Laser Therapy in Rehabilitation: Addressing Back Pain and Patellar Tendonitis

I would like to inquire about "laser" treatment in the field of rehabilitation medicine?

Hello, doctor.
I have two questions to ask: (1) Generally, I feel fine, but in the morning when I wake up, my back hurts significantly (I previously had a strain in my latissimus dorsi, but that was about 3 to 4 months ago).
I have been consistently undergoing physical rehabilitation treatment (electrotherapy, thermotherapy, and laser therapy), so I feel okay when I'm not exerting myself.
However, my back still hurts when I exert myself, and I experience significant pain when I wake up or turn over in bed (possibly due to maintaining a fixed sleeping position for too long).
I'm unsure if this is a muscle issue or if there is a myofascial problem.
If it is a myofascial issue, I wonder if the aforementioned treatments covered by health insurance are effective? (2) I have swelling around my patella, which varies in severity.
It is likely patellar tendinitis.
During physical therapy, especially with the "laser therapy" (the type with two suction cups), the therapist directly asks, "Where is the pain?" and applies the suction directly to the area around the patella.
Many times, it was tolerable, but after the suction treatment, the area around the patella becomes very painful and swells significantly.
Therefore, I would like to ask the doctor, "Is it appropriate to apply laser therapy directly on the bone?" Or is laser therapy more suitable for muscle tissue, and should we avoid applying it directly on bone? Thank you!

Mr. Zheng, 40~49 year old female. Ask Date: 2020/10/28

Dr. Lin Ruixiang reply Rehabilitation

Dear Mr.
Zheng,
Regarding your inquiry, here are the responses:
1.
This is a myofascial issue.
In principle, the mechanism of thermotherapy is based on energy transfer and conversion, allowing the damaged tissue to heal naturally.
However, since it has been 3-4 months, the likelihood of natural healing is low.
It is advisable to consider external interventions (such as manual therapy) as a more suitable option.
2.
Bone is not a contraindication (neither absolute nor relative), but the amount of soft tissue in that area is limited.
The energy from phototherapy (laser) can accumulate after conversion, potentially leading to excessive strain and counterproductive effects.
It is recommended to reduce the dosage or consider using alternative equipment.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2020/10/28

More Info

Laser therapy has gained popularity in rehabilitation settings for its potential benefits in managing various musculoskeletal conditions, including back pain and patellar tendonitis. Let's address your questions regarding its application and effectiveness in your specific cases.

1. Back Pain and Muscle Strain
From your description, it seems you are experiencing significant back pain, particularly upon waking and after prolonged periods of inactivity or specific sleeping positions. This could be indicative of muscle strain, particularly in the latissimus dorsi, or it may involve myofascial pain syndrome, where muscle tightness and trigger points contribute to discomfort.

Understanding Myofascial Pain:
Myofascial pain syndrome is characterized by the presence of trigger points—tight knots in muscles that can cause pain in the affected area and refer pain to other regions. Given that you have a history of muscle strain and ongoing physical therapy, it is crucial to assess whether the pain is primarily muscular or if there are underlying issues such as disc herniation or spinal alignment problems.

Effectiveness of Physical Therapy:
The physical therapies you are undergoing, including electrical stimulation, heat therapy, and laser therapy, can be beneficial. Laser therapy, in particular, is known for its anti-inflammatory properties and ability to promote tissue healing. However, its effectiveness can vary based on the underlying cause of your pain. If the pain is due to muscle tightness or myofascial issues, continued physical therapy focusing on stretching, strengthening, and trigger point release may be necessary.

2. Patellar Tendonitis and Laser Therapy
Regarding your knee pain, which you suspect to be patellar tendonitis, it's essential to understand how laser therapy interacts with different tissues. Laser therapy can be effective in treating tendonitis by promoting healing and reducing inflammation. However, the application technique is crucial.

Application of Laser Therapy:
When using laser therapy, it is generally safe to apply it over the tendon area, but caution is advised when treating bony structures. The laser should ideally target the soft tissue surrounding the tendon rather than directly over the bone. If you are experiencing increased pain and swelling after treatment, it may indicate that the laser is being applied too aggressively or too close to the bony structure.

Recommendations:
1. For Back Pain: Continue with your physical therapy regimen, but consider discussing with your therapist the possibility of incorporating more targeted myofascial release techniques or trigger point therapy. Additionally, evaluate your sleeping posture and consider using supportive pillows to maintain spinal alignment during sleep.

2. For Patellar Tendonitis: Communicate with your therapist about your pain response to laser therapy. It may be beneficial to adjust the treatment parameters or focus on surrounding soft tissues rather than directly on the patellar tendon. Other modalities, such as ultrasound therapy or specific strengthening exercises for the quadriceps and hamstrings, may also be beneficial.

Conclusion
In summary, laser therapy can be a valuable tool in your rehabilitation for both back pain and patellar tendonitis, but its effectiveness largely depends on proper application and the underlying causes of your symptoms. Continuous communication with your healthcare providers about your pain levels and treatment responses is essential for optimizing your rehabilitation outcomes. If symptoms persist or worsen, further diagnostic imaging or a referral to a specialist may be warranted to rule out any serious underlying conditions.

Similar Q&A

Chronic Tendonitis: Treatment Options and Expert Advice for Knee Pain

Hello Doctor, I have been suffering from patellar valgus since mid-last year, which made it nearly impossible for me to walk during severe episodes. After nearly a year of treatment, my condition has gradually improved. However, during the rehabilitation process, due to muscle ti...

Dr. Hong Ximing reply Orthopedics
Patellar valgus can lead to joint wear and pain, where rehabilitation and medication injections serve only as adjunctive treatments. Once the cartilage layer is completely worn away, pain relief can only occur after bone spurs develop in the worn area. In addition to stretching t...

Effective Treatment and Rehabilitation for Quadriceps Tendonitis

Hello, doctor. Could you please tell me how to properly treat quadriceps tendonitis? If rehabilitation is needed, how long will it take to recover? What equipment should be used for rehabilitation (such as heat therapy or electrical stimulation)? I am experiencing pain when press...

Dr. Lin Yijun reply Orthopedics
Hello, Qiu Qiu: You can perform heat therapy at home using a warm towel or a moist heating pad. During the recovery process, tendons require appropriate tension to heal effectively, so it is important to engage in proper stretching and strength training rather than complete rest....

Patellofemoral Pain Syndrome: Can Rehab Therapy Help?

Hello, Director Chen! I have been jogging and playing badminton for a long time. For the past six months, whenever I sit for extended periods or go downhill or down stairs, I experience a dull pain in my knee joint, and occasionally my legs feel weak. If I perform large movements...

Dr. Chen Xianchang reply Rehabilitation
1. Rehabilitation can be initiated to enhance deep heat therapy and electrical stimulation, while also increasing thigh muscle strength. 2. Supplementation with glucosamine and chondroitin, commonly known as "joint support," can be beneficial. 3. When descending hil...

Can Tendonitis Be Treated with Rehabilitation? Expert Insights

Hello Doctor: I often experience finger pain due to prolonged computer use, and even light touch can exacerbate the pain. An orthopedic doctor mentioned that it might be tendonitis. Can tendonitis be rehabilitated? Thank you!

Dr. Chen Xianchang reply Rehabilitation
Hello, thank you for your inquiry. Here are my responses and recommendations: 1. Avoid prolonged computer use, and consider using supportive devices such as a mouse pad, wrist support, and elbow braces to reduce strain. 2. For tendonitis treatment, rest is essential. At home, yo...