e metzger, n hager, r ory, w lucio, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Photobiomodulation therapy (PBMT) involves applying non- ionizing forms of  light from various sources including lasers, light-emitting diodes (LEDs), and broadband light, in  the visible and near infrared spectrum, to biologically modulate cellular activity to enhance  healing. PBMT can enhance repair and regeneration of tissue, stimulate metabolism, and reduce  inflammation and pain during injury recovery. This program investigates the use of PBMT to treat musculoskeletal injury (MSKI) and enhance performance and recovery in United States  (US) military Service Members (SMs).

We conducted five clinical trials and one observational study at US military  installations to assess the application PBMT for MSKIs and performance and recovery.  Currently, 344 participants have enrolled. Data included objective measures and self-reports. 

When applied for plantar fasciitis (PF) and Achilles tendinopathy (AT), there were  improvements in self-reports across the injuries and treatment groups [vs. Sham for PF, and vs.  Standard of Care, extracorporeal shockwave therapy (SWT), PBMT alone, and in combination  with SWT for AT] in the Foot Functionality Captured via Foot and Ankle Ability Measure  (FAAM), Defense and Veteran Pain Rating Scale (DVPRS),Victorian Institute of Sport  Assessment-Achilles (VISA-A), University of Wisconsin Running Injury and Recovery Index  (UWRI), and Lower Extremity Functional Scale (LEFS). Objective ultrasound measures also  trended towards improvement. Further results for treating bone stress injury, general  wellness/recovery, and planned projects for performance will be available at the time of the  conference.

n hughes, b cornell, r rossi, e metzger, n hager, g gabler, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Special Operations Forces (SOF) train continually to maintain peak performance,  thus, are always in a state of recovery. Photobiomodulation therapy (PBMT) is a noninvasive  low-level laser treatment to enhance healing, recovery, and performance. Studies have shown  performance and recovery benefits with focal applications of PBMT. While less evidence exists  for psychological effects of systemic PBMT applications, self-reported fatigue was found to be  lower with focal PBMT compared with placebo. Further, PBMT research in elite warfighters is  limited. The Army Tactical Human Optimization Rapid Rehabilitation and Reconditioning  (THOR3) provides a consistent setting for strength and cardiovascular training, conditioning,  nutritional and behavioral health monitoring and is an optimal setting to assess the effect of  PBMT on performance and behavioral measures. We aim to study the physiologic and  behavioral effects of PBMT, post-exercise, on performance in SOF.

We will conduct a single-blind, randomized-control trial in healthy SOF operators, assigned to receive PBMT or sham-PBMT post- training. Treatment will be administered 3  times/week for 3 weeks to both quadriceps. Objective measures include body fat percentage,  height/weight, isokinetic/isometric leg strength, Oura ring sleep/activity data, and  countermovement jump. Subjective measures include demographics, Rating of Perceived  Exertion, Short Questionnaire of Fatigue, delayed muscle soreness scale, Defense Veterans Pain  Rating Scale, and activity logs.

PBMT shows promise in accelerating musculoskeletal repair, psychological  resilience, thereby reducing injury risk and enhancing overall performance. This study may  inform standards of training and care to maximize readiness among elite warfighting units.

R rossi, j schroeder, s grogan, n hager, e metzger, g gabler, j persinger, n karikari, s mckee, b isaacson, l wagner, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Non-insertional Achilles Tendinopathy (AT) is a common overuse injury in athletes and United States military Service Members. Photobiomodulation therapy (PBMT)  delivers non-ionizing light to produce beneficial outcomes. Extracorporeal shockwave therapy  (SWT) delivers mechanical energy to the tendon and has been shown to be effective for AT. The  addition of PBMT to SWT is hypothesized to enhance these effects by increasing cellular  function and healing. Our primary aim was to evaluate PBMT, SWT, and Physical Therapy (PT)  on non-insertional AT.

Forty-five participants were randomized to: PT only, PBMT+PT, PBMT+SWT+PT, or SWT+PT. SWT treatment: 1x/week/3 weeks at 15hz for 3000 pulses. PBMT treatment: 2x/week/3 weeks at 10 J/cm2, 25W. Study duration was 6 months. Outcomes: activity logs,  pain/functional surveys, ultrasound tendon thickness measurements, and Range of Motion (ROM). 

At 3-months, all groups improved in Defense and Veterans Pain Rating Scale, Lower  Extremity Functional Scale, University of Wisconsin Running Injury and Recovery Index (PBMT+SWT+PT: + 7.1 units; p = 0.1), Patient-Reported Outcomes Measurement Information  System (6-week function scores: SWT+PT > PBMT+PT; p < .1), & Victorian Institute of Sport  Assessment-Achilles. PBMT+SWT+PT group had a Long Axis Maximal Circumference decrease of 3.1 mm (p = 0.1). Treatment with SWT increased Knee Flexed Passive Dorsiflexion  by 5.37° (p = .01). No significant intergroup differences in the above outcomes at 12-weeks (p > 0.1).

These results justify further investigation in the optimal dose/treatment frequency  of SWT+PBMT. Our findings can inform clinical treatment options for AT to optimize recovery  and return to activity.

l cin, j schroeder, c mincey, j persinger, n hager, r rossi, e metzger, c yimyam, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

On average, two million patients receive treatment annually for Plantar Fasciitis  (PF) in the United States. Athletes and Active-Duty Service Members are more prone to PF from repetitive foot stresses and biomechanical predispositions (high arches, excessive pronation, etc.) Photobiomodulation therapy (PBMT) uses non-ionizing light forces to enhance performance,  alleviate pain/inflammation, promote healing and may be effective in treating PF. This study  assessed the clinical effectiveness of PBMT compared to sham-PBMT for PF in Active-Duty Service Members.

Blinded participants were randomized to receive PBMT or sham-PBMT 3x/week x3  weeks at 10 J/cm2, 25W output power using the LightForce XPi and home exercises x6 weeks.  Sham-PBMT participants could crossover after 6-weeks. Outcomes included Defense and  Veterans Pain Rating Scale (DVPRS), Foot Functionality Captured via Foot and Ankle Ability  Measure (FAAM), and ultrasound measured fascial thickness.

FAAM scores improved for the PBMT group (N = 33) at 6-weeks: -17.2 points (SD:16.1; p < .01); sham-PBMT group (N = 35): -11 points (SD:17.1; p = .08); no statistically  significant intergroup differences (p > .05). Both groups experienced median absolute change in  DVPRS scores at 6 weeks: -1.0 points; no significant intergroup differences (p > .05). 6-week  median absolute change in thickness: PBMT: -.01 mm; sham-PBMT: 0.3 mm.

Both groups met the threshold for a minimum clinically important difference on the FAAM (≥ 8-point decrease) and decreased DVPRS. The PBMT group experienced a small  PF thickness decrease. These findings indicate that PBMT may be an effective adjunctive  treatment for PF pain/function.

l. cin, s grogan, j persinger, j schroeder, n hager, r rossi, e metzger, c mincey, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Lower extremity injuries are common sources of disability and time loss for  athletes and military servicemembers. Microvascular flow (MVF) and shear wave elastography  (SWE) may be non-invasive, efficient, and cost effective in early diagnosis and treatment of  musculoskeletal injuries (MSKIs). This study aimed to establish normative values for routine  tendon echo-characteristics, presence/absence of plantaris tendon, MVF vs Power Doppler (PD),  and SWE measurements in the posterior lower leg and Achilles tendon.

Ultrasound was performed on asymptomatic participants using a Samsung RS-85  Prestige. Orthogonal measurements were obtained along the Achilles at the calcaneal insertion  (CI), avascular zone (AVZ), gastro-soleus junction (GSJ), medial gastrocnemius, and soleus.  Outcomes included: thickness/width 2D imaging measurements, vessel quantification in PD &  MVF, SWE analysis, plantaris tendon visualization, Body Mass Index (BMI), ankle Range of  Motion (ROM), and self-reports (demographics & activity).

MVF detected flow in 9 limbs vs 1 by PD (n = 106). Increased BMI resulted in  increased tendon/gastroc measurements: (p < .01); SWE [r(63) = 0.41] & AVZ SWE [r(63) =  .33]. Long-Axis median: GSJ height = 0.2 cm, CI = 0.4 cm, & AVZ height = 0.5 cm. Short-Axis  mean AVZ width: males = 1.5 cm (SD: 0.2), females = 1.4 cm (SD: 0.2). Plantaris tendons  identified in > 50% of study population (59 out of 106 limbs).

Our findings will inform the normal, routine, and novel ultrasound values for the  Achilles tendon complex and its related structures. This may help improve the diagnosis and  treatment of MSKIs.