Clinical Features: A 77-year-old female with bilateral total knee replacement (TKR) and total hip replacement (THR) presented using a walker for gait assistance and in obvious distress. She reported constant pain levels of 3 to 10 out of 10, with sharp pain across the lower back, buttocks, and posterior hips. The symptoms originally began 9 months prior, following left THR. Five epidural steroid injections failed to significantly reduce pain levels. Oxycodone was minimally effective in reducing her pain. MRI revealed L4-5 grade 1 anterolisthesis, with moderate-to-severe right foramen stenosis, mild central stenosis, and L5-S1 disc protrusion abutting the thecal sac and right S1 nerve root, establishing multiple potential pain generators.
Intervention and Outcome: Initially, the only modality utilized was the K-laser 10d Class IV therapeutic laser. Dosage was set at 9 to 10 W, continuous wave and pulsed at variable frequencies from 2 to 10,000 Hz, for each 6-to-10-minute treatment session. A 400-to-900-cm2 area of the lower lumbar and gluteal regions received 1,600 to 3,300 J total per treatment for a 1.8 to 8.2 average J/cm2. Eleven treatments in a 9-week period resolved pain on the left side and reduced the pain scale report on the right side by 50%. Prone diversified-type manual manipulation of the bilateral SI restriction was performed on the 4th visit. Pre–adjustment pressure along the intended line of drive produced no pain referrals, and no extension of the lumbar spine was permitted. This treatment was reported as aggravating and discontinued at the patient’s request. No other interventions were employed, and the patient was asked to increase physical activity as tolerated. Progressive reductions in pain allowed her to be more active, improving range of motion and general conditioning through adding activities of daily living that had been previously intolerable.
Conclusion: Class IV laser therapy may be a treatment option in patients with chronic multi-factorial low-back pain, possibly allowing for earlier active intervention and return to ADLs. Natural history influence on improvement cannot be excluded as a contributory factor in symptom reduction in this case study. Since laser therapy was initiated 9 months post-injury with ongoing symptoms, the amount of contribution is uncertain. More controlled studies with high-power laser therapy and significantly greater total doses than are possible with Class II and III lasers are necessary for a broader understanding of this emerging modality.
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