Traditional treatment options include eccentric strengthening protocols, watchful waiting, corticosteroid injections, and nonsteroidal anti-inflammatory drugs (NSAIDS). Unfortunately, these common treatments rarely offer lasting pain relief. Epicondylitis is a self-limiting condition that usually resolves over a 12-18 month period. Substantial evidence is lacking for traditional treatments, which leaves many patients suffering through an 18 month course of disease. For example, there is limited evidence to support the use of eccentric exercise over splinting, massage, or concentric exercise. Corticosteroid injections and NSAIDs offer short term pain relief, but do not resolve patients concerns in the long term. Watchful waiting, i.e. wait for symptoms to run their course, was shown as effective as physiotherapy and more effective than corticosteroids over a 52 week period.¹ Alternatively, the regenerative potential of laser therapy has been shown to decrease pain and increase functionality in recent studies.

We looked at several studies evaluating the use of laser therapy to treat lateral and medial epicondylitis. While study design and dosage varied, outcomes consistently favored the treatment groups. A placebo controlled study involving 39 patients found favorable pain and functionality outcomes by administering .0275 J per tender point with a 904 nm wavelength laser over 9 sessions.² Another placebo controlled study involving 50 patients found statistically significant improvements in pain with resisted wrist extension, tenderness, and functionality scores after 15 sessions with a 905 nm wavelength laser.³ Favorable results were again observed in a large-scale placebo controlled study with 324 patients; total relief of pain was observed in 82% of patients with acute epicondylitis.⁴ And finally handgrip strength was improved and pain with extension decreased over 8 sessions with a Class IV laser.⁵

Near infrared light penetrates tissues and interacts with the mitochondrial membrane where the electron transport chain unfolds. The fourth complex of the electron transport chain contains a known photoreceptor, cytochrome c oxidase (CcOX). CcOX regularly bonds to nitric oxide (NO), which slows adenosine triphosphate (ATP) production. When light interacts with CcOX, the bond with NO dissociates leading to vasodilation. Additional blood flow increases tissue repair via the migration of tendocytes which rebuild the extracellular matrix within the elbow. Thus the non-invasive application of near infrared light increases the body’s capacity to repair damaged tissues and has been shown to decrease pain while increasing functionality in patients with lateral and medial epicondylitis.