Lasers in Medical Science

, Volume 34, Issue 6, pp 1115–1124 | Cite as

Low-level laser therapy versus trunk stabilization exercises on sternotomy healing after coronary artery bypass grafting: a randomized clinical trial

  • Zeinab Mohammed Helmy
  • Sherin Hassan Mohammed MehaniEmail author
  • Basant Hamdy El-Refaey
  • Eman Hassan Abd Al-Salam
  • El-Sayed Essam El-Sayed Felaya
Original Article


The aim of this study was to investigate the effects of low-level laser therapy (LLLT) versus trunk stabilization exercises on sternotomy healing following coronary artery bypass grafting (CABG) surgery. Forty-five male patients who had acute sternal instability post-CABG surgery in the age range of 45–65 years were divided randomly into three equal groups (n = 15). The laser group received LLLT, while the exercise group received trunk stabilization exercises. The control group only received a routine cardiac rehabilitation programme, which was also provided to both the laser and the exercise groups. All groups were offered 12 sessions over 4 weeks. Sternal separation, median sternotomy photographic analysis, pain and activities of daily living (ADL) performance were evaluated pre- and post-treatment. Statistical significance was set at P < 0.05. There was a significant decrease among the laser group in upper-sternal separation, while the exercise and control groups showed a non-significant decrease. In terms of mid-sternal separation, laser and exercise groups showed a significant decrease while the control group showed a non-significant decrease. In terms of lower-sternal separation, the exercise group showed a significant decrease, while the laser and control groups showed a non-significant decrease. Post-treatment between-groups analysis showed a significant difference only among the laser and control groups with regard to upper-sternal separation, while analysis of the laser, exercise and control groups in the case of upper-sternal separation and the between-groups comparison in terms of mid- and lower-sternal separation revealed no significant differences. LLLT and trunk stabilization exercises were found to be the most effective methods for sternotomy healing post-CABG surgery, with LLLT offering superior performance in the case of the upper sternum while trunk stabilization exercises were more effective for the lower sternum.


Coronary artery bypass grafting Low-level laser therapy Sternotomy healing Trunk stabilization exercises 



We would like to thank all the study patients and team members at the National Heart Institute for general and technical support.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Kirklin JW, Akins CW, Blackstone EH, Booth DC, Califf RM, Cohen LS, Hall RJ, Harrell FE, Kouchoukos NT, McCallister BD, Naftel DC, Parker JO, Sheldon WC, Smith HC, Wechsler AS, Williams JF, Fisch C, Beller GA, DeSanctis RW, Dodge HT, Kennedy JW, Reeves TJ, Weinberg SL (1991) ACC/AHA guidelines and indications for coronary artery bypass graft surgery-a report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on coronary artery bypass graft surgery). Circ 83:1125–1173. CrossRefGoogle Scholar
  2. 2.
    Madan K, Gupta VP, Singh R, Talwar S, Choudhary SK, Airan B, Kumar AS (2006) Comparison of straight sternotomy & interlocking sternotomy in open heart surgery. Indian J Med Res 124:57–62PubMedGoogle Scholar
  3. 3.
    Cahalin LP, LaPier TK, Shaw DK (2011) Sternal precautions: is it time for change? Precautions versus restrictions–a review of literature and recommendations for revision. Cardiopulm Phys Ther J 22:5–15CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tuyl LJ, Mackney JH, Johnston CL (2012) Management of sternal precautions following median sternotomy by physical therapists in Australia: a web-based survey. Phys Ther 92:83–97. CrossRefPubMedGoogle Scholar
  5. 5.
    Olbrecht VA, Barreiro CJ, Bonde PN, Williams JA, Baumgartner WA, Gott VL, Conte JV (2006) Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg 82:902–907. CrossRefPubMedGoogle Scholar
  6. 6.
    Losanoff JE, Collier AD, Wagner-Mann CC, Richman BW, Huff H, Hsieh FH, Diaz-Arias A, Jones JW (2004) Biomechanical comparison of median sternotomy closures. Ann Thorac Surg 77:203–209. CrossRefPubMedGoogle Scholar
  7. 7.
    Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akıncı E (2009) Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anatol J Cardiol/Anadolu Kardiyol Derg 9:411–416Google Scholar
  8. 8.
    Iwakura A, Tabata Y, Miyao M, Ozeki M, Tamura N, Ikai A, Nishimura K, Nakamura T, Shimizu Y, Fujita M, Komeda M (2000) Novel method to enhance sternal healing after harvesting bilateral internal thoracic arteries with use of basic fibroblast growth factor. Circ 102:III307–III311. CrossRefGoogle Scholar
  9. 9.
    Brocki BC, Thorup CB, Andreasen JJ (2010) Precautions related to midline sternotomy in cardiac surgery: a review of mechanical stress factors leading to sternal complications. Eur J Cardiovasc Nurs 9:77–84. CrossRefPubMedGoogle Scholar
  10. 10.
    Singh K, Anderson E, Harper JG (2011) Overview and management of sternal wound infection. Semin Plast Surg 25:25–33. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    El-Ansary D, Adams R, Waddington G (2009) Sternal instability during arm elevation observed as dynamic, multiplanar separation. Int J Ther Rehabil 16:609–614. CrossRefGoogle Scholar
  12. 12.
    Huertas RM, Luna-Bertos ED, Ramos-Torrecillas J, Leyva FM, Ruiz C, García-Martínez O (2014) Effect and clinical implications of the low-energy diode laser on bone cell proliferation. Biol Res Nurs 16:191–196. CrossRefPubMedGoogle Scholar
  13. 13.
    Stein A, Benayahu D, Maltz L, Oron U (2005) Low-level laser irradiation promotes proliferation and differentiation of human osteoblasts in vitro. Photomed Laser Surg 23:161–166. CrossRefGoogle Scholar
  14. 14.
    Renno ACM, McDonnell PA, Crovace MC, Zanotto ED, Laakso L (2010) Effect of 830 nm laser phototherapy on osteoblasts grown in vitro on Biosilicate® scaffolds. Photomed Laser Surg 28:131–133. CrossRefPubMedGoogle Scholar
  15. 15.
    Seifi M, Atri F, Yazdani MM (2014) Effects of low-level laser therapy on orthodontic tooth movement and root resorption after artificial socket preservation. Dent Res J 11:61–66Google Scholar
  16. 16.
    El-Ansary D, Waddington G, Adams R (2007) Trunk stabilisation exercises reduce sternal separation in chronic sternal instability after cardiac surgery: a randomized cross-over trial. Aust J Physiother 53:255–260. CrossRefPubMedGoogle Scholar
  17. 17.
    Fernandes GA, Lima ACG, Gonzaga ICA, Araújo RDB, Oliveira RAD, Nicolau RA (2016) Low-intensity laser (660 nm) on sternotomy healing in patients who underwent coronary artery bypass graft: a randomized, double-blind study. Lasers Med Sci 31:1907–1913. CrossRefPubMedGoogle Scholar
  18. 18.
    Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD (2011) 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 58:2584–2614. CrossRefGoogle Scholar
  19. 19.
    El-Ansary D, Adams R, Toms L, Elkins M (2000) Sternal instability following coronary artery bypass grafting. Physiother Theory Pract 16:27–33. CrossRefGoogle Scholar
  20. 20.
    El-Ansary D, Adams R, Waddington G (2007) Measurement of non-physiological movement in sternal instability by ultrasound. Ann Thorac Surg 83:1513–1516. CrossRefPubMedGoogle Scholar
  21. 21.
    El-Ansary D, Waddington G, Adams R (2007) Relationship between pain and upper limb movement in patients with chronic sternal instability following cardiac surgery. Physiother Theory Pract 23:273–280. CrossRefPubMedGoogle Scholar
  22. 22.
    Coulson SE, Adams RD, O’Dwyer NJ, Croxson ER (2006) Physiotherapy rehabilitation of the smile after long-term facial nerve palsy using video self-modeling and implementation intentions. Otolaryngol Head Neck Surg 134:48–55. CrossRefPubMedGoogle Scholar
  23. 23.
    Uymaz B, Sezer G, Coşkun PK, Tarcan O, Özleme S, Aybek T (2014) Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting. Anatol J Cardiol/Anadolu Kardiyol Derg 14:172–177. CrossRefGoogle Scholar
  24. 24.
    deMacedo RM, Faria-Neto JR, Costantini CO, Casali D, Muller AP, Costantini CR, de Carvalho KA, Guarita-Souza LC (2011) Phase I of cardiac rehabilitation: a new challenge for evidence based physiotherapy World J Cardiol 3:248–255.
  25. 25.
    Wilgus TA (2008) Immune cells in the healing skin wound: influential players at each stage of repair. Pharmacol Res 58:112–116. CrossRefPubMedGoogle Scholar
  26. 26.
    Tajali SB, MacDermid JC, Houghton P, Grewal R (2010) Effects of low power laser irradiation on bone healing in animals: a meta-analysis. J Orthop Surg Res 5(1).
  27. 27.
    Garavello-Freitas I, Baranauskas V, Joazeiro PP, Padovani CR, Dal Pai-Silva M, Cruz-Höfling MAD (2003) Low-power laser irradiation improves histomorphometrical parameters and bone matrix organization during tibia wound healing in rats. J Photochem Photobiol B Biol 70:81–89. CrossRefGoogle Scholar
  28. 28.
    Zati A, Valent A (2006) Laserterapia in medicina. In: Terapia fisica: nuove tecnologie in medicina riabilitativa. Minerva Med, pp 162–185Google Scholar
  29. 29.
    Monici M, Cialdai F, Fusi F, Romano G, Pratesi R (2008) Effects of pulsed Nd: YAG laser at molecular and cellular level. A study on the basis of Hilterapia®. In Proceeding of the international meeting on hilterapia, Venice, pp 26–33Google Scholar
  30. 30.
    Khoo NK, Babazadeh K, Lajevardi M, Dabaghian FH, Mostafavi E (2014) Application of low-level laser therapy following coronary artery bypass grafting (CABG) surgery. J Lasers Med Sci 5:86–91Google Scholar
  31. 31.
    Renno ACM, McDonnell PA, Parizotto NA, Laakso EL (2007) The effects of laser irradiation on osteoblast and osteosarcoma cell proliferation and differentiation in vitro. Photomed Laser Surg 25:275–280. CrossRefPubMedGoogle Scholar
  32. 32.
    Parenti SI, Panseri S, Gracco A, Sandri M, Tampieri A, Bonetti GA (2013) Effect of low-level laser irradiation on osteoblast-like cells cultured on porous hydroxyapatite scaffolds. Ann Ist Super Sanita 49:255–260. CrossRefGoogle Scholar
  33. 33.
    Liu X, Lyon R, Meier HT, Thometz J, Haworth ST (2007) Effect of lower-level laser therapy on rabbit tibial fracture. Photomed Laser Surg 25:487–494. CrossRefPubMedGoogle Scholar
  34. 34.
    Baptista IDC, Chavantes MC, Dallan LDO, Stolf NAG (2009) Laser de baixa intensidade: nova tecnologia para os enfermeiros na cicatrizaçao pós-esternotomia. Rev Soc Cardiol Estado São Paulo 19:3–8Google Scholar
  35. 35.
    Dixit S, Maiya A, Umakanth S, Borkar S (2013) Photobiomodulation of surgical wound dehiscence in a diabetic individual by low-level laser therapy following median sternotomy. Indian J Palliat Care 19:71–75. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Lima ACG, Fernandes GA, Gonzaga IC, de Barros Araújo R, de Oliveira RA, Nicolau RA (2016) Low-level laser and light-emitting diode therapy for pain control in hyperglycemic and normoglycemic patients who underwent coronary bypass surgery with internal mammary artery grafts: a randomized, double-blind study with follow-up. Photomed Laser Surg 34:244–251. Scholar
  37. 37.
    Lima ACG, Fernandes GA, de Barros Araújo R, Gonzaga IC, de Oliveira RA, Nicolau RA (2017) Photobiomodulation (laser and LED) on sternotomy healing in hyperglycemic and normoglycemic patients who underwent coronary bypass surgery with internal mammary artery grafts: a randomized, double-blind study with follow-up. Photomed Laser Surg 35:24–31. CrossRefPubMedGoogle Scholar
  38. 38.
    Snijders CJ, Bakker MP, Vleeming A, Stoeckart R, Stam HJ (1995) Oblique abdominal muscle activity in standing and in sitting on hard and soft seats. Clin Biomech 10:73–78. CrossRefGoogle Scholar
  39. 39.
    Snijders CJ, Ribbers MT, Bakker HVD, Stoeckart R, Stam HJ (1998) EMG recordings of abdominal and back muscles in various standing postures: validation of a biomechanical model on sacroiliac joint stability. J Electromyogr Kinesiol 8:205–214. CrossRefPubMedGoogle Scholar
  40. 40.
    Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J (2002) The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 27:399–405CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Zeinab Mohammed Helmy
    • 1
  • Sherin Hassan Mohammed Mehani
    • 2
    Email author
  • Basant Hamdy El-Refaey
    • 1
  • Eman Hassan Abd Al-Salam
    • 3
  • El-Sayed Essam El-Sayed Felaya
    • 1
  1. 1.Department of Physical Therapy for Internal Medicine, Faculty of Physical TherapyCairo UniversityGizaEgypt
  2. 2.Department of Physical Therapy for Internal Medicine, Faculty of Physical TherapyBeni-Suef UniversityBeni-Suef governorateEgypt
  3. 3.Department of Diagnostic ImagingNational Heart InstituteGizaEgypt

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