title: Low intensity laser and LED therapies associated with lateral decubitus position and flexion exercises of the lower limbs in patients with lumbar disk herniation: clinical randomized trial.
abstract: The objective of this study is to evaluate the effectiveness of laser and LED therapies, associated with lateral decubitus position and flexion exercises of the lower limbs in patients with lumbar disk herniation (LDH). It is a randomized blinded clinical trial. Fifty-four subjects with LDH L4-L5 and L5-S1 were selected and randomly allocated into groups: laser 904 nm, placebo, and LED 945 nm. The numbers of subjects for each group that completed the treatment were 18, 13, and 18, respectively. Twelve points over the lumbar spine region (L2 to S1) and eight points on the injured thigh in the path of the lumbar roots L5 and S1 were irradiated. Irradiation parameters for each point were as follows: laser wavelength 904 ± 10 nm, average power 0.038 ± 20 % W, irradiated area 0.16 cm(2), energy per point 4 J, and treatment time per point 104 s; LED wavelength 945 ± 15 nm, power 0.1 W, irradiated area 1.0cm(2), energy per point 4 J, and treatment time per point 40 s. Lateral decubitus opposite to the side of the radicular was the standard position for all patients. After phototherapy and laser placebo sessions, the subjects performed sequences of flexion exercises of the lower limbs (ten per session) for 15 daily sessions.
  
  
  METHODS
  pain intensity assessed by visual analog scale (VAS), degree of flexion of the affected hip measured by the universal goniometer and functional capacity assessed by the Oswestry Disability Index. The three groups had statistically significant improvement in lumbar and radicular pain, in hip mobility, and in the functional disability index (p ≤ 0.001). There was a statistically significant difference (p = 0.024) in radicular pain between the groups, gait claudication and Oswestry Disability Index. We can conclude that in the treatment of L4-L5 and L5-S1 LDH with radiculopathy, LED, associated with lateral decubitus position and flexion exercises of the lower limbs, showed better therapeutic performance for radicular pain, gait claudication, and functional disability.
authors.affiliation: Biomedical Engineering Institute, University Camilo Castelo Branco, Dr. Altino Bondesan Road, 500 District of Eugênio de Melo, 12247-004, São José dos Campos, São Paulo, Brazil.|Department of Physical Therapy, State University of Piauí, Teresina, Piauí, Brazil.|Department of Physical Therapy, Getulio Vargas Hospital, Teresina, Piaui, Brazil.
authors.forename: Maria Ester I Mendes
authors.initials: ME
authors.lastname: de Carvalho
authors.affiliation: Specialized Medicine Department-Neurology, Federal University of Piauí, Teresina, Piaui, Brazil.|Department of Neurosurgery, Getulio Vargas Hospital, Teresina, Piaui, Brazil.
authors.forename: Reynaldo Mendes
authors.initials: RM
authors.lastname: de Carvalho
authors.affiliation: Department of Rehabilitation, University of São Paulo USP, São Paulo, São Paulo, Brazil.
authors.forename: Amélia Pasqual
authors.initials: AP
authors.lastname: Marques
authors.affiliation: Department of Anesthesiology, Getulio Vargas Hospital, Teresina, Piaui, Brazil.
authors.forename: Lorena Mendes
authors.initials: LM
authors.lastname: de Carvalho Lucio
authors.affiliation: Specialized Medicine Department-Neurology, Federal University of Piauí, Teresina, Piaui, Brazil.
authors.forename: Antonio César Almeida
authors.initials: AC
authors.lastname: de Oliveira
authors.affiliation: Biomedical Engineering Institute, University Camilo Castelo Branco, Dr. Altino Bondesan Road, 500 District of Eugênio de Melo, 12247-004, São José dos Campos, São Paulo, Brazil.
authors.forename: Osmar Pinto
authors.initials: OP
authors.lastname: Neto
authors.affiliation: Biomedical Engineering Institute, University Camilo Castelo Branco, Dr. Altino Bondesan Road, 500 District of Eugênio de Melo, 12247-004, São José dos Campos, São Paulo, Brazil. abvillaverde@gmail.com.|Cité Center of Innovation, Technology, and Education, São José dos Campos, São Paulo, Brazil. abvillaverde@gmail.com.
authors.forename: Antonio Balbin
authors.initials: AB
authors.lastname: Villaverde
authors.affiliation: Biomedical Engineering Institute, University Camilo Castelo Branco, Dr. Altino Bondesan Road, 500 District of Eugênio de Melo, 12247-004, São José dos Campos, São Paulo, Brazil.|Cité Center of Innovation, Technology, and Education, São José dos Campos, São Paulo, Brazil.
authors.forename: Carlos José
authors.initials: CJ
authors.lastname: de Lima
mesh_terms: D000328:Adult; D005081:Exercise Therapy; D005260:Female; D006615:Hip / Q000503:physiopathology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology* / Q000532:radiotherapy*; D053685:Laser Therapy; D007866:Leg / Q000503:physiopathology*; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy; D008297:Male; D010147:Pain Measurement; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: Exercise Therapy; Intervertebral disk displacement; LED therapy; Laser therapy