MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Low-level laser therapy has been used clinically to treat musculoskeletal pain; however, there is limited evidence available to support its use. The current Cochrance review fails to be positive: there are insufficient data to draw firm conclusions on the clinical effect of LLLT for low‐back pain. So, perhaps studies on animals generate clearer answers?

The objective of this study was to evaluate the clinical effectiveness of low-level laser therapy and chiropractic care in treating thoracolumbar pain in competitive western performance horses. The subjects included 61 Quarter Horses actively involved in national western performance competitions judged to have back pain. A randomized, clinical trial was conducted by assigning affected horses to either:

  • laser therapy,
  • chiropractic,
  • or combined laser and chiropractic treatment groups.

Low-level laser therapy was applied topically to local sites of back pain. The laser probe contained four 810-nm laser diodes spaced 15-mm apart in a square array that produced a total optical output power of 3 watts. Chiropractic treatment was applied to areas of pain and stiffness within the thoracolumbar and sacral regions. A single application of a high velocity, low-amplitude (HVLA) manual thrust was applied to affected vertebral segments using a reinforced hypothenar contact and a body-centered, body-drop technique. The HVLA thrusts were directed dorsolateral to ventromedial (at a 45° angle to the horizontal plane) with a segmental contact near the spinous process with the goal of increasing extension and lateral bending within the adjacent vertebral segments. If horses did not tolerate the applied chiropractic treatment, then truncal stretching, spinal mobilization, and the use of a springloaded, mechanical-force instrument were used as more conservative forms of manual therapy in these acute back pain patients.

Outcome parameters included a visual analog scale (VAS) of perceived back pain and dysfunction and detailed spinal examinations evaluating pain, muscle tone, and stiffness. Mechanical nociceptive thresholds were measured along the dorsal trunk and values were compared before and after treatment. Repeated measures with post-hoc analysis were used to assess treatment group differences.

Low-level laser therapy, as applied in this study, produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness. Combined laser therapy and chiropractic care produced similar reductions, with additional significant decreases in the severity of epaxial muscle hypertonicity and trunk stiffness. Chiropractic treatment by itself did not produce any significant changes in back pain, muscle hypertonicity, or trunk stiffness; however, there were improvements in trunk and pelvic flexion reflexes.

The authors concluded that the combination of laser therapy and chiropractic care seemed to provide additive effects in treating back pain and trunk stiffness that were not present with chiropractic treatment alone. The results of this study support the concept that a multimodal approach of laser therapy and chiropractic care is beneficial in treating back pain in horses involved in active competition.

Let me play the devil’s advocate and offer a different conclusion:

These results show that horses are not that different from humans when it comes to responding to treatments. One placebo has a small effect; two placebos generate a little more effects.

42 Responses to Low-Level Laser Therapy and Chiropractic Care for Back Pain in Quarter Horses

  • They are given undue deference being referred to as “authors”. Crackpots, idiots, liars or frauds would have been more accurate. Of course using “Chiropractic” in the title of any “study” suggesting efficacy conveys that to anyone who isn’t a horses’ ass.

    • @Michael Kenny
      Ring the chiropractic bell and you again respond with unprofessional comments coming from a physiotherapist.
      Have any of you bothered to check the Researchgate profiles of any of the authors?
      Their backgrounds, research etc?
      Might be a good idea.

      • Ring the chiropractic bell and you again respond with unprofessional comments coming from a physiotherapist.

        You sound triggered. Serves you right for being part of a dangerously dishonest unprofession.

        • @has
          “dangerously dishonest unprofession.”
          You really are seriously out of touch.
          Maybe its time to keep up with all the research and not just the cherry picked, bias fulfilling papers in this echo chamber.

          • “Maybe its time to keep up with all the research”

            You don’t have any research, just the usual BS customer satisfaction surveys, and your entire system of “medicine” is the standard “One True Cause and Cure” nonsense of AltMed modalities, cooked up by a known serial fraudster as a more popular—and no doubt more profitable—successor to his earlier “magnetic healing” scam.

            And if you really possessed a Critical bone in your body you would admit all this and retrain as a physiotherapist, which is an honest profession with a science-based foundation and no delusions of competence outside its lane. But since you’re a fraud like the rest I suggest you just go twist one instead. C2 would be best.

          • Reading again about the dreadful case of Mr Lawler, via the newpaper article to which ‘has’ provided the link, I see that it says she studied at “Northwestern College of Chiropractic in Canada”.

            I cannot find that institution. The only place I can find with a similar name is in Minnesota, Minneapolis USA. DId the newspaper reporter make a mistake, or has the institution at which she studied since closed down?

            Mrs Scholten conceded that she was not entitled in British law to call herself “Doctor”. I think it seems difficult to believe that someone setting up in a medical practice would be that unaware of the law. If she was genuinely unaware, this surely argues strongly that she did not do “due diligence”, and that neither did (or do) the General Chiropractic Council.

          • @David B: Ah but what is “due dilligence” and “the law” when you can just invent whatever reality suits you?

            (Obligatory.)

          • I liked the Simpsons clip. Specific to Chiropractic, there is also this, from Family guy: https://youtu.be/qTtNFEMPktU

            And this: https://youtu.be/LXvFpYkHQ54

            And perhaps best of all, this: https://youtu.be/y9wwN98N6yw

          • @has
            You are entertaining.
            The irony that you are stuck in 1910 with the vitalistic chiropractors and use identical arguments seems to escape you.
            Carpet bombing critics making sweeping statements are a staple of this forum.
            The regulars here have invested so much time in one extreme view that they are incapable of change.
            That’s human nature and not surprising.
            I realized this years ago and the only reason I come on this blog/echo chamber is to engage with all the other people lurking and reading this. Put both sides into the public record and let those reading this make up their own mind.
            BTW you should go on the Physiotherapy site SomaSimple and have a read.
            Physio has all the issues that chiropractic has but not the critics. The regulars on SomaSimple lament that they are lone voices in the wilderness.
            Your assumptions in regards to physiotherapy are gold.

          • “The irony that you are stuck in 1910 with the vitalistic chiropractors and use identical arguments seems to escape you.”

            Those 1910 vitalistic chiropractors form a large part of your profession today. That you’ve failed to disassociate them says everything about you.

          • @has
            Again showing your out of touch with events “today”.
            Suggest you start here:
            https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00312-x
            As of “today” 170+ chiro PhD’s have now added their name to this statement.
            Research from several countries have shown that vitalists make up around 15-18% of the profession (“large part”? No but still an unacceptable fringe element) and yes we should disassociate/excise them as is discussed in this paper here:
            https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0221-z

            Sweeping statement by cynics like yourself do not help reform and the PhD’s above become unacceptable collateral damage. That hinders reform.
            Happy to discuss the issues within my profession with critics but you need to be more targeted AND support the reformers which is lacking on this blog.

            BTW please read the red banner at the top of this page.

        • “As of “today” 170+ chiro PhD’s have now added their name to this statement.”

          170 signatures in 6 months? Holy heck, and we laugh at the homeopaths for their lack of perspective.

          Hell, the so-called “Great Barrington Declaration” probably has 170 signatures just from “Dr M. Mouse” alone, and it’s only been stumping a month.

          But okay, sure, whatever; you let us know when your mighty petition succeeds in reforming chiropracty into a legitimate science-based medical practice†. You’ll forgive us though if we don’t hold our breath.

          (†Which is not entirely impossible: see Osteopathy in the US, though why they don’t just formally convert it to an MD and avoid the confusion with Osteoquackery as it still exists everywhere else I don’t know.)

          • @uncriticalquaker: The most interesting thing regarding the defense levied by quacks such as yourself (and anyone else willing to paste a DC or ND after their name) is that you have no choice but to vociferously defend yourselves and your pseudo religious profession since you cannot leverage that faux degree into another job…NO ONE hires a DC (UBER may, but you get no advantage having spent $150000 on your “education”). You either screw the gullible public out of cash (or defraud an insurance company) OR you separate yourself from Chiroquackery and work somewhere. You can’t move the DC degree into a university position, a drug company, a hospital, nursing facility, the military (unless you’re doing bogus research under a waste-of-taxpayers money ‘grant’). Yes indeed you need to protect the tiny bit of turf you carve out a living on…or you disappear. You should be very proud of your profession. Now go and thrust on some injured tissue and tell yourself you hold a substantial place in human health care.

          • @has
            Your cynicism is showing just a bit. 😉

            @Michael Kenny
            Your unprofessional spray for a physiotherapist again shows how out of touch you truly are.
            “NO ONE” Nice shout but wrong as usual.
            There are chiro’s here in 4 university faculties, aged care, drug companies, private hospitals etc.
            Nothing personal but I would not like to work in a public hospital as I know what physio’s in private practice think of them as well as doctors and nurses within those hospitals. Also their work conditions are less than ideal and most burn out and leave after a few years to go into private practice or quit the profession.
            BTW I work in a medical centre, most of my referrals are from doctors and I have a good referral network of physio’s, GP’s, neurosurgeons, orthopods, exercise physiologists etc (must be my salesmanship and they are all gullible). I also teach one day a week in university.

          • I hope this university and medical centre advertise they embrace pseudoscience.

          • what subject to you teach?

          • https://www.webpt.com/blog/post/pessimism-and-the-pt-why-were-unhappy-and-where-we-must-go-from-here/

            “We need to call a spade a spade, and admit that with each passing year, a career in physical therapy is becoming a worse financial investment. And with many PT leaders talking about burnout, but not doing much to improve it—productivity requirements are still increasing, and documentation demands are still mounting—PT isn’t the best investment for long-term health and happiness, either.”

          • @DC: So what’s your point? “Overworked and underpaid” seems to be a common theme in real medicine, but that is orthogonal to questions of efficacy.

            All you’re really doing is making our case that AltMed is where the neurotic well with way more money than sense goes to get their egos specially pampered. Which I’m guessing is not what you intended.

      • Physiotherapy like this “shake, bake and fake”. In new Zealand, physiotherapists last in practice seven years before they give up. Perhaps Michael Kenny could tell us why?

        https://www.rnz.co.nz/news/national/429044/physiotherapists-claimed-acc-fees-for-treating-each-other-and-family?fbclid=IwAR3kF0Pcedd3jAsImgkBXtiMHiI2rshF8Fjy8p1UChNWR6wZzaNAkFBZSkc

        • @gibletgiblet: I would suggest most PT and virtually all of Chiroquackery i.e. thrusting on injured tissue with the faith-based assumption it “fixes” something….are based on the same erroneous premise. You can’t “treat” away another persons pain via hand or gizmos. Most of the time It should NOT be paid for by public healthcare insurance and false and misleading advertising should have severe consequences. MacKenzie famously pointed out at least 70% of PT treatments are of no real value, and manipulation shouldn’t be dispensed to the entire population to find the very few who might actually benefit. Research has suggested PT for LBP is typically a net loss in terms of cost-to-benefits….And Professor Menche suggested therapeutic intervention in acute MSK alters the natural outcome in 3% of cases. Burn out happens in all professions but when you have all the stresses of active practice IN ADDITION to having to lie, falsify and overstate your outcomes and recommendations (and if you are disposed to being inherently honest) the stress accumulates much quicker, fueling self doubt, guilt and burnout.

          • @Michael Kenny
            Good reply.
            Then you have Louis Gifford (physio) whose books blew my mind when they came out and made me reevaluate how I practice years ago. Additionally, you have the collaborative work of Liebenson, Cook and Gray and the legacy of the Prague school of medicine that while all interesting and relevant to modern practice does have a cult feel to it. Not to be questioned.

            Even Robin McKenzie, whose rehab I also use (among others though there is no one approach I like or use 100%), suffers from groupies and acolytes and we both refer to them as “McKenzieites”. The BS within physio matches chiro on so many levels its astonishing. Chiro subluxation or physio dysfunction it’s all the same. I have also had long conversations with physio researchers and academics and if both professions follow the science then we should essentially be heading down the same path. As expected though, there are vested interests in both professions who are resistant to change/reform.

            BTW one of my favorite things I like to say to my final year students is “the most important adjustment you can give a patient is north of their atlas and I don’t mean the upper cervical spine”.

  • Hold on, I feel another limerick coming on….

    Ah yes, here it is:

    Not all that it’s cracked up to be,
    Equine chiro is quite hard to see;
    Is adjusting the trunk
    Just egregious bunk
    And do lasers improve things, reallee?

  • Can’t they just objectively measure the subluxation?

  • Poor pones. Horse people are notoriously nuts.

    • As are some of the vets that treat them. I knew a vet that worked for/preyed on racing horse trainers. Every treatment with real medicine was accompanied by a homeopathic and a nice extra earner on the bill.

  • “… that produced a total optical output power of 3 watts”

    I was under the impression that:
    low-level laser therapy is less than 500 mW (Class 3B lasers);
    high-level laser therapy is 500 mW and above (Class 4 lasers).

    • correct: low-level laser therapy normally involves less than 100-200 mW

      • The energy in light from low level lasers is physiologically negligible. It’still just light,even if it is collimared and it dissipates in the surface tissues long before it reaches fascia or muscle, making any use for musculosceletal problems extremely unlikely. Conclusion: A gimmick supported by fairytales and tooth-fairy science.

  • Brennen McKenzie VMD has looked in depth at both low level laser and veterinary chiropractic:

    https://skeptvet.com/Blog/?s=low+level+laser
    https://skeptvet.com/Blog/?s=chiropractic

  • “If horses did not tolerate the applied chiropractic treatment, ” I hope they kicked the quacks out of the paddock. These sports modalities are notoriously dangerous for horses, as well as being a waste of their time. “Treating” the resultant back pain with nonsense is literally adding insult to injury.

  • Critical_Chiro wrote on Wednesday 28 October 2020 at 23:13 “The regulars here have invested so much time in one extreme view”

    @ Critical_Chiro

    Yes, it’s a great public service that they freely give – i.e. spending time and energy on repeatedly explaining the science and outing the pseudoscience.

    • @Blue Wode
      Perhaps this is more accurate:
      “Yes, it’s a great public service that they freely give – i.e. spending time and energy repeatedly cherry picking the science to fit their bias, intentionally ignoring the researchers/research that they “highly regard” who challenges their bias and outing the pseudoscience.”
      This says it all:
      https://edzardernst.com/2017/04/we-have-an-ethical-legal-and-moral-duty-to-discourage-chiropractic-neck-manipulations/
      “Charlotte Leboeuf-Yde, DC,MPH,PhD, is professor in Clinical Biomechanics at the University of Southern Denmark and works at the French-European Institute of Chiropractic in Paris. She is a chiropractor with extensive research experience, for example, she was one of the first chiropractors to have studied adverse reactions of spinal manipulation.
      Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting.”
      “I have always thought highly of Charlotte’s work” yet Edzard has not written about her research or supported it until he could take issue with two sentences in a BLOG then wrote a BLOG in response.
      Critics both within and without the chiropractic profession are a precious resource and I am happy to engage with both.
      BUT there is a difference between a critic and a cynic.
      Michael Kenny’s comments above are a classic example of the later and also unprofessional coming from a physiotherapist.

      • Critical_Chiro wrote: “spending time and energy repeatedly cherry picking the science to fit their bias”

        I wonder where we’ve seen that before…
        http://www.dcscience.net/2009/06/18/british-chiropractic-association-produces-its-plethora-of-evidence/

        • @Blue Wode
          Citing a blog from 2009?
          Your way out of date old boy.
          Have to admit that some chiropractors cherry pick with the best to support their marketing/proprietary technique ™/foolosophy.
          I don’t remain silent with them either.

          • Critical_Chiro wrote: “Citing a blog from 2009? Your way out of date old boy.”

            @ Critical_Chiro

            Do you have any better data than those contained in that DC Science piece?

            And if blogs are such anathema to you, why are you here on this blog (feebly attempting to defend the chiropractic industry)?

          • I’m sure Prof Ernst has no objections to you citing here the full body of high-quality chiropractic research published since 2009, along with your own conclusions distilled from that. 10 years should be plenty time for your profession to learn how to build a robust evidence base instead of punching itself in the nuts.

          • @BW
            The BCA papers quoted in that blog would not be my choice.
            I’m not on this blog for your benefit. I’m here to engage with everyone reading this.

            @MK
            Yep. Agree and Richard Brown should have been fired after that debacle.
            The chiropractic profession does have a track record of shooting itself in the foot. 😉

            My research library consists of over 6000+ articles sorted into 170 odd folders. Which topic interests you? Best perk of teaching one day a week is access to all the journals and online content for free through the uni library. Their from many professions not just chiro. If it is good and improves the way I practice I will take it on board.

            For adverse events start with the work of Charlotte Leboeuf-Yde.
            Additionally:
            Peirre Cote, David Cassidy, Jan Hartvigsen, Luc Aillet, Greg Kawchuk, Carlo Ammendolia, Iben Axen, Philip S. Bolton, Alan Breen, Gert Bronfort, Jason W. Busse, David Byfield, Carol Cancelliere, Diana De Carvalho, Roni Evans, Jonathan Field, Simon French, Christine Goertz, Scott Haldeman, Hazel Jenkins, Tue Secher Jensen, Melker Johhansson, Alice Kongsted, Deborah Kopansky-Giles, David McNaughton, Sidney Rubinstein, André Bussières, Silvano Mior, Michael Schneider

          • Apologies @has not @MK.

  • 1. Pain in horses is a very observer dependeent and subjective measure that should be a blinded, independent evaluation in any trial involviing paiin therapy in animals.
    2. Low-level laser is by definition so weak that it cannot possibly penetrate the fur and thick skin of a horse.
    3. Low-level laser light is only light. Even if it is collimated and monochromatic, it does not do anything more than sunlight that contains the same colour band, probably less effective.

  • Critical_Chiro wrote: “@BW The BCA papers quoted in that blog would not be my choice. I’m not on this blog for your benefit. I’m here to engage with everyone reading this.”

    @ Critical_Chiro

    What papers would be your choice (i.e. ‘paediatric’ chiropractic ones)? Please provide citations/links.

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