“The effectiveness of high intensity laser therapy in the patients with lumbar disc herniation: A

protocol of randomized placebo-controlled trial”

Leonard M. Schrager
State University of New York Downstate School of Health Professions
 The background of this study highlighted that the initial treatment for lumbar disc
herniation is primarily involved with reducing pain, preventing disability and chronic pain, and
hastening the rehabilitation process to return to daily functioning. The first line of therapy is
often non-invasive and includes physical therapy with the addition of modalities such as laser
therapy, which has been shown to be effective in pain management. The current study involved
the use of high intensity laser therapy (HILT), which has its own photomechanical,
photothermal, and photo-chemical effects. Currently, there is limited research on the
effectiveness of HILT in lumbar radiculopathy patients. Therefore, this research article studies
the efficiency and safety of ultrasound and HILT in lumbar disc herniation patients with the
assumption that HILT is as effective as ultrasound therapy. This study was a protocol of
randomized placebo-controlled trial. Meaning that participants were randomly separated into a
control group and an intervention group (HILT group). This randomization was done by a
computer random number generator.
Furthermore, the intervention group received HILT treatment following twenty minutes
of hot pack therapy for two weeks, five days per week. Thus, the intervention group received a
total of ten HILT treatments. The laser settings were set to ten watts of power, twenty five hertz
for frequency, twelve joules per centimeter squared dosage, and the lumbar area covered was
greater than twenty five centimeters squared. This was applied for four minutes on the biological
stimulation setting and was done on the continuous setting for six minutes. For this, the dosage
was 120 J/cm^2 with seven watts of power. The control group received ultrasound treatment for
ten minutes with a power of 1.5 watt/cm in the lumbar area. Additionally, conductivity gel was
used in the ultrasound therapy for the control group in order to ensure the efficacy and absorption
of the treatment.
The inclusion criteria for this study were: that patients had to be diagnosed with lumbar
disc herniation with MRI, additionally, the patients did not have a history of trauma or congenital
conditions. Also, the patients had to have typical or normal psychological function in order to
understand and answer questions on an assessment scale. The exclusion criteria consisted of:
patients who had severe osteoporosis, lumbar injections within four weeks, pain due to
inflammation, recent trauma, surgery in the lumbar region, instability in the lumbar region,
neurological disorders, patients who had severe diseases, cardiovascular diseases, and patients
who had physical treatment within three months.
The methods of measurement consisted of a pain score on a visual analog scale. This
involved a ten centimeter line where zero represented no pain and ten indicated maximum pain.
Patients used this scale to show the degree of their low back pain and then a ruler was used to
measure the distance from zero to the point marked on the line. Additionally, the Roland
Disability Questionnaire was used for the measurement of functional level of patients performing
activities of daily living. This questionnaire asks patients to mark off each applicable statement
in a list of twenty four statements; it is scored from zero to twenty four. Additionally, a range of
motion goniometer was used for the measurement of spine range of motion. Ranges which were
measured were: extension, forward flexion, and lateral flexion.
The purpose of this study was to assess the safety and efficiency of high-intensity laser
therapy in lumbar disc herniation patients as compared to ultrasound therapy. The conclusions of
this study showed that HILT is as effective as ultrasound therapy in pain management for lumbar
disc herniation patients and that it is safe and efficient. This was determined with a 95%
confidence interval with P < 0.05.
A strength of this article includes the fact that this study tested, observed, and
documented high intensity laser therapy for lumbar disc herniation patients, of which the
literature is limited. Additionally, this article had a relatively large sample size of 100
participants. A possible weakness of this article is that the researchers assumed HILT is as
effective as ultrasound therapy.
Areas of future research could try to determine whether HILT is truly as effective as
ultrasound therapy for lumbar disc herniation patients. Now that the current study has proved
that it is safe and efficient, maybe there is a discrepancy in how effective it really is in pain
management. Or perhaps high intensity laser therapy is more effective than ultrasound? A new
study would have to be conducted to answer this question.
 References

Huang Y, Gao D. The effectiveness of high intensity laser therapy in the patients with lumbar
disc herniation: A protocol of randomized placebo-controlled trial. Medicine (Baltimore). 2020
Oct 9;99(41):e22520. doi: 10.1097/MD.0000000000022520. PMID: 33031293; PMCID:
PMC7544293.