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laser therapy. Journal of Health Sciences 2022;12(2):98-109
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laser therapy. Journal of Health Sciences 2022;12(2):98-109
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REVIEW ARTICLE Open Access
Comparison between capacitive and resistive electronic
transfer therapy and high-intensity laser therapy in pain
conditions related to musculoskeletal disorders
Žarko Mitrić1*, Maja Vučković2, Amra Mačak Hadžiomerović3, Miloš Lalović4
1Outpatient Clinic for Physical Medicine and Rehabilitation “Mitrić” Loznica, Serbia, 2Department of Physical Medicine, Institute for Physical
Medicine and Rehabilitation “Dr. Miroslav Zotovic,” Banja Luka, Bosnia and Herzegovina, 3Department of Physiotherapy, Faculty of Health
Studies, University of Sarajevo, Bosnia and Herzegovina, 4Medical School, University of Belgrade, Serbia
ABSTRACT
Introduction: Musculoskeletal disorders (MSDs) imply damage to muscular or skeletal systems, which usually develop
due to strenuous, repetitive activity, or an inflammation process. The therapy with capacitive and resistive electronic
transfer (CRet) and high-intensity laser therapy (HILT) have mainly been applied for pain relief in these conditions. This
paper aims to provide an overview of the efficient results of CRet therapy and HILT in managing pain associated with
musculoskeletal disorders found in the available literature.
Methods: Articles related to musculoskeletal disorders were searched through electronic databases, such as PubMed,
Web of Knowledge, Lilacs, Cochrane, Research Gate, and available website search tools. After excluding records that are
not clinical trials and studies (such as review articles, patient information, and Ph.D. papers) and articles which did not
deal with pain in musculoskeletal disorders, 61 articles met our criteria and were included in the overview.
Results: By reviewing the selected articles related to CRet therapy and HILT effects on pain in musculoskeletal disorders,
it was found that both therapies have a favorable effect on pain reduction.
Conclusion: The selected papers showed that both therapies are powerful tools for pain reduction. Although there are
no specific protocols, including the number and frequency of therapies applied and other parameters, in both therapy
modalities, pain alleviation occurs during or immediately after a therapy cycle application.
Keywords: Capacitive and resistive electronic transfer; TECAR; musculoskeletal disorders; pain; analgesic effects,
high-intensity laser therapy; physical therapy; quality of life
INTRODUCTION
Musculoskeletal disorders (MSDs) imply damage to muscular
or skeletal systems, which usually develop due to strenuous,
repetitive activity, or an inammation process. Musculoskeletal
disorders may aect parts of the human body such as bones,
muscles, joints, cartilages, ligaments, tendons, and other soft
tissues. Symptoms include mild-to-severe aches, numbness,
tingling, atrophy, swelling, redness, and weakness (1).
Considering their various manifestations, from fractures to
irreparable and degenerative chronic diseases, musculoskel-
etal conditions may develop at any age, and many risk fac-
tors vary from those related to everyday activities to those
related to the natural processes of an organism (2).
Musculoskeletal disorders are treated under various med-
ical specialties, including orthopedics, sports medicine,
*Corresponding author: Žarko Mitrić, Bulevar Dositeja Obradovića 6, 15300
Loznica, Serbia. Phone: +381 69 3169595.
E-mail: zarkomitric@gmail.com
Submitted: 12. March 2022/Accepted: 14. Jun 2022
DOI: https://doi.org/10.17532/jhsci.2022.1744
emergency medicine, and rheumatology (1). Some condi-
tions require the administration of medications, but wher-
ever possible, physical treatment should be administered,
given its proven benets and the fact that it commonly
stimulates natural human processes in the body. Whether
in hospital settings or in some specialized rehabilitation
center, nowadays, various physical rehabilitation modalities
are widely used to reduce pain, improve mobility and ex-
ibility, and improve our performance in activities of daily
living (ADL) and hence the quality of life (3). Among these,
there are capacitive and resistive electronic transfer (CRet)
therapy and high-intensity laser therapy (HILT), which
are rather dierent by their nature, but similar in eec-
tiveness (4,5). Compared to many other treatment devices
used in the eld of physical medicine, these two modalities
are not suciently exploited given their immediate eects
and the fact that there are almost no side eects. Based on
our practical experience, where we have been using numer-
ous equipment and settings, other than CRet and HILT,
these two gained our attention for their eectiveness on
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© 2022 Mitrić,
et al
.; licensee University of Sarajevo - Faculty of Health Studies. This is an Open Access article
distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/
by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.
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pain, particularly, and we wanted these two to nd more
signicant applications.
CRet therapy – background and eect mechanism
e capacitive and resistive electronic transfer (also known
as TECAR – the acronym for the French name of this treat-
ment – Transfert Electrique Capacitif Résistif) therapy,
being a type of endogenous thermal treatment, has been
used for heating both the surface and deep tissues, resulting
in tissue reconstruction and pain relief. It was developed
by Jacques Arsene d’Arsonval, a well-known French phy-
sician, and his associate researchers and physicians in the
1920s (4). Since then, this non-invasive physical modality
has further developed and advanced, nding its application
in treating various musculoskeletal conditions (4).
CRet therapy is rated to be a special form of energy. With
non-invasive high-frequency energy, it stimulates the body’s
natural ability to regenerate itself. Natural physiological and
metabolic tissue processes are stimulated by transferring
energy without radiation coming from outside. A device
used for the administration of CRet therapy includes two
electrodes: A movable electrode managed by a therapist,
treating the aected area and a xed electrode used as a
conductor being in contact with the skin of a patient (6).
is device may be used at low-energy levels, which is one
of its major properties. In this way, it is possible to treat
either acute or subacute conditions without worsening an
inammatory process developed due to the increased tissue
temperature (7). CRet therapy has two manners for trans-
ferring electrical charge: Capacitive and resistive. Reactions
produced by the capacitive system through capacitive
electrode are focused on tissues having more electrolytes,
such as soft tissues and muscles, unlike the resistive system,
which focuses on greater and more resistant tissues such as
tendons, bones, and joints. ese two ways of transferring
energy enable the therapy to intensify vasodilation and oxy-
genation, improving microcirculation and causing a rise
in internal temperature (8). With electrical currents in the
frequency range between 0.45 and 0.60 MHz (9), CRet
therapy oers a unique spectrum of treatments for chronic
and acute musculoskeletal diseases, with only a few contra-
indications: Pacemaker, pregnancy, and sensitivity to high
temperatures (10).
High-intensity laser therapy – background and eect
mechanism
Light has always been considered a source of life, so it has
motivated scientists to study it in various ways. Its thera-
peutic properties have been analyzed since the 6thcentury
B.C., and nally, in 1960, the rst laser was developed (10).
Now, it is successfully applied worldwide depending on
approved protocols and experience.
Laser is an acronym for light amplication by stimulated
emission of radiation (11). As indicated by the name itself,
it is a form of radiation originating from solid, liquid, or
gaseous material. e emission occurs after the material is
stimulated by the activation source, and the system of mir-
rors embedded in the optical resonator amplies the laser
light’s electromagnetic waves. ree parameters are consid-
ered when dening the physical characteristics of a laser:
e wavelength, intensity, and emission mode. e wave-
length ranges between 180 and 10,600nm, and laser pen-
etration power depends on it – the greater wavelength, the
greater penetration. e depth of penetration is regulated
by the intensity of the laser. By increasing the laser power,
the penetration depth is also increased. e emission mode
is a way in which the laser is distributed. erefore, it may
be continuous, pulsed, ash, or Q-switched (brief emis-
sions at high peak intensity). With dierent pulsations and
frequencies, we get other eects on the substrate – as fre-
quency decreases, there is more signicant interaction with
the conduction structures and vice-versa (12).
High-intensity laser therapy (HILT), with a power higher
than 500 mW, has been recently introduced in the treatment
of musculoskeletal system disorders. It is a laser mode with
a 1064nm wavelength with an analgesic eect and reactive
vasodilatation as the primary eect, and these are created
by aecting the cutaneous nerve endings (13). Another sig-
nicant mechanism of action is based on tissue stimulation
which develops at various levels: Cell, vascular tissue, inter-
stitial tissue, and immune system level. It enhances regen-
eration and beta-endorphin release by inducing protein
synthesis in synovial uid, exhibiting analgesic and anti-in-
ammatory eects (14). HILT provides a quick reduction
of inammation and painful symptoms (15). Aparticular
waveform, including regular peaks of elevated values of
amplitude and time distances between them, is used to
decrease phenomena of thermal accumulation, and it can
rapidly induce photochemical and photothermic eects in
the deep tissue that increases cell metabolism, vascular per-
meability, and blood ow (16).
METHODS
Further to proven benets and good tolerance to these
two therapy modalities, we were interested in investigating
papers dealing with these within the scope of musculoskel-
etal conditions. Based on available resources and records,
we prepared this results overview of recent clinical articles
published between 2009 and 2021 that include eects of
CRet therapy and HILT in musculoskeletal disorders where
the pain is a dominant symptom.
e papers related to CRet and HILT were searched
through electronic databases, including PubMed, Web of
Knowledge, Lilacs, Cochrane, Research Gate, and available
website search tools. For better sensitivity of the articles,
we used the following keywords related to intervention:
Capacitive and resistive electronic transfer, TECAR therapy,
pulsed radiofrequency therapy, high-intensity laser therapy,
and high-power laser therapy. Within accessible papers,
101 records were identied and screened, either written in
English or another language. After excluding records that
were not clinical trials and studies (such as review articles,
patient information, and Ph.D. papers) and articles which
did not deal with pain in musculoskeletal disorders (in total
n = 40), 61 articles met our criteria. ey were included in
the overview (Table1). ese were further grouped as per
the regions treated for pain with HILT and CRet. ere
was no disagreement between reviewers regarding the selec-
tion of the studies.
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TABLE 1. Overview of the selected studies and results
Citation Author, title, reference number Aim Result
1Stagi P, Paoloni M, Ioppolo F, Palmerini V,
Santilli V. Studio clinico randomizzato in
doppio cieco tecarterapia versus placebo
nel trattamento della lombalgia. (23)
To evaluate the efcacy of TECAR
therapy in chronic low back pain.
There was improvement in the pain symptoms in most
patients treated with TECAR therapy, while the treatment in
the placebo group showed little or no improvement.
2 Paolucci T, Pezzi L, Centra MA, Porreca
A, Barbato C, Bellomo RG, Saggini
R. Effects of capacitive and resistive
electric transfer therapy in patients with
painful shoulder impingement syndrome
– A comparative study. (24)
To determine the effects of CRet on
painful shoulder.
VAS scores in the CRet group improved from 7.23±1.11
at baseline to 2.68±0.99 at follow-up. The placebo group
did not report any improvement. Similarly, functional scale
scores improved in the CRet group compared with the
placebo group.
3 Alguacil-Diego I M, Fernández-
Carnero J, Laguarta-Val S, Cano-de-
la-Cuerda R, Calvo-Lobo C, Martínez-
Piédrola R, et al. Analgesic effects
of a capacitive-resistive monopolar
radiofrequency in patients with
myofascial chronic neck pain – A pilot
randomized controlled trial. (25)
To investigate the immediate effect
of capacitive resistive monopolar
radiofrequency, in comparison with
a placebo, on (1) neck pain intensity
reduction at myofascial trigger points
(MTrP), (2) reducing neck disability, and
(3) improving cervical range of motion
(CROM).
The Wilcoxon test done for VAS indicates statistically
signicant differences between baselines, just following the
rst session and after eight sessions. NDI improved in both
groups after eight sessions, but no differences were found
between groups.
4 Adua G. Ecàcia de la tecar teràpia en
el tractament de les tennis elbow. (26)
To demonstrate the efciency of the
TECAR therapy within the scope of the
Tennis elbow’s treatment in comparison
with the blast waves (shock wave).
TECAR therapy may be used in the treatment of this
condition. TECAR therapy benets may be improved with
combination with other therapies. The results of this study
may be helpful in investigation of efciency of TECAR
therapy in some other conditions.
5Kazalakova K. Efcacy Evaluation of
Targeted Radio frequency Therapy in
Trigger Points and Functional Muscle
Spasms Treatment. (27)
To evaluate the effect of the targeted
radiofrequency therapy (TR therapy) at
500 kHz for treatment of pain caused
by trigger points and functional muscle
spasms compared to the methods of the
conventional physiotherapy.
The average decrease of the pain perception in the
treatment group was 77% and 63% in the control group.
The enhancement of the abilities to perform ADL both in the
treatment group and in the control group was on average
41% and 21%, respectively. Student’s t-test showed a
signicant difference between the post-treatment results in
both groups. There was a statistical difference between the
results from VAS for pain perception of both groups.
6 Tranquilli C, Ganzit G P, Ciufetti A,
Bergamo P, Combi F. Multicenter
study on TECAR therapy in sports
pathologies. (28)
To evaluate pain reduction with VAS and
to reduce motor recovery time.
The results of this study showed signicance both in acute
and chronic injuries with a quick and immediate reduction
of the pain and reduced recovery times, determined by a
prompt return to activity. VAS values were lower both in
chronic and acute cases.
7Kazalakova K. Efcacy evaluation of TR
therapy in the treatment of acute and
chronic disorders in sports. (29)
To demonstrate the efciency of applying
a new non-invasive radiofrequency
(R.F.) device in the treatment of acute
and chronic musculoskeletal disorders.
The nal results showed that there was considerable
improvement in both, articular and muscular and tendinous
disorders with a fast pain relief, measured with VAS. No
adverse cases were noted during the course of the study.
8 Ganzit GP, Stefanini L, Stesina G. Tecar
Therapy in the Treatment of Acute and
Chronic Pathologies in Sports. (10)
To demonstrate efciency of TECAR
therapy in the treatment of acute and
chronic musculoarticular pathology in
athletes.
Most patients reported pain relief and functional improvement
at the end of the treatment. The categories of the modied
Steinbrocker index and VAS were statistically signicant. There
were statistically signicant changes, both in in acute and
chronic cases, and in the three pathology groups observed.
The results indicate that TECAR therapy is a useful tool in
treating locomotor pathologies in sports.
9 Mondardini P, Tanzi R, Verardi L,
Briglia S, Maione A, Drago E. Novel
methods for the treatment of muscle
trauma in athletes. (30)
To present the results of a 2-year study
protocol aimed to verify the efcacy of
TECAR therapy in muscle lesions of
various grades in athletes.
The results were extremely good regarding speed of
resolution of the clinical-symptomatological and ultrasound
situation. Further, the study conrmed theoretical safety of
TECAR therapy given there were no side effects detected.
10 Aftosmidis D, Zakalka I, Spanidou K,
Kagioglou K. The effect of Human
TECAR Synergistic Healthcare
methodology to reduce pain and edema
after the grade II ankle’s sprain. (31)
To evaluate the effectiveness of
human TECAR synergistic healthcare
methodology in rehabilitation of a Grade
II ankle sprain in short time.
After ve treatments, on the 6th day following the injury, the
pain reduced from 7 to 2 at VAS and the mass previously
present on the foot, withdrew with an average reduction of
the edema at 3 cc.
11 Gonkova M, Hasan S. Effect of targeted
radio frequency therapy in combination with
post-isometric relaxation in the treatment of
pain syndrome in cervical region. (32)
To evaluate the combined effect of TR
therapy and post-isometric relaxation
(PIR) in the treatment of pain related to the
cervical spine with mobility limiting factor.
The study shows that there is a statistical difference
between the results obtained in the treatment group
and control group, in terms of levels of improvements in
condition.
12 Molina A, Eschacho B, Molina M V,
Mariscal S. Cervicalgia, lumbago,
sciatica: Application of capacitive energy
transfer system. (7)
To substantiate the efcacy of capacitive
transfer TECAR® therapy in patients
with cervical and lumbar pain, with cases
of pathology being secondary to surgical
treatment.
The clinical evaluation of the obtained data provided
conclusion that a signicant improvement was achieved in
65% of the patients treated with capacitive energy transfer.
(Contd...)
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TABLE 1. (Continued)
Citation Author, title, reference number Aim Result
13 Raffaeta G, Menconi A, Togo R.
Experimental study: Therapeutic
application of TECAR therapy in cervical
pain syndromes. (33)
To evaluate the therapeutic efcacy
of TECAR therapy “by patients,” with
chronic cervical pain syndromes,
recruited on an ongoing basis.
The value NRS decreased from 6.63 to 2.70, up to 2.55
at follow-up to 2 months. The analysis of the results of the
neck pain questionnaire (NPQ) showed that there was
a signicant decrease in the NPQ score from 37.95%
to 16.67% at the end of treatment and after 2 months at
follow-up, it was 12.54%.
14 Vicent Pastor E, Inglés Pernía F.
Effectiveness of therapeutic
hyperthermia by capacitive-resistive
electric transfer for degenerative neck
pain. (34)
To evaluate the effectiveness of
non-invasive hypothermia system by
radiofrequency based on capacitive-
resistive electric transfer in the treatment
of degenerative cervical pain compared
to phonophoresis. The second objective
was to evaluate the patients’ tolerance to
the treatment.
With its faster analgesic effect, the INDIBA’s method of
hyperthermia by capacitive-resistive electric transfer (CRET)
has proved to be an effective and safe method for treating
degenerative neck pain in comparison to commonly applied
ultrasound.
15 Saggini R, De Antoni A, Cancelli F,
Cacchio A, Di Mascio R, Di Nicola M,
et al. Hyperthermia to treat low back
pain and gonarthrosis. (35)
To present the results obtained with
the treatment of low back pain due to
slipped disk and moderate gonarthrosis.
The statistical analyses of the results showed that there is a
signicant pain reduction and reduced intake of NSAID after the
treatment in the case of both disorders. There was an optional
stabilization of VAS results in the group of patients suffering from
gonarthrosis, also at follow-ups 6 and 12 months after treatment.
However, in the case of low back pain, the instances in which
pain returns after 6 and 12 months are statistically signicant.
16 Andrade J, Carvalho P, Crasto C,
Cardoso R, Montes A. Effects of TECAR
Therapy on Delayed Sensation of
Muscle Discomfort in Quadriceps. (36)
To evaluate the effects of TECAR
therapy in delayed onset muscle
soreness on quadriceps.
It was noted that there was signicantly less pain in the
TECAR group than in the group without TECAR, at moment
M24 later. There was difference in the single leg hop and
pressure pain threshold variable.
17 Gi-Wook Kim, Yu Hui Won, Sung-Hee
Park, Jeong-Hwan Seo, Dae-Hyun
Kim, Hyung Nam Lee, et al. Effects of
a Newly Developed Therapeutic Deep
Heating Device Using High Frequency
in Patients with Shoulder Pain and
Disability: A Pilot Study. (37)
To evaluate and compare the
effectiveness of this deep heating
device with ultrasound in pain relief
and enhancing function in patients with
shoulder issues.
All patients presented signicant improvements regarding
shoulder pain and shoulder function when comparing the
results before the treatment and the results immediately
after treatment and 4 weeks following the treatment.
18 Morelli L, Bramani S C, Cantaluppi M,
Pauletto M, Scuotto A. Comparison
among different therapeutic techniques
to treat low back pain: A monitored
randomized study. (38)
To compare two therapeutic methods
for treating this chronic disease:
The oxygen-ozone therapy and the
diathermy through TECAR® therapy.
The results show an improvement in both groups, but in
the second group (treated with oxygen-ozone therapy plus
physio-kinesiotherapy), the improvement is better (from 6%
to 57%) than in the rst group (from 20% to 38%).
19 Terranova A, Vermiglio G, Arena S,
Ciccio A, Di Dio S, Vermiglio M. TECAR
therapy in the post-surgical treatment of
femur fractures. (39)
To evaluate the results of the pain and
edema treatment with TECAR therapy
in patients suffering from fracture of
the femur and treated surgically with
osteosynthesis, endo, or arthroplasty.
In the group treated with TECAR therapy, there was statistically
signicant reduction on the 4th day and on the 7th day. There
was no signicant pain reduction in in the control group.
Regarding edema, the values decreased in a statistically
insignicant way in both groups until reaching a similar value on
the 30th day. The decrease in volume developed earlier in the
TECAR group than in the control group.
20 Shanthanna H, Chan P, McChesney J,
Thabane L, Paul J. Pulsed
radiofrequency treatment of the
lumbar dorsal root ganglion in patients
with chronic lumbar radicular pain: A
randomized, placebo-controlled pilot
study. (40)
To determine feasibility of a larger trial
(primary objective) and investigate the
efcacy of PRF in pain reduction.
It was practically not feasible to conduct a large-scale trial
to establish efcacy considering that the effect was minor.
It is necessary to recruit a challengingly large number
of participants over a number of years. Considering the
recent evidence, until clearer parameters for the application
of PRF are set, physical practitioners will have to use
their personal experience judgment regarding its clinical
applicability.
21 Notarnicola A, Maccagnano G,
Gallone M F, Covelli I, Tafuri S, Moretti B.
Short-term efcacy of capacitive-resistive
diathermy therapy in patients with low
back pain: A prospective randomized
controlled trial. (41)
To compare the effectiveness of Doctor
TECAR TherapyTM with the laser
therapy in the management of low back
pain (LBP).
The pain and disability tended to improve over time in these
two groups. This improvement was statistically signicant
in the TECAR group at all follow-ups (F.U.s) but only at
T1 in the laser group. When these two treatments were
compared, there was a signicant difference in favor of the
TECAR group at T2 and T3.
22 Osti R, Pari C, Salvatori G, Massari L.
Tri-length laser therapy associated to
TECAR therapy in the treatment of low
back pain in adults: a preliminary report
of a prospective case series. (9)
The aim of this study was to evaluate the
efcacy of HILT associated with TECAR
therapy in the treatment of low back
pain, with or without leg pain.
The results of this study clearly evidence the efcacy of the
combination of CRet and laser therapy in the treatment of
low-back pain. The VAS score decreased from an average
value 8.1 before the treatment to an average value of 2.6 at
the 8-week follow-up with a statistically signicant difference
(p < 0.01).
(Contd...)
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TABLE 1. (Continued)
Citation Author, title, reference number Aim Result
23 Santamato A, Solfrizzi V, Panza F,
Tondi G, Frisardi V, Leggin G. B, et al.
Short-term Effects of High-Intensity
Laser Therapy Versus Ultrasound
Therapy in the Treatment of People With
Subacromial Impingement Syndrome: A
Randomized Clinical Trial. (42)
To evaluate the short-term effectiveness
of high-intensity laser therapy (HILT)
versus ultrasound (U.S.) therapy in the
treatment of subacromial impingement
syndrome (SAIS).
Statistically signicant differences in pain level, articular
movement, functionality, and muscle strength were
observed after 10 treatment sessions for subjects in the
HILT group compared to subjects in the U.S. therapy group.
Only the difference in change of VAS score between groups
(1.65 points) surpassed the accepted minimal clinically
important difference for this tool.
24 Štiglić-Rogoznica N, Stamenković D,
Frlan-Vrgoč Lj, Avancini-
Dobrović V,Schnurrer-Luke Vrbanić T.
Analgesic Effect of High-Intensity Laser
Therapy in Knee Osteoarthritis. (43)
To investigate the prompt analgesic
effect of HILT on patients with knee
osteoarthritis.
There was statistically signicant decrease in VAS after
the treatment (p < 0.001). HILT enables prompt analgesic
effects in the treatment of knee osteoarthritis.
25 Fiore P, Panza F, Cassatella G,
Russo A, Frisardi V, Solfrizzi V, et al.
Short-term effects of high-intensity
laser therapy versus ultrasound therapy
in the treatment of low back pain: A
randomized controlled trial. (44)
To evaluate the short-term effectiveness
of high-intensity laser therapy (HILT)
versus ultrasound (U.S.) therapy in the
treatment of low back pain (LBP).
At the end of the 3 weeks’ intervention, participants in the
HILT group showed a signicantly greater decrease in pain
(measured by the VAS) and an improvement of related
disability (measured by the OLBPDQ) compared with the
group treated with U.S. therapy. The ndings obtained
after 15 treatment sessions with the experimental protocol
suggested greater effectiveness of HILT than of U.S.
therapy in the treatment of LBP.
26 Viliani T, Carrabba C, Mangone G,
Pasquetti P. High-intensity pulsed
Nd:YAG laser in painful knee
osteoarthritis: the biostimulating
protocol. (45)
To analyze the clinical efcacy and the
safety of HILT, using a biostimulating
protocol in patients with symptomatic
knee osteoarthritis.
Subjects were assigned into two groups: (A) A treatment
group and (B) waiting list. Patients in Group A showed
a highly statistically signicant improvement between t0
and t1 in WOMAC scale, and the improvement was kept
at follow-up (t2). The patients in the waiting list showed a
worsening tendency. The HILT group showed good clinical
results regarding pain and functional issues.
27 Alayat MSM, Atya AM, Ali MME, Shosha
TM. Long-term effect of high-intensity
laser therapy in the treatment of
patients with chronic low back pain: A
randomized blinded placebo-controlled
trial. (46)
The aim of this study was to compare
the effect of high-intensity laser therapy
(HILT), alone or combined with exercise,
in the treatment of chronic low back pain
(CLBP).
The range of motion signicantly increased after 4 weeks
of treatment in all groups, then decreased after 12 weeks at
follow-up, but was still signicantly more than the baseline value
in Groups 1 and 2. Visual analog scale (VAS) and functional
disability by both the Roland Disability Questionnaire (RDQ) and
the Modied Oswestry Disability Questionnaire (MODQ) results
showed signicant decrease after the treatment in all groups,
although the RDQ and MODQ results were not signicantly
different between groups 2 and 3. It appears that HILT combined
with exercise is more effective in patients with CLBP than either
HLLT alone or placebo laser with exercise.
28 Kheshie AR, Alayat MSM, Ali MME.
High-intensity versus low-level laser
therapy in the treatment of patients
with knee osteoarthritis: A randomized
controlled trial. (47)
To compare the effects of low-level
laser therapy (LLLT) and high-intensity
laser therapy (HILT) on pain and
functional improvement in case of knee
osteoarthritis (KOA).
The result was that HILT and LLLT combined with exercise
were effective in decreasing the VAS and WOMAC scores
after 6 weeks of treatment. HILT with exercises was more
effective than LLLT with exercises, and both treatment
modalities were better than exercises alone in case of KOA.
29 Gabrhel J, Popracová Z, Tauchmannová
H, Nemšák M. Hilterapia® – high-
intensity laser therapy in the treatment of
severe tendon and ligament injuries. (48)
To objectify the effect of high-intensity
laser therapy (HILT) in the treatment of
severe tendon and ligament lesions
The results showed that high-intensity laser therapy promoted
normalization of temperature patterns in most cases, reparation
of tendon and ligament structures in all cases, reduction of pain,
and the improved musculoskeletal condition in all cases.
30 Vervainioti A. Nd:YAG laser in the
management of low back pain. (49)
To compare the efcacy of high-intensity
laser therapy (HILT) with a standard
physiotherapy protocol on low back
pain and a combination of the two
methods. This study also addressed the
variation of pain through pain type and
localization.
The results showed that a signicant percent of patients with
acute pain gained full recovery, while there was a signicant
improvement of pain symptoms in patients affected by chronic
pain, but healing was not achieved. Focal pain was alleviated
more effectively than distributed pain. The results showed that
a therapeutical protocol based on the combination of HILT
and standardized physiotherapy may be successfully used
to obtain improvement of pain symptoms and early healing in
patients with non-specic pain of the lumbar area.
31 Šifta P, Danilov D. Effects of high-
intensity laser on gonarthrosis. (50)
To verify the effectiveness of high-
intensity laser therapy (HILT) in
alleviating pain and increasing the range
of motion in the affected joint of patients
suffering from arthrosis of the knee joint
of higher grades.
After the HILT, there was a statistically signicant decrease
in the WOMAC, WOMAC-A, WOMAC-B, and WOMAC-C
indexes. The t-test proved, with a probability of 99%, that HILT
signicantly reduced pain, stiffness, and problems with normal
daily activities. The study resulted in the following ndings:
• An analgesic effect of a high-intensity laser was observed
after the rst application
• Pain at rest and at night alleviated soon.
• None of the patients noticed any side effect of the HILT.
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TABLE 1. (Continued)
Citation Author, title, reference number Aim Result
32 Dundar U, Turkmen U, Toktas H,
Ulasli AM, Solak O. Effectiveness of
high-intensity laser therapy and splinting
in lateral epicondylitis; a prospective,
randomized, controlled study. (51)
To investigate the effects of high-
intensity laser therapy (HILT) in patients
with lateral epicondylitis (L.E.) and to
compare the results with those of a
brace and placebo HILT.
Comparison of the parameters percentage changes after
treatment in relation to pretreatment values did not present
a signicant difference between HILT and brace groups. It
is concluded that HILT and splinting are effective physical
therapy modalities for patients with L.E. in reducing pain
and improving disability, quality of life, and grip strength.
33 Akkurt E, Kucuksen S, Yılmaz H,
Parlak S, Sallı A, Karaca G. Long-term
effects of high-intensity laser therapy in
lateral epicondylitis patients. (52)
To investigate short- and long-term
effects of high-intensity laser therapy
(HILT) in lateral epicondylitis (L.E.)
patients.
The results of the study suggest that HILT is a reliable,
safe, and effective treatment option in L.E. patients in the
short and long term considering pain, functional status, and
quality of life.
34 Kim SH, Kim YH, Lee HR, Young Eun
Choi. Short-term effects of high-intensity
laser therapy on frozen shoulder:
A prospective randomized control
study. (53)
To evaluate the clinical efcacy of high-
intensity laser therapy (HILT) in patients
with frozen shoulder.
Patients were assigned into two groups: (1) HILT group and
(2) a placebo group. The results showed that the HILT group
had a lower pain VAS score at 3 weeks and 8 weeks but no
statistically signicant difference in the VAS was observed
at the nal follow-up (12 weeks) between the two groups.
No statistical difference in the range of motion ROM and
the satisfaction VAS was observed between the two groups
at serial follow-ups. It is concluded that HILT provided
signicant pain relief at 3 and 8 weeks in the management
of frozen shoulder, but not at the nal follow-up.
35 Angelova A, M. Ilieva E. Effectiveness
of High-Intensity Laser Therapy
for Reduction of Pain in Knee
Osteoarthritis. (54)
To present the effect of high-intensity
laser therapy in patients with knee
osteoarthritis.
There were two groups: (1) Therapeutic (test) treated with
HILT and (2) control group treated with sham laser. Pain
levels measured by VAS and dolorimetry signicantly
decreased in the therapeutic group after 7 days of treatment
(p < 0,001). This is the reason why HILT can be a method of
choice in the treatment of gonarthrosis.
36 Pekyavas NO, Baltaci G. Short-term
effects of high-intensity laser therapy,
manual therapy, and Kinesio taping in
patients with subacromial impingement
syndrome. (55)
To compare the effects of Kinesio®
taping (K.T.), exercise (EX), manual
therapy (M.T.), and high-intensity laser
therapy (HILT) on pain, range of motion
(ROM), and functioning in patients with
subacromial impingement syndrome
(SAIS).
Statistically signicant differences were found in the treatment
results of all parameters in MT+ KT+EX and HILT +MT+
KT+EX groups (p < 0.05). Statistically signicant differences
were found between all the groups (p < 0.05) when comparing
the means of range of motion (ROM) and shoulder pain and
disability index (SPADI). These differences were signicant
especially between the groups MT + KT+EX and KT + EX
(p < 0.05) and HILT +MT + KT + EX and KT + EX (p < 0.05).
HILT and M.T. were found to be more effective in minimizing
pain and disability and increasing ROM in patients with SAIS.
37 Pins L. Use of Class IV, High-Intensity
Laser Therapy as an Adjunct in Treating
a Patient with an Acute Shoulder injury:
A Case Report. (56)
To present a case in which high-intensity
laser therapy was used successfully
to treat a patient with acute shoulder
pain. The author also aimed to present
evidence supporting the use of high-
intensity laser therapy as a supplement
to conservative interventions in patients
with musculoskeletal injuries.
After the treatment, the patient demonstrated an increase
of 20 points on the questionnaire - Focus on Therapeutic
Outcomes (FOTO) - representing improved functional
status. Further, the patient demonstrated improved ROM
and had a notable decrease in pain levels. This case report
supports the use of high-intensity laser therapy combined
with physical therapy for improving ROM, pain levels, and
overall functional status.
38 Metin Ökmen B, Ökmen K, Özkuk K,
Uysal B, Sezer R, Koyuncu E.
Comparison of the Efcacy of
High-Intensity Laser and Ultrasound
Therapies in Chronic Shoulder Pain;
Randomized Controlled Single-Blind
Study. (57)
To compare the efcacy of the high-
intensity laser therapy (HILT) and
ultrasound therapy (U.S.) for pain and
daily activities of patients with chronic
shoulder pain.
141 patients were assigned into two groups: (1) US (n = 70)
and (2) HILT (n = 71). In Group 1 and Group 2, statistically
signicant improvements were found in all the evaluation
parameters both post-treatment 1st day and post-treatment
ndings 30th day (p < 0.05). When the groups are
compared, statistically signicant difference was found in
Group 2 both post-treatment 1st day and post-treatment
ndings 30th day, in all evaluation parameters (p < 0.05).
The study demonstrates that HILT is superior to U.S.
therapy in decreasing pain and improving function in short
term in chronic shoulder pain.
39 White PF, Cao X, Elvir-Lazo L,
Hernandez H. Effect of High-Intensity
Laser Treatments on Chronic Pain
Related to Osteoarthritis in Former
Professional Athletes: A Case Series. (58)
To evaluate the use of a higher intensity
cold laser for treating chronic pain
related to osteoarthritis (O.A.) in former
NFL football players.
The chronic pain scores were signicantly reduced both at
rest and with activity after each treatment. The duration of
the benecial effect lasted 1–3 weeks in 64% of the players
treated.
40 Choi HW, Lee J, Lee S, Choi J, Lee K,
Kim BK, Kim GJ. Effects of high-intensity
laser therapy on pain and function of
patients with chronic back pain. (59)
To examine the effects of high-intensity
laser therapy on pain and function of
patients with chronic back pain.
In a comparison between the studied groups, both VAS
and Oswestry Disability Index signicantly decreased. It
is concluded that high-intensity laser therapy can be an
effective nonsurgical intervention method for reducing pain
and helping the performance of daily routines of patients
suffering from chronic back pain.
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TABLE 1. (Continued)
Citation Author, title, reference number Aim Result
41 Alayat MSM, Abdel-Kafy EM,
Elsoudany AM, Helal OF, Alshehri MA.
Efcacy of high-intensity laser therapy in
the treatment of male with osteopenia or
osteoporosis: a randomized placebo-
controlled trial. (60)
To investigate the effect of high-intensity
laser therapy (HILT) on pain, health-
related quality of life and fall risk in male
with osteopenia or osteoporosis, applied
either solely or combined with exercise.
All measured values signicantly decreased after treatment in
all treatment groups. It is concluded that high-intensity laser
is an effective treatment for male patients with osteopenia or
osteoporosis. Laser combined with exercise is more effective
than exercises or laser alone in decreasing pain, fall risk an
increasing quality of life 12 weeks after the treatment.
42 Herdiansyah D, Prabowo T, Goesasi RZ.
The Difference on Pain and Range of
Motion After High-Intensity Laser Therapy
on Myositis Ossicans of the Right
Deltoid Muscle: A Case Report. (61)
To show effects of high-intensity laser
therapy (HILT) on pain and range of
motion (ROM) in a patient suffering from
myositis ossicans (MO).
Pain decreased after the therapy and the right shoulder
movements were easier. After 2 times/week for 4 weeks of
therapy, there was no pain, and the X-ray showed reduced
the scope of calcication.
43 Haładaj R, Pingot M, Topol M. The
Effectiveness of Cervical Spondylosis
Therapy with Saunders Traction Device
and High-Intensity Laser Therapy: A
Randomized Controlled Trial. (62)
To evaluate analgesic effect and
improvement of active mobility of
the cervical spine after having been
subjected to traction therapy with the
Saunders device and high-intensity laser
therapy (HILT) at different time intervals.
The results obtained in the two groups were similar
immediately after the therapy and after 4 weeks (the medium-
term follow-up). However, in long-term follow-up, therapeutic
effects of HILT maintained positive. Both therapeutic methods
improved the efciency and demonstrated analgesic efcacy
in patients with cervical spondylosis immediately and in the
medium term after the therapy. HILT was more effective than
the Saunders method in long-term follow-up.
44 White PF, Zafereo J, Elvir-Lazo OL,
Hernandez H. Treatment of
drug-resistant bromyalgia symptoms
using high-intensity laser therapy: A
case-based review. (63)
To evaluate low (1 W), intermediate (42
W) and high level (75 W) high-intensity
laser therapy (HILT) in a woman with
long-standing bromyalgia syndrome.
The 1 W treatment produced minimal symptom relief,
both the 42 and the 75 W treatments produced a dramatic
reduction in overall pain, improved quality of sleep, and
increased the level of physical activity for 4–10 days after
these treatment sessions.
45 Akkurt F, Akkurt HE, Yılmaz H, Olgun Y,
Sen Z. Efcacy of High-Intensity Laser
Therapy and Silicone Insole in Plantar
Fasciitis. (64)
To investigate the short-term efcacy of
high-intensity laser therapy (HILT) and
silicone insole in the treatment of plantar
fasciitis (P.F.) and to compare it with a
full-length silicone insole alone.
Both groups showed a signicant improvement regarding all
parameters (pain scores, function and quality of life scores,
and fat pad thickness) 1 month after treatment. Conjunction
of HILT and insole therapy was considered to be more
effective than only silicone insole with regard to decrease in
pain and increase in quality of life.
46 Ciplak ED, Akturk S, Buyukavci R,
Ersoy Y. Efciency of high-intensity
laser therapy in patients with knee
osteoarthritis. (65)
To compare the effects of high-
intensity laser treatment (HILT) and
the transcutaneous electrical nerve
stimulation (TENS) and ultrasound
(U.S.) combined treatment on pain,
functionality, and quality of life in
the patients suffering from knee
osteoarthritis.
In both groups, a statistical signicant change was observed
in all parameters after the treatment. In the comparison
between the groups, it was observed that HILT provided
a signicant improvement in pain scores both after the
treatment and in the 6th week than TENS and U.S. combined
treatment. HILT in knee osteoarthritis is a statistically
signicant efcient method for pain and functional scales
compared to combination of TENS and U.S.
47 Nicolaou EPT, Dimitrios S, Lamnisos D.
Treatment of chronic patellar
tendinopathy using an exercise program
consisting of eccentric training and static
stretching exercises combined with high-
intensity light therapy. A pilot study. (66)
To investigate the effects of an exercise
program consisting of eccentric training
and static stretching exercises combined
with high-intensity laser therapy
(HILT) in patients with chronic patellar
tendinopathy (CPT).
At week 4, there was a rise in VISA-P score of about 37
units. This rise was kept at 1 month follow-up. The results
suggest that the combination of an exercise program with
HILT is an adequate treatment for patients with CPT.
48 Kolu E, Buyukavci R, Akturk S, Eren F,
Ersoy Y. Comparison of high-intensity
laser therapy and combination of
transcutaneous nerve stimulation
and ultrasound treatment in patients
with chronic lumbar radiculopathy: A
randomized single-blind study. (67)
To compare the effects of high-intensity
laser therapy (HILT) and a combination
of transcutaneous nerve stimulation
(TENS) with ultrasound (U.S.) therapy
on pain and functionality in patients with
chronic lumbar radiculopathy.
In two groups, VAS and Oswestry Disability Index scores
showed signicant changes. HILT and TENS+US combined
with exercise were effective treatment modalities in
decreasing the VAS and ODI scores. TENS+US combined
with exercises were more effective than HILT combined with
exercise.
49 Taradaj J, Rajfur K, Rajfur J, Ptaszkowski K,
Ptaszkowska L, Sopel M, Rosińczuk J,
Dymarek R. Effect of laser treatment on
postural control parameters in patients
with chronic nonspecic low back pain: A
randomized placebo-controlled trial. (19)
The main objective was to evaluate
static postural stability using an objective
tool in patients with chronic non-specic
lumbar pain after laser treatment with
different doses and wavelengths.
Low- and high-intensity laser therapy did not lead to a
signicant improvement in postural sway in patients with
chronic non-specic lumbar pain compared with standard
stabilization training based on short- and long-term
observation.
50 Nazari A, Moezy A, Nejati P,
Mazaherinezhad A. Efcacy 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. (68)
To compare the effects of high-intensity
laser therapy (HILT), conventional
physical therapy (CPT), and exercise
therapy (E.T.) on pain and function in
patients with knee osteoarthritis.
In comparison to other groups, HILT was more efcient in
decreasing the VAS, increasing FROM and improving the
WOMAC scores both after treatment and after 12 weeks. The
effect of HILT and CPT on the knee exion range of motion,
timed up and go test, 6-min walk test, and Western Ontario
and McMaster Universities Osteoarthritis pain subscale,
was not signicantly different after treatment, and both were
better than E.T. However, HILT was signicantly better than
the others at follow-up. HILT combined with exercise therapy,
could have positive impacts on knee osteoarthritis patients.
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TABLE 1. (Continued)
Citation Author, title, reference number Aim Result
51 Gocevska M, Nikolikj-Dimitrova E,
Gjerakaroska-Savevska C. Effects
of High-Intensity Laser in Treatment
of Patients with Chronic Low Back
Pain. (69)
To compare the effects between high-
intensity laser (HILT) and ultrasound
(U.S.) therapy in the treatment of
patients with chronic low back pain.
This study has shown that pain and disability in patients
with chronic low back pain treated with a high-intensity laser
have been signicantly reduced, range of motion has been
improved. The positive effect was kept for 3 months.
52 Ghanbarnasab M, Nejati P, Moeinoddin
R, Nejati L. The effect of high-intensity
laser therapy on trapezius focal myositis:
a rare case report. (70)
To present a case of a patients suffering
from focal myositis (F.M.) in the left
trapezius muscle who had an excellent
response to high-intensity laser therapy
(HILT).
The pain level was signicantly lower after 3–4 sessions. At
the end of the 8th session, there was a dramatic decrease in
the VAS score, and nally, the pain completely disappeared
after 1 week. After 3 months, the patient had no pain. The
shoulder MRI viewed lesion smaller than before. After 6
months, she had no pain or tenderness in that area and was
able to perform all daily tasks without any pain.
53 Ezzati K, Laakso E, Saberi A,
Yousefzadeh Chabok S, Nasiri E,
Bakhshayesh Eghbali B. A comparative
study of the dose-dependent effects
of low level and high-intensity
photobiomodulation (laser) therapy on
pain and electrophysiological parameters
in patients with carpal tunnel syndrome:
A randomized controlled trial. (71)
To compare the dose-dependent effects
of low-level laser therapy (LLLT) and
high-intensity laser therapy (HILT) on
pain and electrophysiology studies in
patients with carpal tunnel syndrome
(CTS).
After 3 weeks, in all groups, VAS was signicantly lower,
compound muscle action potential (CMAP) latency decreased.
The interaction of group and time (5 × 2) was signicant
for pain, the latency of CMAP and CMAP amplitude. The
interaction of group and time was not signicant for the CMAP
conduction velocity, sensory nerve latency, and amplitude. HILT
with a power of 1.6 W and low uence of 8 J/cm2 was superior
in reduction of pain and improvement of the median motor
nerve conduction compared to LLLT and exercise-only control
groups.
54 Kaydok E, Ordahan B, Solum S,
Karahan AY. Short-Term Efcacy
Comparison of High-Intensity and Low-
Intensity Laser Therapy in the Treatment
of Lateral Epicondylitis: A Randomized
Double-Blind Clinical Study. (72)
To evaluate and compare the short-term
efcacy of high-intensity laser therapy
and low-intensity laser therapy in the
treatment of lateral epicondylitis.
After 3 weeks, there were signicant improvements in all of the
parameters. However, in the high-intensity laser therapy group,
the QDASH, hand grip strength, and SF-36 physical component
summary (PCS) scores showed superior improvement
compared to the low-intensity laser therapy group. However,
each treatment modality was found to be effective and safe for
the short-term treatment of lateral epicondylitis.
55 Ahmed M, Abu Taleb E, El Desoky T,
Lasheen R, Ameen H. High intensity
laser therapy effect on pain in patients
with myofascial trigger points. (73)
To investigate the effect of high-intensity
laser therapy on pain intensity in patients
with acute cervical myofascial trigger
points in the upper trapezius muscle.
The results showed that there was signicant difference
between the two groups in the post-treatment outcome
measures where the effect in group (B) is more signicant
than in the control group (A) at p > 0.001. High-intensity
laser therapy was found to be quite effective as a physical
treatment for patients with cervical myofascial trigger points.
56 Abdelbasset WK, Nambi G, Alsubaie SF,
Abodonya AM, Saleh AK, Ataalla NN,
et al. A Randomized Comparative Study
between High-Intensity and Low-
Level Laser Therapy in the Treatment
of Chronic Non-specic Low Back
Pain. (74)
To compare the effects of high-intensity
laser therapy (HILT) versus low-level
laser therapy (LLLT) on chronic non-
specic low back pain.
Both LLLT and HILT groups showed a signicant improvement
of the Oswestry Disability Index (ODI), visual analog scale
(VAS), lumbar range of motion (ROM), and European Quality
of Life (EuroQol) scores, while the control group did not show
signicant changes. Comparison among the three study
groups post-intervention showed signicant differences in the
outcome measures, while comparison between the LLLT and
HILT groups showed non-signicant differences.
57 Chen Y-W, Cheng Y-Y, Lee Y,
Chang S-T. The Immediate Effect
of High-Intensity Laser Therapy on
Pain Relief and Shoulder Function in
Patients with Subacromial Impingement
Syndrome. (75)
To evaluate the immediate effects of
high-intensity laser therapy (HILT) on
patients with subacromial impingement
syndrome (SAIS).
At the end of the evaluation period, comparisons before
and after treatment in the HILT group showed signicant
improvements in all outcome measures, including VAS,
shoulder ROM, and CMS. HILT can immediately reduce
pain and disability and improve shoulder exion range of
motion in patients with SAIS.
58 Kamal W, Saber M, Aiad K, Serag M,
Mostafa EM, Heba A, et al. Effect of
High-Power Laser on Shoulder Mobility
in Subacromial Impingement Syndrome:
Randomized Controlled Trial. (76)
To investigate effects of high-intensity
laser therapy (HILT) on shoulder mobility
in case of subacromial impingement
syndrome.
Comparing HILT and exercise groups after the
treatment revealed a statistically signicant reduction in
ultrasonography dimension of supraspinatus and VAS
and signicant increase in range of motion of shoulder
exion and abduction in favor to HILT group compared
to exercise group. It is concluded that HILT yielded more
improvement for shoulder mobility in case of impingement
syndrome.
59 Abdel-Aal NM, Ali KM, Eladl HM.
Efcacy of high-intensity laser therapy
on arthropathy of the hands in patients
with systemic lupus erythematosus: A
double-blinded, randomized controlled
trial. (77)
To nd the efcacy of high-intensity laser
therapy (HILT) on hands arthropathy
in patients with systemic lupus
erythematosus.
There were statistically signicant differences in handgrip
strength, joint swelling count, joint tenderness count, and
VAS in favor of the study group. Adding HILT to the standard
physical therapies might be more effective than standard
physical therapies alone in improving handgrip strength,
decreasing joint swelling counts, joint tenderness counts,
and pain in patients with hands arthropathy.
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RESULTS
By reviewing the selected articles related to the eects of
CRet therapy on various forms of musculoskeletal disor-
ders, it was found that this therapy has a favorable eect
and is mainly applied in pain reduction, improvement of
muscles and joint mobility, and edema reduction. CRet’s
positive eects may be attributed to its capability to increase
tissue temperature and enhance blood circulation (8). e
analysis of the accessed articles related to HILT eects in
musculoskeletal disorders has provided information that
this therapy, although having an anti-edematous, anti-in-
ammatory, and reparative eect, is mostly applied in pain
reduction, being either applied solely or in combination
with some other physical treatment (17,18).
Analgesic eects of CRet therapy and HILT
Among 61 reviewed papers dealing with analgesic eects
of CRet therapy and HILT, it may be noted that the appli-
cation of these two therapies signicantly diers regarding
pain location. Namely, while CRet therapy papers mostly
deal with pain in joints, muscles, and tendons (n = 7), low
back pain (n = 6.5), and neck pain (n = 4) (Figure1), HILT
is largely applied in knee conditions (n = 11), shoulder pain
(n = 9), and low back pain (n = 8) (Figure2). Further, it
has to be noted that this overview includes more papers
on HILT (n = 39) than on CRet therapy (n = 22). When
viewed in total, for both therapies, most papers deal with
low back pain (n = 14.5), pain in knees (n = 11.5), shoul-
der (n = 11), joints, muscles, and tendons (n = 10), neck
(n = 5), elbow (n = 4), hands (n = 2), bones (n = 2), and feet
(n = 1) (Figure3).
Considering that there is no other applicable method for
determining pain level except for a subjective assessment, the
pain was assessed by the commonly approved and accepted
visual analog scale – VAS (51 articles), numeric pain rating
scale – NPRS (four articles), Western Ontario and McMaster
Universities Osteoarthritis Index – WOMAC (two articles),
verbal rating scale – VRS (one article), Victorian Institute
of Sport Assessment questionnaire – VISA-P (one article),
and Oswestry Low Back Pain Disability Questionnaire (one
article) (Figure4). Given that the vast majority of studies
use questionnaires, scales, and surveys, Taradaj et al. were
eager to nd a more objective way for pain assessment in the
FIGURE 1. Distribution of articles per pain locations treated with CRet
therapy.
FIGURE 2. Distribution of articles per pain locations treated with HILT.
Citation Author, title, reference number Aim Result
60 Ammendolia A, Marotta N, Marinaro C,
Demeco A, Mondardini P, Costantino
C. The synergic use of the High-Power
Laser Therapy and Glucosamine sulfate
in Knee osteoarthritis: A Randomized
Controlled Trial. (78)
To determine the efcacy of high-power
laser therapy (HPLT) applied together
with glucosamine sulfate (G.S.) in knee
osteoarthritis
In the mean scores for VAS at T1, no signicant differences
were found between the two groups with paired T and
ANOVA test. However, signicant differences between the
groups in all outcomes were observed at 6 months (T2). It is
concluded that HILT is useful in treating knee osteoarthritis,
but when combined with glucosamine sulfate, it may
achieve a long-term effect up to 6 months after treatment.
61 Koevska V, Dimitrova-Nikolic E,
Mitrevska B, Savevska-Gjerakaroska C,
Gocevska M, Kalcovska B. Application of
high-intensity laser in pain treatment of
patients with knee osteoarthritis. (79)
To compare the effect of HILT with LILT
in the treatment of knee osteoarthritis
There is a signicant difference between the two groups in
VAS score after 10 therapies where signicantly lower score
was in the HILT group. The comparison of the VAS score
between the 2 times in the two groups separately showed
that in both, the HILT and the LILT groups, the VAS score
after 10 days of therapy was signicantly lower compared to
that at 0 time. Patients treated with HILT had better results,
that is, had a signicant reduction in pain than patients
treated with LILT. HILT was more effective than LILT.
TABLE 1. (Continued)
HILT application. ey tried to analyze the posture stabil-
ity parameters considering that posture stability is partially
conditioned by pain level. ey used a double-plate stabilo-
metric platform and unfortunately the results did not meet
FIGURE 3. Distribution of articles per pain location treated with
CRet and HILT.
107
Žarko Mitrić, et al.: Comparison between capacitive and resistive electronic transfer therapy and high-intensity www.jhsci.ba
laser therapy. Journal of Health Sciences 2022;12(2):98-109
www.jhsci.ba Žarko Mitrić, et al.: Comparison between capacitive and resistive electronic transfer therapy and high-intensity
laser therapy. Journal of Health Sciences 2022;12(2):98-109
their expectations, but they believe that this could be used
in further studies (19).
Pain assessment is an important guide in the clinical work
of a physiotherapist as it helps them dene adequate proto-
cols and improves the quality of a treatment cycle. Although
it is subjective, it has to be noted that all studies carried
out within various settings and under various conditions
through subjective pain assessment scales showed that both
therapies yielded signicant analgesic eects.
DISCUSSION
is article aims to compare the eectiveness of CRet and
HILT in the case of painful musculoskeletal conditions by
overviewing recent studies. e overviewed papers showed
that both therapies are powerful tools in pain reduction.
Although in most of these papers, the set protocols, number
and frequency of therapies applied, and other parameters
usually dier, in both modalities, pain alleviation occurs
during or immediately after a therapy cycle application.
is only proves that they have eects valuable for further
research aiming to nd and set the most favorable protocol
resulting in complete pain alleviation in both short-term
and long-term sense.
CRet therapy analgesic eect develops very fast and lasts
long. By observing the therapy eects in the most common
musculoskeletal pathologies, it is found that signicant
eects were achieved immediately after the rst therapy
cycle. Such results are likely to result from a biological eect
on muscles – anti-edemic, anti-inammatory, and myore-
laxant – through a release of endorphins and controlling
both pain types – nociceptive and neuropathic (20). e
results of the published papers underline the signicance of
CRet, whether applied individually or in combination with
other physiotherapy procedures. Apossibility to be applied
in any phase of the condition also has a great signicance
because it is possible to act even in an early phase and pre-
vent greater motor decit and development of chronicity.
Further, CRet is considered ecient in chronic conditions
where most other physiotherapy procedures do not result
in signicant recovery. Although there is a small number of
clinical studies in this eld, CRet appears to be an eective
treatment method for pain relief and better functionality of
patients and therefore improved quality of life.
e pain relieving eect of HILT is achieved by the “gate
control system,” and it is a result of the irradiation stim-
ulating eect on the regeneration of nerve bers (21,22).
Regardless that the selected studies have dierent settings
and conditions, that some of them searched for short term,
some for long term, and some for any eect, it can be seen
that the rst analgesic eects were noticed immediately
following HILT’s application. It should be noted that long-
term eects are usually achieved by applying HILT com-
bined with other physical procedures or medicines. is is
probably due to all achieved impacts by HILT – anti-in-
ammatory, analgesic, and biostimulating. However, one
should not neglect that HILT’s eects are quite satisfac-
tory even when applied solely. While searching databases
for papers related to CRet and HILT, we found only one
article by Raaella Osti et al. partially dealing with both
therapies (8). e study’s results evidence the ecacy of
combined CRet and HILT therapies in treating low back
pain. e decrease in VAS score had a statistically signi-
cant dierence (9).
CONCLUSION
Although there are no precisely dened protocols for appli-
cation either of CRet or HILT in the selected papers, they
report positive and encouraging eects. ere are still a
small and insucient number of clinical studies and sub-
jects involved in them, and considering the remarkable
eects, these two therapies have on pain relief and better
functionality of patients, which further result in improved
quality of life, both therapies deserve much more attention
and research. Considering that studies related to CRet and
HILT mostly deal with dierent pain locations and mainly
focus on a few body areas, it is necessary to carry out some
research within the scope of other impaired body areas,
which also may have a negative impact on quality of life.
Learning and understanding all aspects of these two ther-
apies would enable those administering physical therapies
not only to establish corresponding protocols for various
therapy applications but also to combine these with other
physical therapies and medicines to get faster, more ecient,
and longer-lasting results. Pain as a dominant characteristic
of musculoskeletal conditions not only impairs one’s func-
tionality and adversely aects the quality of life but it is also
an economic issue. Hence, proper and prompt treatment
may be signicant for individuals and society. erefore,
further research and studies related to the eects of CRet
and HILT and for evidencing their results are needed.
COMPETING INTERESTS
ere are no conicts of interest to declare by any of the
authors of this study.
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