Is Over-Treatment with High-Energy Laser Therapy Affecting Recovery?

Over-treatment (High-energy laser)

Hello: 1.
After a fall on 1/5, X-rays showed no fractures or bone cracks in the ankle, but there was soft tissue swelling and a ligament tear.
On 5/18, I fell again while riding a bike and turning, after getting caught on my crutches, with the diagnosis being the same as the first incident.
2.
Since the injury, I have been undergoing rehabilitation therapy daily.
Aside from a decrease in pain after receiving anti-inflammatory and vascular injections on 5/10, which allowed me to lightly touch the ground with my foot, there has been no significant improvement.
3.
Starting from 5/31, I began receiving high-energy laser therapy twice a week, and the bruising and swelling began to subside.
After the third session, the bruising and swelling were only mild, but pressing on the bone still caused pain.
Therefore, during the fourth laser session, I asked the therapist to focus on the areas of pain and swelling (including the painful bone area); after the treatment, the ankle was noticeably more swollen, and the pain increased, although the bruising had decreased slightly.
4.
I would like to ask: (1) Is it possible that this is a result of overtreatment? If not, what other treatments can I pursue? (Currently, it seems that my foot only responds well to high-energy laser therapy.) (2) If it is overtreatment, should I apply ice or temporarily refrain from any treatment? Can I still undergo high-energy laser therapy? What about low-energy laser therapy? (3) My bone is painful when pressed, and the doctor mentioned that it is likely still inflamed, but the clinic can only prescribe anti-inflammatory medication for three days, while rehabilitation can take up to six days to prescribe medication and does not include gastric medication (which causes me stomach pain).
What should I do? How can I quickly control the inflammatory response? PS.
Thank you very much, as I cannot find a clinic nearby willing to perform an ultrasound examination.

Xiao Jie, 40~49 year old female. Ask Date: 2021/06/16

Dr. Li Yanheng reply Rehabilitation

Based on the description, it is still recommended to perform an ultrasound examination to confirm the condition of the ligaments and fascia, as well as to observe whether there is indeed an inflammatory response or a subcutaneous hematoma.
If the inflammatory response is not significant, excessive use of anti-inflammatory medications should be avoided.

Reply Date: 2021/06/16

More Info

In your situation, it seems that you are dealing with a complex recovery process following multiple injuries to your ankle, including soft tissue swelling and ligament tears. The use of high-energy laser therapy (HELT) has shown some positive effects in reducing bruising and swelling, but it appears that you are experiencing increased pain and swelling after the last treatment. Let's address your questions systematically.

1. Is this possibly a result of over-treatment?
It is indeed possible that the increase in pain and swelling after your last high-energy laser therapy session could be a sign of over-treatment. High-energy laser therapy can stimulate healing, but excessive application can lead to inflammation or irritation of the tissues. The response to laser therapy can vary significantly among individuals; while some may experience rapid improvement, others may have adverse reactions. If you feel that the treatments are causing more harm than good, it may be wise to take a break from high-energy laser therapy and consult your healthcare provider about adjusting your treatment plan.

2. Should you ice the area or refrain from treatment?
If you are experiencing increased swelling and pain, applying ice to the affected area can help reduce inflammation. Ice therapy is generally recommended for acute injuries, especially within the first 48 hours post-injury. You might consider taking a break from high-energy laser therapy and possibly switching to low-energy laser therapy, which tends to be less intense and may help with pain relief without exacerbating swelling. However, it is crucial to consult your physical therapist or physician before making any changes to your treatment regimen.

3. Managing pain and inflammation:
Given that your doctor has prescribed anti-inflammatory medication for only three days, and you are concerned about gastrointestinal side effects, it is essential to communicate these concerns with your healthcare provider. You may need to discuss alternative medications that are easier on the stomach or consider adjunct therapies such as physical therapy modalities, including ultrasound therapy, which can help manage pain and inflammation without the gastrointestinal side effects associated with oral medications. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) can be effective, but you should ensure they are compatible with your health history.

4. Continued treatment options:
If high-energy laser therapy has been beneficial, you might want to continue with it but at a reduced frequency or intensity. Low-energy laser therapy could also be a viable option, as it is generally considered safer and can promote healing without the risk of over-stimulation. Other modalities such as ultrasound therapy, electrical stimulation, or even gentle mobilization exercises (as tolerated) may also be beneficial in your recovery process.

In summary, while high-energy laser therapy can be effective, it is essential to monitor your body's response closely. If you notice increased pain and swelling, it may be time to reassess your treatment approach. Always communicate openly with your healthcare providers about your symptoms and concerns, as they can help tailor a treatment plan that best suits your recovery needs. Remember, recovery from soft tissue injuries can take time, and patience is key.

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