Page 128 - Veterinary Laser Therapy in Small Animal Practice

114 Veterinary Laser Therapy in Small Animal Practice

inflammation, and inflammatory mediators related to recommended to also treat other structures that might
the inflammatory and catabolic process of OA, such be secondarily affected, such as contracted muscles or
as IL-1 and metalloproteinases. [296] The treated group stiff joints. Rest and proper immobilization or support
received a low dose (1.5 J/cm of 830 nm light) three remain important measures for tendon and ligament
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times a week; effects were seen after 6 weeks of therapy. injuries; don’t let the patient put too much strain or
The pain associated with ligament and tendon inju- tension on the tendon/ligament despite the initial clini-
ries can also be alleviated with LT. A placebo-con- cal improvement it may show in terms of pain.
trolled, double-blinded clinical study in human patients
with lateral epicondylitis reported significant improve- 9.4 Muscle and laser therapy
ment in pain and functionality scores. They used 6–7
J/cm , treating at 10 W and with around 0.5–1 W/cm Muscular conditions and injuries can also be treated
2
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of power density. [111] Using lower doses and power, with LT. The proangiogenic effect of LT enhances
another randomized, placebo-controlled clinical trial muscle repair; the biochemical activity of muscle cells
found an analgesic and anti-inflammatory effect of LT increases and more myofibers differentiate. As in other
in Achilles tendinitis, also describing a fast decrease in tissues, inflammation and regeneration/proliferation
peritendinous prostaglandin E (PGE ) concentrations. are related in muscle repair: prolonged inflammation
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2
[297] interferes with healing and recovery, and can lead to
The above are just examples of experimental and muscle fibrosis. Functional muscle contractures are also
clinical studies about the benefits of LT in tendon and rewarding to treat, since the patient tends to experience
ligament injuries. One of the reasons these transection a relatively fast relief (Fig. 9.4).
models cannot be directly extrapolated to the dog is that Animal models show LT can help prevent muscle
in our canine patients, although sudden and complete fibrosis and atrophy and suggest its use should be inves-
cranial cruciate ligament rupture (CCLR) can occur, it tigated in patients with disuse atrophy, atrophy due to
is usually a chronic condition that starts with a partial peripheral nerve injury, and even as part of the treat-
tear that progresses after an initial period of apparent ment of Duchenne dystrophy. [148, 149, 299] Genetically
stabilization and improvement. Breed conformation is manipulated mice that undergo a similar process of
also involved. muscular dystrophy show less muscle damage and less
Another clinical study is relevant here: although muscle inflammation when treated with LT. [299] An
it did not have the aim of investigating the effect of experimental model of induced myositis showed LT (3
2
LT, the study described excellent results in dogs with J/cm ) reduced the number of inflammatory cells and
partial CCLR using bone marrow aspirate concentrate amount of edema [300] ; a similar dose was used to prove
or adipose-derived progenitor cells in combination increased regeneration and decreased inflammation
with platelet-rich plasma therapy. These patients had after muscle contusion in rats. [301]
at least 50% of the craniomedial band of the ligament Alves et al. concluded in 2014 after a systematic
intact, as diagnosed by arthroscopy, and together with review of the literature that LT should be considered
the stem cell treatment, they underwent a rehabilita- “an excellent therapeutic resource for the treatment of
tion program in which LT was included, and wore a skeletal muscle injuries in the short term” ; but more
[8]
customized stifle orthotic. Not only did pain ratings clinical studies on LT and muscular conditions should
improve, but in more than half of the cases that were be performed, ideally comparing different treatment
re-examined arthroscopically, the cranial cruciate liga- protocols. There are, however, some trials in sports
ment had fully regenerated. [298] medicine reporting that LT inhibits the post-exercise
To treat tendon and ligament injuries, 4–10 J/cm increase in creatinine kinase levels and accelerates
2
are used, staying at the lower end of the range for post-exercise lactate removal, [302] which would mean
relatively superficial structures such as the calcaneal a faster post-exercise recovery. On the other hand,
tendon; 3–10 W can be used, but for superficial and/ others found no effect on the recovery of strength per-
or very inflamed and tender areas keep the power formance despite the attenuation in creatinine kinase
density within 0.5–1 W/cm . Initially, treatment activity. [303]
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should be performed at least three times a week (see Treating large muscle groups can take some time,
section 9.1, “General treatment considerations”). It is and should be well planned to include all the area of

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