Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review.

QUESTION: In people with non-specific low back pain (LBP), what are the effects of photobiomodulation therapy (PBMT) on pain, disability and other outcomes when compared with no intervention, sham PBMT and other treatments, and when used as an adjunct to other treatments? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: People with acute/subacute or chronic non-specific LBP. INTERVENTIONS: Any type of PBMT (laser class I, II and III and light-emitting diodes) compared with no treatment, sham PBMT and other types of treatment, or used as an adjunct to another treatment. OUTCOME MEASURES: Pain intensity, disability, overall improvement, quality of life, work absence and adverse effects. RESULTS: Twelve randomised controlled trials were included (pooled n = 1,046). Most trials had low risk of bias. Compared with sham PBMT, the effect of PBMT on pain and disability was clinically unimportant in people with acute/subacute or chronic LBP. In people with chronic LBP, there was no clinically important difference between the effect of PBMT and the effect of exercise on pain or disability. Although benefits were observed on some other outcomes, these estimates were imprecise and/or based on low-quality evidence. PBMT was estimated to reduce pain (MD -11.20, 95% CI -20.92 to -1.48) and disability (MD -11.90, 95% CI -17.37 to -6.43) more than ultrasound, but these confidence intervals showed important uncertainty about whether the differences in effect were worthwhile or trivial. Conversely, PBMT was estimated to reduce pain (MD 19.00, 95% CI 9.49 to 28.51) and disability (MD 17.40, 95% CI 8.60 to 26.20) less than Tecar (Energy Transfer Capacitive and Resistive) therapy, with marginal uncertainty that these differences in effect were worthwhile. CONCLUSION: Current evidence does not support the use of PBMT to decrease pain and disability in people with non-specific LBP. REGISTRATION: CRD42018088242.

Does the combination of photobiomodulation therapy (PBMT) and static magnetic fields (sMF) potentiate the effects of aerobic endurance training and decrease the loss of performance during detraining? A randomised, triple-blinded, placebo-controlled trial.

BACKGROUND: Photobiomodulation (PBMT) is a therapy that uses non-ionising forms of light, including low-level lasers and light-emitting diodes (LEDs) that may be capable of modulating cellular activity. Some biological processes may also interact with static magnetic fields (sMF), leading to modulatory effects on cells. Previous studies have verified that the combination of PBMT and sMF (PBMT/sMF) enhances the performance of individuals during aerobic training programs. The detraining period can cause losses in aerobic capacity. However, there is no evidence of the existence of any recourse that can decrease the effects of detraining. We aimed to investigate the effects of PBMT/sMF application during training and detraining to assess the effectiveness of this treatment in reducing the effects of detraining. METHODS: Sixty male volunteers were randomly allocated into four groups- participants who received PBMT/sMF during the training and detraining (PBMT/sMF + PBMT/sMF); participants who received PBMT/sMF during the training and a placebo in the detraining (PBMT/sMF + Placebo); participants who received a placebo during the training and PBMT/sMF in the detraining (Placebo+PBMT/sMF); and participants who received a placebo during the training and detraining (Placebo+Placebo). Participants performed treadmill training over 12 weeks (3 sessions/week), followed by 4 weeks of detraining. PBMT/sMF was applied using a 12-diode emitter (four 905 nm super-pulsed lasers, four 875 nm light-emitting diodes (LEDs), four 640 nm LEDs, and a 35 mT magnetic field) at 17 sites on each lower limb (dosage: 30 J per site). The data were analysed by two-way repeated measures analysis of variance (ANOVA, time vs experimental group) with post-hoc Bonferroni correction. RESULTS: The percentage of change in time until exhaustion and in maximum oxygen consumption was higher in the PBMT/sMF + PBMT/sMF group than in the Placebo+Placebo group at all time-points (p < 0.05). Moreover, the percentage of decrease in body fat at the 16th week was higher in the PBMT/sMF + PBMT/sMF group than in the Placebo+Placebo group (p < 0.05). CONCLUSIONS: PBMT/sMF can potentiate the effects of aerobic endurance training and decrease performance loss after a 4-week detraining period. Thus, it may prove to be an important tool for both amateur and high-performance athletes as well as people undergoing rehabilitation. TRIAL REGISTRATION: NCT03879226. Trial registered on 18 March 2019.

Acute effects of photobiomodulation therapy and magnetic field on functional mobility in stroke survivors: a randomized, sham-controlled, triple-blind, crossover, clinical trial.

Identify the optimal energy delivered with a single application of the combination of photobiomodulation therapy (PBMT) combining different light sources (low-level laser therapy-LLLT and light emitting diode therapy-LEDT) and static magnetic field (sMF) in order to determine the acute effects on functional mobility of stroke survivors. Was conducted a randomized, placebo-controlled, crossover, triple-blind, clinical trial (RCT). Twelve patients were recruited, however ten concluded the study, they were randomly treated with four PBMT/sMF energies (sham-0 J, 10 J, 30 J, and 50 J per site irradiated), with 1-week interval washout between treatments. PBMT/sMF were administered after the pre-intervention (baseline) evaluation and the total energy delivered per site at each treatment was determined based on the results of the randomization procedure. PBMT/sMF were administered in direct contact with the skin and applied with slight pressure to nine sites on the knee extensors, six sites on the knee flexors, and two sites on the plantar flexors' muscles in both lower limbs (bilaterally). The primary outcome measure was the 6-min walk test (6MWT) and the secondary outcome was the Timed Up and Go (TUG) test. Significant improvements were found in the 6MWT test using a total energy of 30 J per site compared with sham (0 J) (p < 0.05) and compared with the baseline evaluation (p < 0.01). And in the TUG test significant improvements were also found using a total energy per site of 30 J per site compared to sham (0 J) and baseline (p < 0.05). PBMT with different light sources (laser and LEDs) and wavelengths in combination with sMF with a total energy per site of 30 J has positive acute effects on functional mobility in stroke survivors.

Infrared Low-Level Laser Therapy (Photobiomodulation Therapy) before Intense Progressive Running Test of High-Level Soccer Players: Effects on Functional, Muscle Damage, Inflammatory, and Oxidative Stress Markers-A Randomized Controlled Trial.

The effects of preexercise photobiomodulation therapy (PBMT) to enhance performance, accelerate recovery, and attenuate exercise-induced oxidative stress were still not fully investigated, especially in high-level athletes. The aim of this study was to evaluate the effects of PBMT (using infrared low-level laser therapy) applied before a progressive running test on functional aspects, muscle damage, and inflammatory and oxidative stress markers in high-level soccer players. A randomized, triple-blind, placebo-controlled crossover trial was performed. Twenty-two high-level male soccer players from the same team were recruited and treated with active PBMT and placebo. The order of interventions was randomized. Immediately after the application of active PBMT or placebo, the volunteers performed a standardized high-intensity progressive running test (ergospirometry test) until exhaustion. We analyzed rates of oxygen uptake (VO2 max), time until exhaustion, and aerobic and anaerobic threshold during the intense progressive running test. Creatine kinase (CK) and lactate dehydrogenase (LDH) activities, levels of interleukin-1ß (IL-1-ß), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α), levels of thiobarbituric acid (TBARS) and carbonylated proteins, and catalase (CAT) and superoxide dismutase (SOD) activities were measured before and five minutes after the end of the test. PBMT increased the VO2 max (both relative and absolute values-p < 0.0467 and p < 0.0013, respectively), time until exhaustion (p < 0.0043), time (p < 0.0007) and volume (p < 0.0355) in which anaerobic threshold happened, and volume in which aerobic threshold happened (p < 0.0068). Moreover, PBMT decreased CK (p < 0.0001) and LDH (p < 0.0001) activities. Regarding the cytokines, PBMT decreased only IL-6 (p < 0.0001). Finally, PBMT decreased TBARS (p < 0.0001) and carbonylated protein levels (p < 0.01) and increased SOD (p < 0.0001)and CAT (p < 0.0001) activities. The findings of this study demonstrate that preexercise PBMT acts on different functional aspects and biochemical markers. Moreover, preexercise PBMT seems to play an important antioxidant effect, decreasing exercise-induced oxidative stress and consequently enhancing athletic performance and improving postexercise recovery. This trial is registered with Clinicaltrials.gov NCT03803956.

Effects of photobiomodulation therapy combined to static magnetic field in strength training and detraining in humans: protocol for a randomised placebo-controlled trial.

INTRODUCTION: In recent years, it has been demonstrated that photobiomodulation therapy (PBMT) using low-level laser therapy and/or light-emitting diode therapy combined to static magnetic field (sMF) has ergogenic effects, improving muscular performance and accelerating postexercise recovery. However, many aspects related to these effects and its clinical applicability remain unknown. Therefore, the aim of this project is to evaluate the ergogenic effects of PBMT/sMF in detraining after a strength-training protocol. METHODS AND ANALYSIS: The study will be a randomised, triple-blind, placebo-controlled clinical trial. Healthy male volunteers will be randomly distributed into four experimental groups: PBMT/sMF before training sessions + PBMT/sMF during detraining, PBMT/sMF before training sessions + placebo during detraining, placebo before training sessions + PBMT/sMF during detraining and placebo before training sessions + placebo during detraining. Strength-training sessions will be carried out over 12 weeks, and the detraining period will occur during the 4 weeks after. The muscular strength and the structural properties of quadriceps will be analysed. ETHICS AND DISSEMINATION: This study was approved by the Research Ethics Committee of Nove de Julho University. The results from this study will be disseminated through scientific publications in international peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER: NCT03858179.

Effects of photobiomodulation therapy in aerobic endurance training and detraining in humans: Protocol for a randomized placebo-controlled trial.

INTRODUCTION: Over the last 10 years, it has been demonstrated that photobiomodulation therapy (PBMT), also known as phototherapy, using low-level laser therapy (LLLT) and/or light-emitting diode therapy (LEDT) has ergogenic effects, improving athletic performance and also accelerating post-exercise recovery. However, many aspects related to these effects and its clinical applicability remain unknown. Therefore, the aim of this project is to evaluate the ergogenic effects of PBMT in detraining after an aerobic endurance training protocol. METHODS AND ANALYZES: A randomized, triple-blind, placebo-controlled clinical trial will be carried out. Healthy male volunteers will be randomly distributed into 4 experimental groups: PBMT before and after training sessions + PBMT during detraining, PBMT before and after training sessions + placebo during detraining, placebo before and after training sessions + PBMT during detraining, and placebo before and after training sessions + placebo during detraining. The aerobic endurance training sessions will be carried out using motorized treadmills during 12 weeks, and the detraining period will consist in the next 4 weeks after that. It will be analyzed the time until exhaustion, maximal oxygen uptake (VO2max), and fat percentage of volunteers. DISCUSSION: Despite the increasing body of evidence for the use of PBMT as an ergogenic agent, several aspects remain unknown. The findings of this study will contribute to the advance of knowledge in this field regarding clinical applications. ETHICS AND DISSEMINATION: This study was approved by the Research Ethics Committee of Nove de Julho University. The results from this study will be further disseminated through scientific publications in international peer-reviewed journals and presentations at national and international scientific meetings. TRIAL REGISTRATION NUMBER: NCT03879226.

Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial.

Cryotherapy for post-exercise recovery remains widely used despite the lack of quality evidence. Photobiomodulation therapy (PBMT) studies (with both low-level laser therapy and light-emitting diode therapy) have demonstrated positive scientific evidence to suggest its use. The study aims to evaluate PBMT and cryotherapy as a single or combined treatment on skeletal muscle recovery after eccentric contractions of knee extensors. Fifty healthy male volunteers were recruited and randomized into five groups (PBMT, cryotherapy, cryotherapy + PBMT, PMBT + cryotherapy, or placebo) for a randomized, double-blinded, placebo-controlled trial that evaluated exercise performance (maximum voluntary contraction (MVC)), delayed onset muscle soreness (DOMS), and muscle damage (creatine kinase (CK)). Assessments were performed at baseline; immediately after; and at 1, 24, 48, 72, and 96 h. Comparator treatments was performed 3 min after exercise and repeated at 24, 48, and 72 h. PBMT was applied employing a cordless, portable GameDay™ device (combination of 905 nm super-pulsed laser and 875- and 640-nm light-emitting diodes (LEDs); manufactured by Multi Radiance Medical™, Solon - OH, USA), and cryotherapy by flexible rubber ice packs. PBMT alone was optimal for post-exercise recovery with improved MVC, decreased DOMS, and CK activity (p < 0.05) from 24 to 96 h compared to placebo, cryotherapy, and cryotherapy + PBMT. In the PBMT + cryotherapy group, the effect of PBMT was decreased (p > 0.05) but demonstrated significant improvement in MVC, decreased DOMS, and CK activity (p < 0.05). Cryotherapy as single treatment and cryotherapy + PBMT were similar to placebo (p > 0.05). We conclude that PBMT used as single treatment is the best modality for enhancement of post-exercise restitution, leading to complete recovery to baseline levels from 24 h after high-intensity eccentric contractions.

Using Pre-Exercise Photobiomodulation Therapy Combining Super-Pulsed Lasers and Light-Emitting Diodes to Improve Performance in Progressive Cardiopulmonary Exercise Tests.

CONTEXT: Skeletal muscle fatigue and exercise performance are novel areas of research and clinical application in the photobiomodulation field, and positive outcomes have been reported in several studies; however, the optimal measures have not been fully established. OBJECTIVE: To assess the acute effect of photobiomodulation therapy (PBMT) combining superpulsed lasers (low-level laser therapy) and light-emitting diodes (LEDs) on muscle performance during a progressive cardiopulmonary treadmill exercise test. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty untrained male volunteers (age = 26.0 ± 6.0 years, height = 175.0 ± 10.0 cm, mass = 74.8 ± 10.9 kg). INTERVENTION(S): Participants received PBMT with either combined superpulsed lasers and LED (active PBMT) or placebo at session 1 and the other treatment at session 2. All participants completed a cardiopulmonary test on a treadmill after each treatment. For active PBMT, we performed the irradiation at 17 sites on each lower limb (9 on the quadriceps, 6 on the hamstrings, and 2 on the gastrocnemius muscles), using a cluster with 12 diodes (four 905-nm superpulsed laser diodes with an average power of 0.3125 mW, peak power of 12.5 W for each diode, and frequency of 250 Hz; four 875-nm infrared LED diodes with an average power of 17.5 mW; and four 640-nm red LED diodes with an average power of 15 mW) and delivering a dose of 30 J per site. MAIN OUTCOME MEASURE(S): Distance covered, time until exhaustion, pulmonary ventilation, and dyspnea score. RESULTS: The distance covered (1.96 ± 0.30 versus 1.84 ± 0.40 km, t19 = 2.119, P < .001) and time until exhaustion on the cardiopulmonary test (780.2 ± 91.0 versus 742.1 ± 94.0 seconds, t19 = 3.028, P < .001) was greater after active PBMT than after placebo. Pulmonary ventilation was greater (76.4 ± 21.9 versus 74.3 ± 19.8 L/min, t19 = 0.180, P = .004) and the score for dyspnea was lower (3.0 [interquartile range = 0.5-9.0] versus 4.0 [0.0-9.0], U = 184.000, P < .001) after active PBMT than after placebo. CONCLUSIONS: The combination of lasers and LEDs increased the time, distance, and pulmonary ventilation and decreased the score of dyspnea during a cardiopulmonary test.