IMPORTANT

La prise en charge thérapeutique de la tendinite nécessite l'intervention d'un professionnel de la santé, habileté à poser un diagnostic précis, qui pourra juger de manière réaliste de ce qui vous convient le mieux.
 
Laser doux : LLLT is as well documented as NSAIDs and steroid injections for shoulder tendinitis/bursitis and epicondylaglia.
Posté par drdesforges le 25-06-2008 (3229 lectures)

The Norwegian physiotherapist Jan M Bjordal published his thesis .Low level laser therapy in shoulder tendinitis/bursitis, epicondylalgia and ankle sprain. in 1997, at the Division of Physiotherapy Science, University of Bergen. It has also been published in Physical Therapy Reviews. 1998; 3: 121-132.



Here is the Conclusion of the thesis: .A systematic review has been performed on the effect of LLLT for three diagnoses. LLLT was evaluated on similar criteria for methodological assessments of trials as previously established for medical interventions. No evidence was found to indicate that randomized controlled trials on LLLT for tendinitis/bursitis of the shoulder, lateral epicondylalgia and ankle sprains were methodologically inferior to RCTs on medical interventions. The clinical effects of LLLT were found to be supported by scientific evidence regarding short (0-4 weeks) and medium term (<3 months) efficacy for subacute or chronic lateral epicondylitis, and short term efficacy (>3 months) for subacute or chronic lateral epicondylitis, and short term efficacy (> 3 months) for subacute or chronic shoulder tendinitis/bursitis.


The evidence of effect from LLLT for acute ankle sprain in inconclusive, although there seems to be a slight tendency in favor of LLLT. Adverse effects of LLLT are rarely seen and only in minor forms (nausea, headache) compared to medication, where more serious gastrointestinal discomfort or ulcers are not uncommon. It has also been shown that trials in favor of active treatment had more treatments per week than the trials showing no difference in effect. In short one could say that LLLT should be used much in the same way as NSAID are used for short periods of time. Most trials showing significant effects used an IR 904 nm laser, but some results in favor of IR lasers with wavelengths of 780, 820 and 830 nm were also observed. Clinical effects of LLLT were best in subacute conditions. In chronic conditions a higher dosage and more treatments seem to be needed. The results of the high quality LLLT trials were all in favor of treatment with confidence intervals not including zero, and the trials came from several different research groups. Evidence was found to be at the highest or the second highest level depending on what level of clinical significance is decided according to the classification of Oxman (1994) and McQuay (1997). The review found little support for the alleged large placebo effects of LLLT. In chronic cases the placebo effect is probably less that 10%, after the natural history of the complaints is taken into account.


In the .Summary of discussion on clinical effect estimates for LLLT. the author writes:


The majority of the included LLLT-trials found significant clinical effect from LLLT. Seven of the eleven LLLT-trials with acceptable methods included calculations of 95% confidence limits above zero, and one LLLT-trial on ankle sprain included zero (Axelsen & Bjerno 1993). The clinical effect estimates from LLLT-trials for shoulder tendinitis/bursitis are similar or higher than for NSAID or steroid injections. For lateral epicondylalgia estimates for short term clinical effects are similar or lower for LLLT than for steroid injections, but medium clinical effect estimates are similar or higher for LLLT. Recurrence of symptoms in lateral epicondylalgia is less likely after LLLT than after steroid injections. Evidence of clinical effects from ankle sprain is inconclusive. Adverse effects from LLLT are seldom seen and they appear less serious than for patients treated with NSAID and steroid injections.


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