Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects

By Sidney Jones, SPT


Osteoarthritis (OA) is a common degenerative joint disease that is usually associated with pain, limited range of motion, muscle weakness, difficulty with activities of daily living and impaired quality of life. The knee is the most common joint in the body affected by osteoarthritis. Low-level laser therapy has been studied and used for pain control, anti-inflammatory effects and its healing efficacy. The purpose of this study was to determine the effects of adding low-level laser therapy (LLLT) to an exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, knee range of motion, and quality of life in older subjects with knee OA.


Men and women between 60-72 years old with chronic osteoarthritis according to the American College of Rheumatology (ACR) criteria grades II & III and knee OA according to the Kellgren-Lawrence grade. Participants also had to have the ability to stand independently and willingness to participate in the study.

Methods – laser therapy treatment

Group1: 18 subjects 7 males & 11 females were treated with a laser dose of 6 J/cm² over 8 points around the knee. Each point received energy of 6 J/point for 60 seconds.

Group 2: 18 subjects 6 males & 12 females were treated with a laser dose of 3 J/cm² on 9 points around the knee. Each point received energy of 3 J/point for 50 seconds.

Group 3: 15 subjects 5 males & 10 females participated as the control group. Procedure was identical but without emission of energy.

Exercise Training Program

All participants in each group participated in the same exercise training program for 30 to 45-minute sessions 2 times a week for 8 weeks. The program included stretching the quadriceps, hamstrings, adductors, and calf muscles. Strengthening exercises included knee extension, straight leg raises and quadriceps setting. All participants were instructed to practice these exercises as a home program.

Each participant was evaluated pre and post 8 weeks of physical therapy interventions on:

  • Pain intensity with Visual Analogue Scale (VAS)
  • Physical function with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
  • Knee range of motion, active knee flexion range of motion was measured with long arm universal goniometer.
  • Isometric strength of knee flexor and extensor muscles was measured using Handheld Dynamometer


The best improvements in VAS, WOMAC pain, knee range of motion and physical function were seen in patients who were treated with 6 J/cm² then 3 J/cm² and then placebo group. Mean values for WOMAC significantly reduced, which means improved physical function. Isometric strength of the quadriceps and hamstring muscles increased significantly in each group after interventions. The largest increase in isometric strength of the quadriceps and hamstring muscles and knee flexion range of motion was seen in patients who received 6 J/cm² followed by 3 J/cm² and then the placebo group. Mean values of knee flexion range of motion increased significantly after physical therapy interventions in each group with significant differences among the 3 groups.

Discussion about adding laser therapy

The current study suggests that adding LLLT to exercise training program could be an important modality for treating older adults with OA than exercise training alone. The active laser groups either 6 J/cm² or 3 J/cm² had a significant reduction of pain intensity in VAS and WOMAC, increase in physical function, increase in isometric quadriceps and hamstring muscle strength, and increase in range of motion after treatment of knee OA.


Adding LLLT to an exercise training program is more effective than exercise training alone in treatment of patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm² or 3 J/cm².

PTF Approach to adding laser therapy 

Here at Physical Therapy First, we perform a complete evaluation and based on those findings we design a treatment plan that best addresses our patient’s needs. Our goal is to provide quality patient care and as this study suggests, multiple interventions can and should be used to treat knee osteoarthritis simultaneously. At Physical Therapy First, laser therapy and strengthening are options along with several other interventions such as soft tissue mobilization, stretching and providing our patients with a home exercise program to maximize outcomes.

Original Article about Laser Therapy

Youssef, E. F., Muaidi, Q. I., & Shanb, A. A. (2016). Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. Journal of Lasers in Medical Sciences,7(2), 112-119. doi:10.15171/jlms.2016.19

How does my health insurance actually work?

By Lillian Wynn, PT, DPT 

Health insurance can be a very confusing and complicated thing to navigate. We try very hard to work with all of our patients to understand what their coverage is so we can be honest up front with how much PT will cost you.

This is by no means a complete list of everything you need to know, but we are hoping it will help answer some of your questions about how things work.

Health Insurance Premium

This is the amount of money that you pay to your insurance company every month to buy coverage. The amount varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for.


Health insurance companies and health care providers also sign contracts with each other to determine if you are ‘in network’ or ‘out of network’. Oftentimes your coverage is different depending on whether you are in or out of network

Health Insurance Deductible

Not everyone has a deductible. This is the amount you must pay ‘out of pocket’ before your insurance starts helping pay for things. How much deductible you have varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for. If you have a high deductible plan, you often qualify for a Health Savings Account (HSA).


This is the amount that you owe out of pocket at each doctor’s visit. This is IN ADDITION to your monthly premium. If you have a deductible, this may still apply after your deductible has been met. The amount of your copay depends on which health insurance company you have, how much coverage you are paying for, how many people you are paying for, and which type of doctor you are seeing.

I still have questions about:
  • My premium
  • Which plan I have
  • Whether I qualify for an HSA

Please call your health insurance company at the number on the back of your card

I still have questions about:
  • If PT First is ‘in network’
  • If I’ve met my deductible
  • What my co-pay or out of pocket cost is
We can help, feel free to give us a call!

I had an ankle sprain, why are you strengthening my hip?

By Logan Swisher SPT

Ankle Sprain – Background:

Lateral ankle sprains are a significant burden on U.S healthcare with estimated costs of $6.2 billion annually. They can be associated with long-term consequences such as decreased health-related quality of life, decreased physical activity and post-traumatic ankle osteoarthritis. Some patients with a history of lateral ankle sprain develop chronic ankle instability; which is commonly marked by repetitive ankle injury, balance and mobility deficits, and perceived instability of the ankle.  Other patients with a history of lateral ankle sprain do not develop the subsequent characteristics of chronic ankle instability. Studies have shown that lateral ankle sprain copers have more favorable ankle range of motion, ankle strength, joint stability and postural control as compared to those who develop chronic ankle instability.

Dynamic postural control is the ability to maintain your balance while moving any part of your body (ie catching a ball, jumping, carrying, etc). Patients with chronic ankle instability tend to have limited dynamic postural control. In clinical practice, a star-excursion balance test (SEBT) is a simple measure of dynamic postural control. This study aimed to examine the differences in SEBT performance and hip strength in those with chronic ankle instability, lateral ankle sprain copers and control groups.


84 participants total:

-30 chronic ankle instability

-29 lateral ankle sprain copers

-25 control


Single-blinded, cross-sectional, case-control study design was utilized. One physical therapy clinic assigned patients to their appropriate group, and then after treatment, results were collected and analyzed. All participants were tested for leg length, SEBT, and isometric hip strength.  Averages of SEBT and isometric strength were taken from three trials respectively.


This research revealed that individuals with chronic ankle instability had lower SEBT score decreased hip strength compared to lateral ankle sprain copers and control groups. This indicates that dynamic postural control and isometric hip strength is compromised in individuals with chronic ankle instability.

Ankle Sprain – Clinical Application:

Physical therapists treating patients with chronic ankle instability should include exercises to target hip muscular strength deficiencies which may in turn have a positive effect on dynamic postural control performance.  Here at PT First we approach a patient globally and work to incorporate any insufficiencies found during examination into a well-rounded, dynamic rehabilitation program.

Original article – ankle sprain:

McCann, R. S., Crossett, I. D., Terada, M., Kosik, K. B., Bolding, B. A., & Gribble, P. A. (2017). Hip strength and star excursion balance test deficits of patients with chronic ankle instability. Journal of Science and Medicine in Sport, 20(11), 992-996. doi:10.1016/j.jsams.2017.05.005


Running with Knee Osteoarthritis-Part 3

By Lillian Wynn PT, DPT
Physical Therapist


40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the third of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary


This paper is a systematic review and meta-analysis, so the authors compiled research on knee osteoarthritis (OA) and running, and summarized the findings in order to provide a concise recommendation based on the general consensus of research. Articles were included if they: were level I-III evidence, written in English, used physician diagnosed OA with clinical and/or radiographic findings, and running was compared to non-running. Articles that compared running to other forms of exercises were not included in this study.


Literature searches were performed, and 1,907 articles were reviewed. Of those, 25 met their inclusion criteria. Statistical analysis was performed on those 25 studies to come to a meta-analysis, which summarizes and confirms the general recommendations based on significant research.


The authors concluded that recreational running was in fact associated with lower levels of OA when compared to sedentary individuals. Competitive running was associated with higher levels of OA than recreational runners. Overall, sedentary subject demonstrated the most symptomatic OA. The study also argues that this simply compares runners to non-runners. So the only conclusion that can be drawn is that running is better than being sedentary. More research should be done into seeing if running vs other forms of exercise is the best for of exercise.

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther, 47(6), 373-390. doi:10.2519/jospt.2017.7137

Cost-Effectiveness of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome

by Leah Flamm, PT,

César Fernández-de-las-Peñas, PT, PhD, DMSc, Ricardo Ortega-Santiago, PT, PhD, Homid Fahandezh-Saddi Díaz, MD, PhD, Jaime Salom-Moreno, PT, PhD, Joshua A. Cleland, PT, PhD, Juan A. Pareja, MD, PhD, José L. Arias-Buría, PT, MSc, PhD.


Carpal tunnel syndrome (CTS) costs more than $2 billion annually in the United States. Considered the most common nerve entrapment in the arm, CTS results in less work productivity and other healthcare costs. Surgery is most often recommended to treat CTS, perhaps because of limited evidence supporting nonsurgical treatments such as exercise and mobilization. A recent study found that compared to surgery, manual therapy (such as desensitization of the central nervous system) resulted in better short-term outcomes and similar long-term effects on pain intensity and function. This study compares healthcare costs between manual therapy and surgery in women with CTS.


Women younger than 65

Diagnosed with CTS based on clinical and electrophysiological findings

Must have had symptoms for at least 12 months


Alongside a randomized clinical trial in a hospital in Madrid, Spain, the researchers performed an economic evaluation to determine the cost-effectiveness of surgery versus manual physical therapy. Patients were randomly assigned to receive either manual physical therapy or a surgical procedure. Those in the manual physical therapy group received three 30-minute sessions once a week, with soft tissue mobilization at areas where the median nerve may be entrapped, lateral glides to the neck, and tendon- and nerve-glide exercises (which patients were also taught to do at home). Those in the surgery group had open or endoscopic release of the carpal tunnel and the same home exercises on tendon- and nerve-glides the manual physical therapy group received.

Economic Evaluation

For the economic evaluation, the researchers looked at direct healthcare costs, direct non-healthcare costs, and indirect costs due to CTS. For direct healthcare costs, they looked at the costs of each treatment (such as the number of sessions, number of visits to manual physical therapists), additional visits to healthcare providers, additional treatments received, prescribed medications, and professional home care. For direct non-healthcare costs, they looked at costs of over-the-counter medications, time spent visiting a healthcare provider, and travel expenses. They also looked at indirect costs of lost productivity due to CTS-related absence from work.


The researchers also measured health-related quality of life at baseline and at each follow-up period.


The researchers found the surgery group was significantly more expensive than the manual physical therapy group. Additionally, patients in the surgery group also received a greater number of other treatments, mostly complementary manual physical therapy, and also made more visits to their orthopaedic surgeon and/or neurologist than those in the manual physical therapy group.

Missing paid work was significantly higher within the surgery group than in the manual physical therapy group, both in terms of the number of people missing work (86.7% vs. 6.9%) and the number of days off from work (mean, 65 versus 28 days; total, 3360 vs. 112 days).

Mean cost (including work absence) was €12,147 for manual physical therapy and €167,143 for surgery. Similarly, mean cost per participant (including work absence) was statistically higher in the surgery group than in the manual physical therapy group (€2785 versus €209, P<.001).


The researchers found that manual physical therapy group was less costly (€−154,996) and more effective (5.844 Quality-Adjusted Life Years) than the surgery group.


The results showed that manual physical therapy was more cost-effective than surgery, and healthcare costs and missed work within the surgery group were significantly greater than in the manual physical therapy group.

The generalizability of the results may be limited, as only women from a single hospital in Spain were included and the study was conducted in a particular health system. However, the study suggests that manual physical therapy, including desensitization of the central nervous system, may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to, or instead of, surgery.

Here at Physical Therapy First, we perform a complete evaluation to try to figure out what is the underlying cause of every patient’s symptoms. We may examine any or all of the following: range of motion, strength, muscle imbalances, joint mobility, functional movement, posture, and more. Based on those findings, we create custom treatment plans to reduce symptoms and help our patients return to living a full and healthy life. Just as the study suggests, some of our treatments may include soft tissue mobilization and neural desensitization, as well as other interventions such as muscle strengthening and stretching, improving posture, and creating a home exercise program.

Original article:

Fernández-De-Las-Peñas, C., Ortega-Santiago, R., Díaz, H. F., Salom-Moreno, J., Cleland, J. A., Pareja, J. A., & Arias-Buría, J. L. (2019). Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy,49(2), 55-63. doi:10.2519/jospt.2019.8483

Peñas, C. F., Ortega-Santiago, R., Llave-Rincón, A. I., Martínez-Perez, A., Díaz, H. F., Martínez-Martín, J., . . . Cuadrado-Pérez, M. L. (2015). Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial. The Journal of Pain,16(11), 1087-1094. doi:10.1016/j.jpain.2015.07.012