Skip to main content
SpringerLink
Log in

Association of photobiomodulation therapy (PBMT) and exercises programs in pain and functional capacity of patients with knee osteoarthritis (KOA): a systematic review of randomized trials

  • Review Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Knee osteoarthritis (KOA) is a common degenerative disease in which several treatments and treatment associations have been investigated. This review analyzed the efficacy of the association of photobiomodulation therapy (PBMT) and exercises for people with KOA in randomized controlled clinical trials. PubMed, Scopus, and EMBASE databases were searched using the following terms: “knee osteoarthritis,” “laser,” “low-level laser,” “photobiomodulation,” “phototherapy,” and “exercise.” Seven RCT studies involving humans that examined PBMT treatment in association with were found. Most studies used mainly near-infrared PBMT irradiation, with a fluence ranging from 610 mJ/cm2 to 200 J/cm2, 23.55 J to 2400 J total energy per knee, and number of treatment sessions from 10 to 24. In addition, all the protocols included exercises to increase lower limb muscle strength that were performed alone or in association with other types of exercises. However, only 2 studies, considered as a high quality, showed the additional effect of PBMT (lower doses) on an exercise program (involving warming-up, motor learning, balance coordination and strengthening exercises, and stretching) for improvement of pain and functional capacity in people with KOA. This review demonstrates that there is a controversy on the effects PBMT associated with exercises for pain and functional capacity improvement for people with KOA, because there is a heterogeneity between studies in related to PBMT parameters, as dose, number of therapy sessions and the type of PBMT (either LLLT and HILT), and the exercise protocols proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Martel-Pelletier J, Barr AJ, Cicuttini FM et al (2016) Osteoarthritis. Nat Rev Dis Prim 2:16072. https://doi.org/10.1038/nrdp.2016.72

    Article  PubMed  Google Scholar 

  2. Cross M, Smith E, Hoy D et al (2014) The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:1323–1330. https://doi.org/10.1136/annrheumdis-2013-204763

    Article  PubMed  Google Scholar 

  3. Le Pen C, Reygrobellet C, Gérentes I (2005) Financial cost of osteoarthritis in France. Jt Bone Spine 72:567–570. https://doi.org/10.1016/j.jbspin.2005.01.011

    Article  Google Scholar 

  4. Hunter DJ, Bierma-Zeinstra S (2019) Osteoarthritis. Lancet 393:1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9

    Article  PubMed  CAS  Google Scholar 

  5. Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196. https://doi.org/10.1016/S0140-6736(12)61729-2

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lawrence RC, Felson DT, Helmick CG et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 58:26–35. https://doi.org/10.1002/art.23176

    Article  PubMed  PubMed Central  Google Scholar 

  7. Glyn-Jones S, Palmer AJR, Agricola R et al (2015) Osteoarthritis. Lancet 386:376–387. https://doi.org/10.1016/S0140-6736(14)60802-3

    Article  PubMed  CAS  Google Scholar 

  8. Bannuru RR, Osani MC, Vaysbrot EE et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil 27:1578–1589. https://doi.org/10.1016/j.joca.2019.06.011

    Article  CAS  Google Scholar 

  9. Fernandes L, Hagen KB, Bijlsma JWJ et al (2013) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 72:1125–1135. https://doi.org/10.1136/annrheumdis-2012-202745

    Article  PubMed  Google Scholar 

  10. Rausch Osthoff A-K, Niedermann K, Braun J et al (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:1251–1260. https://doi.org/10.1136/annrheumdis-2018-213585

    Article  PubMed  Google Scholar 

  11. Garber CE, Blissmer B, Deschenes MR et al (2011) Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. Med Sci Sports Exerc 43:1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb

    Article  PubMed  Google Scholar 

  12. World Health Organization (2010) Global Recommendations on Physical Activity for Health. https://www.who.int/publications/i/item/9789241599979. Accessed 03 Nov 2020

  13. Americal College of Sports Medicine (2017) ACSM’s guidelines for exercise testing and prescription 10th Ed. 2017. Lippincott Williams & Wilkins

  14. Ferraresi C, Huang Y-Y, Hamblin MR (2016) Photobiomodulation in human muscle tissue: an advantage in sports performance? J Biophotonics 9:1273–1299. https://doi.org/10.1002/jbio.201600176

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Gendron DJ, Hamblin MR (2019) Applications of photobiomodulation therapy to musculoskeletal disorders and osteoarthritis with particular relevance to Canada. Photobiomodulation, Photomedicine, Laser Surg 37:408–420. https://doi.org/10.1089/photob.2018.4597

    Article  Google Scholar 

  16. Huang Z, Chen J, Ma J et al (2015) Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 23:1437–1444. https://doi.org/10.1016/j.joca.2015.04.005

    Article  CAS  Google Scholar 

  17. Rayegani SM, Raeissadat SA, Heidari S, Moradi-Joo M (2017) Safety and effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. J Lasers Med Sci 8:S12–S19. https://doi.org/10.15171/jlms.2017.s3

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hamblin MR (2018) Mechanisms and mitochondrial redox signaling in photobiomodulation. Photochem Photobiol 94:199–212. https://doi.org/10.1111/php.12864

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  22. Vassão PG, Silva BA, de Souza MC et al (2020) Level of pain, muscle strength and posture: effects of PBM on an exercise program in women with knee osteoarthritis – a randomized controlled trial. Lasers Med Sci. https://doi.org/10.1007/s10103-020-02989-1

  23. Vassão PG, de Souza MC, Silva BA et al (2019) Photobiomodulation via a cluster device associated with a physical exercise program in the level of pain and muscle strength in middle-aged and older women with knee osteoarthritis: a randomized placebo-controlled trial. Lasers Med Sci 35:139–148. https://doi.org/10.1007/s10103-019-02807-3

    Article  PubMed  Google Scholar 

  24. de Matos Brunelli Braghin R, Libardi EC, Junqueira C et al (2019) The effect of low-level laser therapy and physical exercise on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis: a blind randomized clinical trial. Disabil Rehabil 41:3165–3172. https://doi.org/10.1080/09638288.2018.1493160

    Article  PubMed  Google Scholar 

  25. Kheshie AR, Alayat MSM, Ali MME (2014) High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 29:1371–1376. https://doi.org/10.1007/s10103-014-1529-0

    Article  PubMed  Google Scholar 

  26. Alfredo PP, Bjordal JM, Dreyer SH et al (2012) Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehabil 26:523–533. https://doi.org/10.1177/0269215511425962

    Article  PubMed  Google Scholar 

  27. Nazari A, Moezy A, Nejati P, Mazaherinezhad A (2019) Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up. Lasers Med Sci 34:505–516. https://doi.org/10.1007/s10103-018-2624-4

    Article  PubMed  Google Scholar 

  28. de Paula Gomes CAF, Leal-Junior ECP, Dibai-Filho AV et al (2018) Incorporation of photobiomodulation therapy into a therapeutic exercise program for knee osteoarthritis: a placebo-controlled, randomized, clinical trial. Lasers Surg Med 50:819–828. https://doi.org/10.1002/lsm.22939

    Article  PubMed  Google Scholar 

  29. Dworkin RH, Turk DC, McDermott MP et al (2009) Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain 146:238–244. https://doi.org/10.1016/j.pain.2009.08.019

    Article  PubMed  Google Scholar 

  30. Terwee CB, Roorda LD, Knol DL et al (2009) Linking measurement error to minimal important change of patient-reported outcomes. J Clin Epidemiol 62:1062–1067. https://doi.org/10.1016/j.jclinepi.2008.10.011

    Article  PubMed  Google Scholar 

  31. Regnaux J-P, Lefevre-Colau M-M, Trinquart L et al (2015) High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010203.pub2

  32. Maldonado M, Nam J (2013) The role of changes in extracellular matrix of cartilage in the presence of inflammation on the pathology of osteoarthritis. Biomed Res Int 2013:284873. https://doi.org/10.1155/2013/284873

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Fu S, Thompson CL, Ali A et al (2019) Mechanical loading inhibits cartilage inflammatory signalling via an HDAC6 and IFT-dependent mechanism regulating primary cilia elongation. Osteoarthr Cartil 27:1064–1074. https://doi.org/10.1016/j.joca.2019.03.003

    Article  CAS  Google Scholar 

  34. Tsai S-R, Hamblin MR (2017) Biological effects and medical applications of infrared radiation. J Photochem Photobiol B Biol 170:197–207. https://doi.org/10.1016/j.jphotobiol.2017.04.014

    Article  CAS  Google Scholar 

  35. Fukuda VO, Fukuda TY, Guimarães M et al (2011) SHORT-term efficacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial. Rev Bras Ortop 46:526–533. https://doi.org/10.1016/S2255-4971(15)30407-9

    Article  PubMed  Google Scholar 

  36. Hamblin MR (2013) Can osteoarthritis be treated with light? Arthritis Res Ther 15:120. https://doi.org/10.1186/ar4354

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hamblin MR (2017) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys 4:337–361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. World Association of Laser Therapy (WALT) (2010) Dose table 780- 860nm for low level laser therapy

  39. World Association of Laser Therapy (WALT) (2010) Dose table 904nm for low level laser therapy

  40. Stausholm MB, Naterstad IF, Joensen J et al (2019) Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open 9:e031142. https://doi.org/10.1136/bmjopen-2019-031142

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo—2016/08503-0.

Author information

Authors and Affiliations

  1. Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil

    Patricia Gabielli Vassão, Julia Parisi, Ana Beatriz Balão & Ana Claudia Muniz Renno

  2. Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luís km 235 - SP-310, São Carlos, SP, 13565-905, Brazil

    Thaíse Fernanda Campos Penha & Mariana Arias Avila

Authors
  1. Patricia Gabielli Vassão
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Parisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thaíse Fernanda Campos Penha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Beatriz Balão
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Claudia Muniz Renno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mariana Arias Avila
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PGV, TFCP, and ABB—design of the study and data analysis of manuscript. PGV, JP, ACMR, and MAA—concept, writing, and preparation of manuscript.

Corresponding author

Correspondence to Patricia Gabielli Vassão.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vassão, P.G., Parisi, J., Penha, T.F.C. et al. Association of photobiomodulation therapy (PBMT) and exercises programs in pain and functional capacity of patients with knee osteoarthritis (KOA): a systematic review of randomized trials. Lasers Med Sci 36, 1341–1353 (2021). https://doi.org/10.1007/s10103-020-03223-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-020-03223-8

Keywords

Search

Navigation