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Class IV Therapy Laser Case Studies Report 2013

OBJECTIVE

To describe the clinical management of Achilles tendinitis by using a “high-power” Class IV therapeutic laser.


CLINICAL FEATURES
This is a case of a fifty-eight year old woman, 5’4”, 155 lbs., presenting with bilateral Achilles tendon pain, the left foot for two years, the right for one year. She did not respond to physical therapy or steroid injections. Rest relieved the pain, weight bearing activity increased the pain. There was pain on palpation over her Achilles tendons. She showed decreased ankle dorsiflexion1, and displayed genu valgum and foot pronation10. Resisted neutral position isometric dorsiflexion and active eccentric dorsiflexion exacerbated the pain. Passive eccentric dorsiflexion did not exacerbate the pain. The patient filled out a VAS describing her “worst” pain, “best” pain, and pain “now.” This was filled out on each visit. The patient was accepted for laser therapy.


INTERVENTION AND OUTCOME
The laser used was the Avicenna class IV infrared laser, model AVI HP-7 5, continuous wave (non-pulsing). The laser emits a visible red beam at 635 nm wavelengths, and an infrared laser beam at 980 nm wavelength12. The power used was 7.5 watts; the dose was 2250 joules; the area was
15 cm; the energy density was .5 w/cm2; the treatment time was 5 minutes per side and the treatment distance was 2 cm. Treatment distance was ensured by securing the laser wand stylus to maintain the treatment distance. The stylus was kept in light contact with the patient. A swatch of cotton fabric was placed over the tendon with a 3x5 cm hole cut from it to allow for consistent laser treatment area. One open end was placed over the Achilles insertion, and extending proximally. The patient showed significant reduction in pain as indicated by the VAS scores, and significant increase in dorsiflexion flexibility as measured after four sessions with a goniometer.


CONCLUSION
This case demonstrates the potential benefit of conservative management for Achilles tendinitis with the utilization of “high-power” Class IV therapeutic laser technology to decrease the symptoms associated with Achilles tendinitis.


KEY WORDS
Class IV laser; Achilles tendonitis; laser therapy; Avicenna laser.


INTRODUCTION
All providers of health care are under significant pressure to demonstrate efficacy of treatment the FDA provided clearance of the use of “Low-Level” Class III therapeutic lasers in 2002 and "High Power" Class IV therapeutic lasers in 2004. Since that time, the use of therapeutic
lasers technology for the treatment of musculoskeletal conditions has grown in popularity. Although many articles have been written on the topic of laser therapy, and its application for somatic pain conditions, there is a lack of scientific papers that utilize any of the outcome assessments tar are required in today’s evidence – based healthcare environment. This paper is the first in a series to utilize generally accepted outcome assessments to determine the effectiveness of a "High-Power", Class IV laser therapy treatment protocol in reducing the symptoms of chronic somatic pain. The Achilles tendon is the largest and strongest tendon in the body, and one of the most frequently injured tendons1,2,17. Risk factors include decreased dorsiflexion, hyperpronation, and presence of Haglund's deformity, age, overuse and genetics.1,2,11. Generally, Haglund’s bump can cause direct mechanical pressure on the tendon during exercise. Age related loss of flexibility is a risk factor; most ruptures occur in athletes in their 30's and 40’s, and Type O blood types have a congenitally higher risk of Achilles problems2. Systemic diseases such as Reiter’s syndrome can predispose one to Achilles tendon symptoms2, 11...