2522:2940 -2953. Davidson
M Keating J 2001 a comparison of five low back disability questionnaires: reliability and
responsiveness. Physical Therapy 2002 82:8-24.
19. Boonstra Anne M Schiphorst Preuper. “Reliability and validity of the visual analogue scale for disability
in patients with chronic musculoskeletal pain". US National library of medicine.2008 Jun 312:165-9.
20. Goldsmith and Terry Minuk Renee Williams Jill Binkley Ralph Bloch Charles H “Reliability of the
modified-modified schober and double inclinometer methods for measuring lumbar flexion and
extension”. Physical Therapy. 1993 January 73:26-37.
21. Huang Z Ma J Chen J Shen B Pei F Kraus V. The effectiveness of low-level laser therapy for
nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther. 2015 171.
22. Froud R Bjørkli T Bright P Rajendran D Buchbinder R Underwood M et al. The effect of journal
impact factor reporting conflicts and reporting funding sources on standardized effect sizes in back pain
trials: a systematic review and meta-regression. BMC Musculoskeletal Disorders. 2015 161.
23. Soriano F Ríos R. gallium arsenide laser treatment of chronic back pain: A prospective randomizes and
double blind study. Laser therapy. 1998 104:175-180.
slide 10: Akhil Mathew et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 216-225
225
24. Patel V Wasserman R Imani F. Interventional Therapies for Chronic Low Back Pain: A Focused Review
Efficacy and Outcomes. Anesthesiology and Pain Medicine. 2015 54.
25. Gross A. Low Level Laser Therapy LLLT for Neck Pain: A Systematic Review and Meta-Regression.
The Open Orthopedics Journal. 2013 71:396-419.
How to cite this article: Akhil Mathew Dr. Dhanesh Kumar K U Dr. Ajith S and Subash Chandra
Rai. Effect of low level laser therapy in acute low back pain with radiculopathy: a single blinded
randomized control study. Int J of Allied Med Sci and Clin Res 2016 42: 216-225.
Source of Support: Nil. Conflict of Interest: None declared.