Efficacy of High Intensity Laser Therapy in Patients with Chronic Lumbar Radiculopathy
Due to Disc Herniation , Ankara 2025
Low back pain is an important and widespread health problem that negatively affects the
quality of life from past to present, causes deterioration in functional status and may
cause disability and psychologically wears out human health in the chronic period. In
epidemiological studies, the prevalence of low back pain has been found to be
approximately 40% throughout life.
Low back pain is classified as acute, subacute and chronic according to its duration and
as mechanical and inflammatory according to the character of the pain. Low back pain
lasting more than 12 weeks is defined as chronic low back pain.
Etiological factors include fracture, malignancy, infection, trauma, osteoporosis,
inflammatory diseases, myogenic causes, etc. One of the most important and common causes
of mechanical causes is intervertebral disc herniation. Disc herniation may also cause
radicular pain in the form of numbness, burning, electrification, pins and needles in the
dermatome area of the related nerve due to neural root compression.
There are many treatment modalities for radicular low back pain due to lumbar disc
herniation. These include medical treatment, lumbar and abdominal strengthening exercises
given outside the acute painful period, physical therapy modalities, alternative medicine
methods, laser therapy, epidural steroid injections and surgical treatment.
The term laser is defined as "light amplification by stimulated radiation emission". It
is a non-invasive and painless treatment. There are two types of laser therapy, low and
high intensity, with different intensity according to peak power and wavelength. Pulsed
neodymium-doped yttrium aluminium garnet (Nd:YAG) high intensity laser, HILT, works with
high peak power and 1.064nm wavelength. The laser has 5 basic mechanisms of action:
thermal, mechanical, electrical, photochemical, biostimulate. Biostimulation, antiedema,
analgesic and anti-inflammatory effects in the applied area are more pronounced due to
its high intensity and specific wavelength, but the exact mechanism of action in reducing
pain has not yet been clearly clarified.
This study, aimed to investigate the effects of high-intensity laser therapy (HILT) on
the patient's disability, functionality, and neuropathic and nociceptive patterns of pain
in radicular pain due to lumbar disc herniation in the chronic period and its superiority
over the conventional electrotherapy modalities we frequently use. The study was designed
as a randomised, placebo-controlled, double-blind, prospective study.
This study includes patients admitted to the outpatient clinics of Ankara City Hospital
Physical Medicine and Rehabilitation Hospital who have low back pain radiating to the
lower extremities for more than 12 weeks and have sensory deficit and/or pain sensation
in dermatomal distribution due to radicular lesion accompanying lumbar disc herniation
shown by lumbar MRI. Patients will be randomly divided into two groups.
A total of 70 patients aged 18-65 years of male and female sex will be included in the
study and the patients will be randomly divided into two groups of equal number.
Patients in Group A (n:35) will receive 15 sessions of hotpack and 15 sessions of TENS
(transcutaneous electrical nerve stimulation) five days a week for 3 weeks, 15 sessions
of HIRO TT (ASA Laser, Arcugnano, Italy) device in lumbosciatica mode in three phases
(fast scanning, trigger point, slow scanning) over an area of 25 cm². Isometric lumbar
strengthening and core stabilisation exercises will be given to the patients as a home
programme.
Patients in group B (n:35) will receive TENS (Transcutaneous Electrical Nerve
Stimulation), Hotpack, Lumbar and Core Stabilisation Exercises and sham High Intensity
Laser treatments and the protocols will be the same as in group A. Patients will be
evaluated 3 times in total: pre-treatment, post-treatment and 3 months.