Laser Therapy for Patellar Tendinopathy
Laser therapy (low-level laser therapy/LLLT) is not recommended for patellar tendinopathy, as it provides no clinically meaningful benefit beyond placebo and is inferior to established first-line treatments like eccentric exercise.
Evidence Against Laser Therapy
The available evidence demonstrates that LLLT lacks clinical utility for patellar tendinopathy:
A 2016 systematic review found that although LLLT may reduce pain from baseline measurements, it performs no better than placebo treatment and shows no advantage over standard therapies including ultrasound, moist heat, electrical stimulation, or therapeutic exercise 1
The American Family Physician guidelines for patellar tendinopathy treatment make no mention of laser therapy among recommended interventions, notably excluding it from their evidence-based treatment algorithm 2
Recommended First-Line Treatment Instead
Rather than pursuing laser therapy, implement the following evidence-based approach:
Primary Treatment (Start Immediately)
Eccentric strengthening exercises are the cornerstone intervention with the strongest available evidence - they reduce symptoms, increase strength, and promote tendon healing by stimulating collagen production and guiding proper collagen fiber alignment 2, 3, 4
Implement relative rest by reducing repetitive loading activities (jumping, stair climbing) while maintaining general activity to prevent muscle atrophy and deconditioning 2, 3
Pain Management Adjuncts
NSAIDs (oral or topical) provide short-term pain relief but do not alter long-term outcomes - topical formulations eliminate gastrointestinal hemorrhage risk 2, 3
Cryotherapy through a wet towel for 10-minute periods provides effective acute pain relief 2, 3
Deep transverse friction massage reduces pain and may provide additional benefit 2, 3
Secondary Options (If First-Line Fails After 6-12 Weeks)
Corticosteroid iontophoresis (not direct injection) is effective for pain and function improvement 2, 3
Extracorporeal shock wave therapy (ESWT) is safe and noninvasive but has mixed evidence - a 2021 network meta-analysis showed no superiority over sham ESWT when both groups performed eccentric exercise 5
Critical Pitfalls to Avoid
Never inject corticosteroids directly into the tendon substance - this inhibits healing, reduces tensile strength, and predisposes to spontaneous rupture 2, 3, 6
Avoid complete immobilization - this causes muscular atrophy and deconditioning 2, 3, 6
Do not proceed to surgery without 3-6 months of well-managed conservative treatment 3, 6, 7
Expected Outcomes
Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment centered on eccentric exercise 3, 6
A 2012 systematic review identified "strong evidence" for eccentric training as the treatment of choice, while other modalities including ultrasound (similar mechanism to laser) showed no benefit 4
Why Laser Therapy Fails
The theoretical mechanism of LLLT involves increasing cellular respiration and metabolism through mitochondrial cytochrome activation, potentially increasing blood flow 1. However, this theoretical benefit does not translate to clinically meaningful outcomes when compared to placebo or established treatments 1. The total accumulated joules across treatment sessions may be a relevant parameter, but no dosing protocol has demonstrated superiority over standard care 1.