Systematic review and meta-analysis of laser physical agent for pain and disability in rotator cuff tendinopathy: subgroup analysis and meta-regression exploration of randomized control trials.

Abstract

Laser therapy is increasingly used in the management of rotator cuff tendinopathy; however, the comparative effectiveness of different laser types and treatment parameters remains unclear. This study aimed to evaluate the effects of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) on pain and disability. A systematic search of PubMed, Medline-Ovid, PEDro, and ClinicalTrials.gov was conducted from inception to July 2025. Randomized controlled trials comparing LLLT or HILT with placebo laser, exercise-based interventions, or other physical agents were included. Pain and disability outcomes were pooled using random-effects models. Subgroup and meta-regression analyses explored the influence of laser type, treatment regimen, control conditions, emission mode, wavelength, treatment duration, session frequency, and study quality. Laser therapy significantly reduced pain (Hedges' g = -0.701) and disability (Hedges' g = -0.691). HILT showed greater effect sizes than LLLT across outcomes. Pulsed-mode LLLT showed significant effect on pain reduction. Meta-regression analyses did not identify significant associations between sessions per week and treatment outcomes. HILT, applied alone or as an adjunctive therapy, provides significant benefits for pain and disability in rotator cuff tendinopathy, whereas standalone LLLT shows limited effectiveness. Further studies should examine long-term outcomes and standardized laser dosing.