Effects of low-level laser therapy and functional exercises in the treatment of chronic ankle sprain: A randomized controlled trial
Abstract
Objective: Chronic ankle sprains can be described as a failure of the lateral ankle joint complex following an acute or recurrent ankle injury. It is estimated that 80% to 85% of ankle sprains and lateral ankle complex failures can be successfully treated with a functional ankle rehabilitation program. However, most previous functional training has focused on enhancing local ankle function, with less attention paid to the damaged tissue cells and to the systematic consideration of the human lower limb kinetic chain. The more comprehensive approach to combined therapy requires further research. The purpose of this study is to investigate whether low-level laser therapy (LLLT) combined with functional exercise, is more effective than functional exercise alone in treating chronic ankle sprain. At the same time, to observe the dose-response relationship of LLLT in the treatment of chronic ankle sprains. Methods: Thirty-three patients with chronic ankle sprains were randomly divided into three groups: exercise alone, low-dose laser plus exercise, and high-dose laser plus exercise, with eleven patients in each group. Two “laser groups” received laser irradiation at an intensity of 398 mW/cm2 and 796 mW/cm2 (doses of 119 J/cm2 and 239 J/cm2), respectively, which were applied to two acupoints of Ki 3 (Taixi) and Bl 60 (Kunlun), and two pain points of the ankle. The functional exercise program consisted of ankle resistance exercises, resistance kinematic chain exercises, heel raise exercises, and BOSU ball exercises. All patients received five treatments per week for four weeks. At the end of this treatment and at baseline, observing the changes in ankle pain, range of motion (ROM), muscle strength, and balance postural control, and evaluating the curative effects. Results: After the 4-week intervention, all groups showed significant improvement in outcomes (P < 0.05). The high-dose laser irradiation combined with functional exercise resulted in more significant improvements in the primary outcomes than the other two regimens (P < 0.05). However, there were no significant differences (P > 0.05) between the low-dose laser irradiation combined with functional exercise and functional exercise alone. Conclusion: 1) Systematic functional exercise can significantly reduce the pain of patients with chronic ankle sprains, meanwhile improves the ROM, muscle strength, and balance control of the ankle joint. 2) LLLT enhances the efficacy of functional exercise in the treatment of chronic ankle sprains. 3) The therapeutic effect of LLLT on chronic ankle sprains is related to the irradiation intensity, and the effects of 796 mW/cm2 irradiation being more effective than 398 mW/cm2 irradiation.
References
1. Tang H, Mao M, Fong DTP, et al. Effects of Tai Chi on the neuromuscular function of the patients with functional ankle instability: a study protocol for a randomized controlled trial. Trials. 2022;23(1):107.
2. Thomas BS, Laura A, Debbie P, et al. Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol. BMC Musculoskeletal Disorders, 2021, (No.1): 1-11.
3. Wikstrom EA, Mckeon PO. Predicting manual therapy treatment success in patients with chronic ankle instability: Improving self-reported function. Journal of Athletic Training (Allen Press), 2017, (No.4): 325-31.
4. Jingyuan Li. 164 cases of clinical observation techni gues combined with acupuneture and Chiness medicine topical treatment of old ankle sprain. Journal of Basic Chinese Medicine, 2013, (No.4): 480.
5. Haiquan Liu. Clinical observation on 72 cases of chronic ankle sprains treated by manipulation with traditional Chinese herbal fumigation]. Journal of New Chinese Medicine, 2009, (No.12): 62-3.
6. Wang B, Zhang X, Zhu F, et al. A randomized controlled trial comparing rehabilitation with isokinetic exercises and Thera-Band strength training in patients with functional ankle instability. PloS one, 2022, (No.12): e0278284.
7. Alahmari KA, Kakaraparthi VN, Reddy RS, et al. Combined Effects of Strengthening and Proprioceptive Training on Stability, Balance, and Proprioception Among Subjects with Chronic Ankle Instability in Different Age Groups: Evaluation of Clinical Outcome Measures. Indian Journal of Orthopaedics, 2020, (Suppl 1): 199-208.
8. Flanagan SP, Song JE, Wang MY, et al. Biomechanics of the heel-raise exercise. Journal of aging and physical activity, 2005 Apr;13(2):160-71.
9. Cruz-Diaz D, Lomas-Vega R, Osuna-Prez MC, et al. Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial. International journal of sports medicine, 2015, (No.9): 754-60.
10. Hall EA, Kingma JJ, Docherty CL, et al. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures. Journal of Athletic Training (Allen Press), 2018, (No.6): 568-77.
11. Mckeon PO, Ingersoll CD, Kerrigan DC, et al. Balance training improves function and postural control in those with chronic ankle instability. Medicine and science in sports and exercise, 2008, (No.10): 1810-9.
12. Tang F, Yin S, Gao P, Chen L. The effect of joint mobilization of Maitland on chronic ankle instability: A randomized trial. Medicine (Baltimore). 2024;103(32):e39100.
13. Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. Journal of Athletic Training (Allen Press), 2019, (No.6): 572-88.
14. Theisen A, Day J. Chronic Ankle Instability Leads to Lower Extremity Kinematic Changes During Landing Tasks: A Systematic Review. International journal of exercise science, 2019, (No.1): 24-33.
15. Pallotta RC, Bjordal JM, Frigo L, et al. Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation (Article). Lasers in Medical Science, 2012, (No.1): 71-8.
16. Mesquita-Ferrari RA, Fernandes KPS, Deana AM, et al. Effects of low-level laser therapy on skeletal muscle repair: A systematic review. American Journal of Physical Medicine and Rehabilitation, 2014, (No.12): 1073-85.
17. Zou Q, Zhang S, Jiang C, Xiao S, Wang Y, Wen B. Low-level laser therapy on soft tissue healing after implantation: a randomized controlled trial. BMC Oral Health. 2024;24(1):1477.
18. Graeme Ewan Glass. Photobiomodulation: The Clinical Applications of Low-Level Light Therapy. Aesthetic surgery journal, 2021, (No.6): 723-38.
19. Ramezani F, Neshasteh-Riz A, Ghadaksaz A, Fazeli SM, Janzadeh A, Hamblin MR. Mechanistic aspects of photobiomodulation therapy in the nervous system. Lasers Med Sci. 2022;37(1):11-18.
20. Uta D, Ishibashi N, Tao S, Sawahata M, Kume T. Photobiomodulation inhibits neuronal firing in the superficial but not deep layer of a rat spinal dorsal horn. Biochem Biophys Res Commun. 2024;710:149873.
21. Yuqing Wang, Wenxin Song, Fengyun Liu, Junfeng Liao. Amelioration of semi-conductor laser on the pain symptom in patients with ankle joint sprain. Laser Journal, 2008, (No.6): 85-6.
22. Izukura H, Miyagi M, Harada T, et al. Low Level Laser Therapy in patients with chronic foot and ankle joint pain. LASER THERAPY, 2017, (No.1): 19-24.
23. Xiaohua Yan. Effects of low-intensity laser in the treatment of acute ankle sprains; South China Normal University, 2011.
24. Jeon K-K, Kim T-Y, Lee S-H. The effects of a strategic strength resistance exercise program on the isokinetic muscular function of the ankle. Journal of Physical Therapy Science, 2015, (No.10): 3295-7.
25. Schaefer JL, Sandrey MA. Effects of a 4-week dynamic-balance-training program supplemented with graston instrument-assisted soft-tissue mobilization for chronic ankle instability. Journal of Sport Rehabilitation, 2012, (No.4): 313-26.
26. Hall EA, Docherty CL, Simon J, et al. Strength-Training Protocols to Improve Deficits in Participants With Chronic Ankle Instability: A Randomized Controlled Trial. Journal of athletic training, 2015, (No.1): 36-44.
27. Mohamadi S, Rahmani N, Ebrahimi I, Salavati M, Dadgoo M. The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls. Arch Bone Jt Surg. 2023;11(3):206-211.
28. Lazaros L, Nikolaos K, Georgios P, Eleftherios K. Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain. Journal of Back & Musculoskeletal Rehabilitation, 2018, (No.3): 437-46.
29. Yekdaneh A, Mutlu ÇY. Effects of Balance and Strength Training for Ankle Proprioception in People with Chronic Ankle Instability: A Randomized Controlled Study. J Am Podiatr Med Assoc. 2024;114(3):23-008.
30. Benca E, Ziai P, Hirtler L, et al. Biomechanical evaluation of different ankle orthoses in a simulated lateral ankle sprain in two different modes. Scandinavian Journal of Medicine & Science in Sports, 2019, (No.8): 1174-80.
31. Hertel J. Functional Anatomy, Pathomechanics,and Pathophysiology of Lateral Ankle Instability. Journal of athletic training, 2002, (No.4): 364-75.
32. Tang F, Xiang M, Yin S, Li X, Gao P. Meta-analysis of the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability. BMC Musculoskelet Disord. 2024;25(1):689.
33. Asagai Y, Imakiire A, Ohshiro T. Thermographic study of low level laser therapy for acute-phase injury. LASER THERAPY, 2000, (No.1): 31-3.
34. Dong Z, Zhu J, Lu D, et al. Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats. American Journal of Therapeutics, 2018, (No.3): e314-e9.
35. Stergioulas A. Low-level laser treatment can reduce edema in second degree ankle sprains. Journal of clinical laser medicine & surgery, 2004, (No.2): 125-8.
36. Babuccu C, Keklikoğlu N, Baydoğan M, Kaynar A. Cumulative effect of low-level laser therapy and low-intensity pulsed ultrasound on bone repair in rats. International journal of oral and maxillofacial surgery, 2014, (No.6): 769-76.
Copyright (c) 2024 Yuanzheng Chen, Yicai Fan, Quan Zhou, Haonan Qian
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright on all articles published in this journal is retained by the author(s), while the author(s) grant the publisher as the original publisher to publish the article.
Articles published in this journal are licensed under a Creative Commons Attribution 4.0 International, which means they can be shared, adapted and distributed provided that the original published version is cited.
Submit a Paper
