ORIGINAL PAPER
High-intensity laser therapy and stretching exercises for chronic non-specific neck pain: a feasibility study
1
Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
2
Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
Submission date: 2025-06-04
Acceptance date: 2025-09-01
Online publication date: 2026-05-27
Corresponding author
Hernán Andrés de la Barra Ortiz
Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, Las Condes, Santiago, Chile, Postal code: 7591538
Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, Las Condes, Santiago, Chile, Postal code: 7591538
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Chronic nonspecific neck pain (CNNP) is a prevalent musculoskeletal disorder that negatively impacts quality of life. High-intensity laser therapy (HILT) has shown promise as a therapeutic resource for managing musculoskeletal pain. This study aimed to evaluate the feasibility, participant adherence, implementation, and safety of a HILT protocol to inform the design of a future randomised clinical trial.
Methods:
This clinical trial included 21 patients with CNNP, who received two weekly sessions of HILT combined with stretching exercises over four weeks. Primary outcomes included resting pain intensity (RPI), movement pain intensity (MPI), pain pressure threshold (PPT), and neck disability (NDI). Secondary outcomes included cervical range of motion (CROM). Assessments were performed at baseline, post-treatment, and one-month follow-up. Statistical analysis included Shapiro–Wilk for normality, Friedman and Wilcoxon tests for repeated measures, and Cohen’s d for effect sizes.
Results:
Significant improvements were observed in RPI (d = 1.7–1.8) and MPI (d = 1.2–1.4; both p < 0.01), with average pain reductions of 2.6 and 1.8 points (CI 95%:1.9,3.2), respectively, and an average increase in PPT of 1.9 lb (CI 95%:1.5,2.4) (p < 0.05, d = 0.5–1.7). Subgroup analysis showed greater improvements in men, particularly for MPI and PPT. Post-treatment, a mean reduction of 6.5 (CI 95%:5.8,7.2) points in NDI (d = 1.4–1.5, p < 0.01) was observed, with women showing a larger reduction. CROM improved significantly only for flexion and left-side bending (p < 0.05).
Conclusions:
HILT was safe, feasible, and potentially effective in reducing pain and disability in individuals with CNNP. High adherence and absence of adverse events support clinical applicability. Further randomised trials are needed to confirm its efficacy and compare it with other treatments.
Chronic nonspecific neck pain (CNNP) is a prevalent musculoskeletal disorder that negatively impacts quality of life. High-intensity laser therapy (HILT) has shown promise as a therapeutic resource for managing musculoskeletal pain. This study aimed to evaluate the feasibility, participant adherence, implementation, and safety of a HILT protocol to inform the design of a future randomised clinical trial.
Methods:
This clinical trial included 21 patients with CNNP, who received two weekly sessions of HILT combined with stretching exercises over four weeks. Primary outcomes included resting pain intensity (RPI), movement pain intensity (MPI), pain pressure threshold (PPT), and neck disability (NDI). Secondary outcomes included cervical range of motion (CROM). Assessments were performed at baseline, post-treatment, and one-month follow-up. Statistical analysis included Shapiro–Wilk for normality, Friedman and Wilcoxon tests for repeated measures, and Cohen’s d for effect sizes.
Results:
Significant improvements were observed in RPI (d = 1.7–1.8) and MPI (d = 1.2–1.4; both p < 0.01), with average pain reductions of 2.6 and 1.8 points (CI 95%:1.9,3.2), respectively, and an average increase in PPT of 1.9 lb (CI 95%:1.5,2.4) (p < 0.05, d = 0.5–1.7). Subgroup analysis showed greater improvements in men, particularly for MPI and PPT. Post-treatment, a mean reduction of 6.5 (CI 95%:5.8,7.2) points in NDI (d = 1.4–1.5, p < 0.01) was observed, with women showing a larger reduction. CROM improved significantly only for flexion and left-side bending (p < 0.05).
Conclusions:
HILT was safe, feasible, and potentially effective in reducing pain and disability in individuals with CNNP. High adherence and absence of adverse events support clinical applicability. Further randomised trials are needed to confirm its efficacy and compare it with other treatments.
REFERENCES (61)
1.
Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, Kolahi A-A, Safiri S. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 2022;23(1):26; doi: 10.1186/s12891-021-04957-4.
2.
Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284–99; doi: 10.1016/j.mayocp.2014.09.008.
3.
Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del-Moral O, Pacheco-da-Costa S, Prieto-Merino D, Sánchez-Sánchez B. Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health Qual Life Outcomes. 2018;16(1):207; doi: 10.1186/s12955-018-1032-6.
4.
Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del Moral O, Sánchez-Sánchez B, Dommerholt J, Gutiérrez-Ortega C. Prevalence of myofascial pain syndrome in chronic non-specific neck pain: A population-based cross-sectional descriptive study. Pain Med. 2016;17(12):2369–77; doi: 10.1093/pm/pnw114.
5.
Ortego G, Villafañe JH, Doménech-García V, Berjano P, Bertozzi L, Herrero P. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res. 2016;90:70–81; doi: 10.1016/j.jpsychores.2016.09.006.
6.
Opara M, Kozinc Ž. Which muscles exhibit increased stiffness in people with chronic neck pain? A systematic review with meta-analysis. Front Sports Act Living. 2023;5:1172514; doi: 10.3389/fspor.2023.1172514.
7.
Bernal-Utrera C, Gonzalez-Gerez JJ, Anarte-Lazo E, Rodriguez-Blanco C. Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial. Trials. 2020;21(1):682; doi: 10.1186/s13063-020-04610-w.
8.
Castellini G, Pillastrini P, Vanti C, Bargeri S, Giagio S, Bordignon E, Fasciani F, Marzioni F, Innocenti T, Chiarotto A, Gianola S, Bertozzi L. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother. 2022;68(4):244–54; doi: 10.1016/j.jphys.2022.09.007.
9.
Huang J-F, Meng Z, Zheng X-Q, Qin Z, Sun X-L, Zhang K, Tian H-J, Wang X-B, Gao Z, Li YM, Wu A-M. Real-world evidence in prescription medication use among U.S. adults with neck pain. Pain Ther. 2020;9(2):637–55; doi: 10.1007/s40122-020-00193-1.
10.
Fredin K, Lorås H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;31:62–71; doi: 10.1016/j.msksp.2017.07.005.
11.
Martimbianco ALC, Porfírio GJ, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst Rev. 2019;12(12):CD011927; doi: 10.1002/14651858.CD011927.pub2.
12.
Häkkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med. 2007;39(7):575–9; doi: 10.2340/16501977-0094.
13.
Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374(9705):1897–908; doi: 10.1016/S0140-6736(09)61522-1.
14.
de la Barra Ortiz HA, Arias M, Liebano RE. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain. Lasers Med Sci. 2024;39(1):124; doi: 10.1007/s10103-024-04069-0.
15.
Clijsen R, Brunner A, Barbero M, Clarys P, Taeymans J. Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2017;53(4):603–10; doi: 10.23736/S1973-9087.17.04432-X.
16.
de la Barra Ortiz HA, Parizotto N, Arias M, Liebano R. Effectiveness of high-intensity laser therapy in the treatment of patients with frozen shoulder: a systematic review and meta-analysis. Lasers Med Sci. 2023;38(1):266; doi: 10.1007/s10103-023-03901-3.
17.
Chow RT, David MA, Armati PJ. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst. 2007;12(1):28–39; doi: 10.1111/j.1529-8027.2007.00114.x.
18.
de la Barra Ortiz HA, Avila MA, Miranda LG, Liebano RE. Effect of high-intensity laser therapy in patients with non-specific chronic neck pain: study protocol for a randomized controlled trial. Trials. 2023;24(1):563; doi: 10.1186/s13063-023-07599-0.
19.
Arroyo-Fernández R, Aceituno-Gómez J, Serrano-Muñoz D, Avendaño-Coy J. High-intensity laser therapy for musculoskeletal disorders: a systematic review and meta-analysis of randomized clinical trials. J Clin Med. 2023;12(4):1479; doi: 10.3390/jcm12041479.
20.
Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):00068; doi: 10.15406/mojor.2015.02.00068.
21.
Alayat MS, Elsodany AM, Miyajan AF, Alzhrani AA, Alzhrani HMS, Maqliyah AM. Changes in local skin temperature after the application of a pulsed Nd:YAG laser to healthy subjects: a prospective crossover-controlled trial. Lasers Med Sci. 2019;34(8):1681–8; doi: 10.1007/s10103-019-02769-6.
22.
Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophys. 2007;43(1):79–89.
23.
Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, Gianola S, Ferrante S, Zanoli G, Moja L. Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database Syst Rev. 2015;2015(5):CD010664; doi: 10.1002/14651858.CD010664.pub2.
24.
Hopewell S, Chan A-W, Collins GS, Hróbjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson D, Vohra S, White IR, Boutron I. CONSORT 2025 statement: updated guideline for reporting randomized trials. Nat Med. 2025;31(6):1776–83; doi: 10.1038/s41591-025-03635-5.
25.
Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021;18:17; doi: 10.3352/jeehp.2021.18.17.
26.
Dundar U, Turkmen U, Toktas H, Solak O, Ulasli AM. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double- blind, placebo-controlled study. Lasers Med Sci. 2015;30(1):325–32; doi: 10.1007/s10103-014-1671-8.
27.
Abdelbasset WK, Nambi G, Alsubaie SF, Abodonya AM, Saleh AK, Ataalla NN, Ibrahim AA, Tantawy SA, Kamel DM, Verma A, Moawd SA. A randomized comparative study between high-intensity and low-level laser therapy in the treatment of chronic nonspecific low back pain. Evid Based Complement Alternat Med. 2020;2020(1):1350281; doi: 10.1155/2020/1350281.
28.
Andrade C. Mean difference, standardized mean difference (SMD), and their use in meta-analysis: as simple as it gets. J Clin Psychiatry. 2020;81(5); doi: 10.4088/JCP.20f13681.
29.
Morton NA de. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129–33; doi: 10.1016/s0004-9514(09)70043-1.
30.
Peron R, Rampazo ÉP, Liebano RE. Traditional acupuncture and laser acupuncture in chronic nonspecific neck pain: study protocol for a randomized controlled trial. Trials. 2022;23(1):408; doi: 10.1186/s13063-022-06349-y.
31.
Peron R, Back CGN, Rampazo ÉP, Branco M, Ferraresi C, Liebano RE. Immediate effects of traditional and laser acupuncture in chronic non-specific neck pain: a randomized controlled clinical trial. Lasers Med Sci. 2024;39(1):291; doi: 10.1007/s10103-024-04235-4.
32.
Neck pain guidelines: Revision 2017: Using the evidence to guide physical therapist practice. J Orthop Sports Phys Ther. 2017;47(7):511–2; doi: 10.2519/jospt.2017.0507.
33.
Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64–72; doi: 10.1177/0269215515575747.
34.
Rampazo ÉP, de Andrade ALM, da Silva VR, Back CGN, Liebano RE. Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients: Study protocol clinical trial (SPIRIT Compliant). Medicine. 2020;99(8):e19191; doi: 10.1097/MD.0000000000019191.
35.
Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use?. Am J Emerg Med. 2018;36(4):707–14; doi: 10.1016/j.ajem.2018.01.008.
36.
Audette I, Dumas J-P, Côté JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010;40(5):318–23; doi: 10.2519/jospt.2010.3180.
37.
Andrade Ortega JA, Delgado Martínez AD, Ruiz RA. Validation of the Spanish version of the neck disability index. Spine. 2010;35(4):114–8; doi: 10.1097/brs.0b013e3181afea5d.
38.
MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39(5):400–17; doi: 10.2519/jospt.2009.2930.
39.
Rampazo da Silva ÉP, Silva VR, Bernardes AS, Matuzawa F, Liebano RE. Segmental and extrasegmental hypoalgesic effects of low-frequency pulsed current and modulated kilohertz-frequency currents in healthy subjects: randomized clinical trial. Physiother Theory Pract. 2021;37(8):916–25; doi: 10.1080/09593985.2019.1650857.
40.
Gupta A, Mishra P, Pandey C, Singh U, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1):67; doi: 10.4103/aca.aca_157_18.
41.
Pearson N, Naylor P-J, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for conducting feasibility and pilot studies for implementation trials. Pilot Feasibility Stud. 2020;6(1):167; doi: 10.1186/s40814-020-00634-w.
42.
Teresi JA, Yu X, Stewart AL, Hays RD. Guidelines for designing and evaluating feasibility pilot studies. Med Care. 2022;60(1):95–103; doi: 10.1097/MLR.0000000000001664.
43.
Reddy GK. Photobiological basis and clinical role of low-intensity lasers in biology and medicine. J Clin Laser Med Surg. 2004;22(2):141–50; doi: 10.1089/104454704774076208.
44.
Tobore TO. Towards a comprehensive theory of non-cancer acute and chronic pain management: the critical role of reactive oxygen and nitrogen species in pain, and opioid dependence, addiction, hyperalgesia, and tolerance. Adv Redox Res. 2021;2(100003):100003; doi: 10.1016/j.arres.2021.100003.
45.
Cheng K, Martin LF, Slepian MJ, Patwardhan AM, Ibrahim MM. Mechanisms and pathways of pain photobiomodulation: a narrative review. J Pain. 2021;22(7):763–77; doi: 10.1016/j.jpain.2021.02.005.
46.
Heijmans L, Mons MR, Joosten EA. A systematic review on descending serotonergic projections and modulation of spinal nociception in chronic neuropathic pain and after spinal cord stimulation. Mol Pain. 2021;17:17448069211043965; doi: 10.1177/17448069211043965.
47.
Bjordal JM, Lopes-Martins RAB, Joensen J, Iversen VV. The anti-inflammatory mechanism of low level laser therapy and its relevance for clinical use in physiotherapy. Phys Ther Rev. 2010;15(4):286–93; doi: 10.1179/1743288x10y.0000000001.
48.
Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, Mir MA, Cano A, Muriel A, Zamora J, Del Real MTG, Gestoso M, Mufraggi N; Spanish Back Pain Research Network. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008;9(1):43; doi: 10.1186/1471-2474-9-43.
49.
Choi JC, Park Y-H, Park SK, Lee JS, Kim J, Choi JI, Yoon KB, Lee S, Lim DE, Choi JY, Kim HM, Park G, Choi SS, Lee J-M. Testosterone effects on pain and brain activation patterns. Acta Anaesthesiol Scand. 2017;61(6):668–75; doi: 10.1111/aas.12908.
50.
Asimov MM, Asimov RM, Rubinov AN, Gisbrecht AI. The impact of myoglobin on the efficiency of the therapeutic effect of laser radiation. Acta Phys Pol A. 2013;124(1):151–4; doi: 10.12693/aphyspola.124.151.
51.
Failla MD, Beach PA, Atalla S, Dietrich MS, Bruehl S, Cowan RL, Monroe TB. Gender differences in pain threshold, unpleasantness, and descending pain modulatory activation across the adult life span: a cross sectional study. J Pain. 2024;25(4):1059–69; doi: 10.1016/j.jpain.2023.10.027.
52.
Stratton H, Lee G, Dolatyari M, Ghetti A, Cotta T, Mitchell S, Yue X, Ibrahim M, Dumaire N, Salih L, Moutal A, François-Moutal L, Martin L, Navratilova E, Porreca F. Nociceptors are functionally male or female: from mouse to monkey to man. Brain. 2024;147(12):4280–91; doi: 10.1093/brain/awae179.
53.
Smith AF, Plumb AN, Berardi G, Sluka KA. Sex differences in the transition to chronic pain. J Clin Invest. 2025;135(11):e191931; doi: 1172/JCI191931.
54.
Walton DM, Levesque L, Payne M, Schick J. Clinical pressure pain threshold testing in neck pain: comparing protocols, responsiveness, and association with psychological variables. Phys Ther. 2014;94(6):827–37; doi: 10.2522/ptj.20130369.
55.
Oliveira AK de, Dibai-Filho AV, Soleira G, Machado ACF, Guirro RR de J. Reliability of pressure pain threshold on myofascial trigger points in the trapezius muscle of women with chronic neck pain. Rev Assoc Med Bras. 2021;67(5):708–12; doi: 10.1590/1806-9282.20201149.
56.
Park SJ, Lee R, Yoon DM, Yoon KB, Kim K, Kim SH. Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain: a retrospective cross-sectional study. Medicine. 2016;95(37):e4698; doi: 10.1097/MD.0000000000004698.
57.
Churruca K, Pomare C, Ellis LA, Long JC, Henderson SB, Murphy LED, Leahy CJ, Braithwaite J. Patient-reported outcome measures (PROMs): a review of generic and condition-specific measures and a discussion of trends and issues. Health Expect. 2021;24(4):1015–24; doi: 10.1111/hex.13254.
58.
Moore A, Tumin D. Overlap of pain-related and general measures of disability among adults with chronic pain. Pain Pract. 2024;24(1):62–71; doi: 10.1111/papr.13281.
59.
Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JHB, Reneman MF. Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index. Eur Spine J. 2012;21(12):2550–7; doi: 10.1007/s00586-012-2407-8.
60.
Young BA, Boland DM, Koppenhaver SL, Puentedura EJ, Cleland JA. Patient-determined important change for the neck disability index with application of credibility analysis: an exploratory study. J Manipulative Physiol Ther. 2024;47(1–4):77–84; doi: 10.1016/j.jmpt.2024.08.016.
61.
El-Sadany SM, Sayed AA-A, Kamel KM, El-ghitany SI. High intensity laser therapy versus scapular stabilization exercises on ventilatory function in forward head posture. Adv Rehabil. 2024;38(4):1–9; doi: 10.5114/areh.2024.144671.
Share
RELATED ARTICLE
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
