Is there any difference between high-intensity laser and low-level laser in the treatment of tennis elbow? A Meta-analysis of randomized controlled trials

Abstract Objective To evaluate the efficacy of laser therapy (high-intensity vs. low-level) in treating tennis elbow. Design PubMed, Scopus, Embase, and Web of Science were systematically searched for RCTs up to February 2025. Cochrane risk-of-bias tool was used for quality assessment. Data were analyzed via RevMan 5.4. Result Twelve randomized controlled trials were included. Laser therapy demonstrates significant improvements in pain, grip strength, and functional outcomes for tennis elbow patients. Subgroup analysis reveals that both high-intensity laser therapy (HILT, P = 0.01) and low-level laser therapy(LLLT, P < 0.00001) effectively reduce pain versus baseline with comparable efficacy, though HILT shows non-significant improvement versus placebo(P = 0.07). Regarding functional improvement, HILT is similar to LLLT (both significant, P < 0.05). For grip strength, both modalities show significant improvement(P < 0.05), with HILT exhibiting superior effects. Further analysis of combination therapies showed that laser combined with bandage demonstrates more significant pain relief and functional improvement. Conclusion HILT and LLLT are both effective modalities for improving symptoms of tennis elbow (pain, function, and grip strength). LLLT demonstrates more consistent significance in pain relief, while HILT shows greater advantages in enhancing grip strength. More importantly, laser therapy combined with bandage produces synergistic effects, highlighting its value as a key complementary component within multimodal rehabilitation programs.