Effectiveness of low-level laser therapy combined with an exercise program to reduce pain and increase function in adults with shoulder pain: a critically appraised topic.

CLINICAL SCENARIO Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including Subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM). Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear. FOCUSED CLINICAL QUESTION Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?