Key takeaways.
- Lower-limb tendinopathy and plantar fasciitis have the strongest laser evidence of any condition.
- Pain fell 13.15 mm on a 100 mm scale in the pooled trials, and disability improved alongside it.
- Laser added to exercise beat exercise alone by 18.15 mm, the largest effect in the review.
- Correct dosing raised the placebo-controlled result to 14.98 mm.
- No adverse events were reported across the included trials.
Why tendons are the strongest case.
A 2022 systematic review and meta-analysis in BMJ Open pooled randomised controlled trials of laser therapy in lower-extremity tendinopathy and plantar fasciitis. It found pain reduced by 13.15 mm on a 100 mm visual analogue scale at the end of treatment, with a confidence interval of 7.82 to 18.48 mm, and still 12.56 mm lower four to twelve weeks afterwards.
Disability improved too, with a standardised mean difference of 0.39 at completion and 0.32 at four to nine weeks. The reviewers rated study quality as moderate to high, and reported no adverse events.
None of that makes laser a cure for a tendon. It makes laser a reasonable, evidenced way to lower the pain of one, which is a smaller and more useful claim.
The number that should decide your treatment plan.
The most important result in that review is not the headline. It is the comparison where laser was added to exercise therapy and measured against exercise therapy alone. That combination reduced pain by 18.15 mm, confidence interval 10.55 to 25.76, and held 15.90 mm lower four to nine weeks later.
That is the largest effect anywhere in the paper, and it comes from the pairing. Laser on its own is a weaker proposition than laser used to make a loading programme possible. Any tendinopathy plan we build here is a loading plan first, with the laser in a supporting role.
How we use it for a painful Achilles or patellar tendon.
A reactive tendon is one that has been overloaded recently and is now painful with almost any use. Pushing straight into heavy loading tends to make it worse, and doing nothing lets it stiffen and deteriorate. The gap between those two is where laser is useful.
We use it to bring the day-to-day pain down enough that isometric and then progressive loading become tolerable, then we build the loading. As tolerance improves the laser gets used less, because at that point the exercise is doing the work and appointment time is better spent progressing it.
For a patellar tendon in a jumping athlete, the same logic applies against a return-to-sport timeline. Our jumper’s knee page covers the loading side of that in detail.
Plantar fasciitis and the first step in the morning.
Plantar fasciitis has a signature: the worst pain of the day is the first few steps out of bed, easing as you move and returning after sitting. That morning pain is the marker we track, because it responds before anything else does.
Laser is used here to reduce the local irritability so that calf loading, foot intrinsic work, and gradual walking tolerance become possible. Those are what change the condition over months. If your morning pain has not shifted after a first block of sessions, the plan needs changing rather than extending.
Our plantar fasciitis condition page covers footwear, orthotics, and the loading progression that sits alongside this.
Why it may not have worked for you before.
People tell us laser did nothing for their tendon at a previous clinic. The most likely explanation is dose. The BMJ Open reviewers deliberately separated trials following World Association for Laser Therapy dose recommendations from those that did not, and the correctly dosed ones reduced pain by 14.98 mm against placebo, better than the pooled average.
The second explanation is that the laser was the whole plan. A course of any modality, delivered without a loading programme attached, is unlikely to change a tendon that got sore because of how it was being loaded in the first place.
Frequently asked questions.
Does laser therapy work for tendinopathy?
Lower-limb tendinopathy is where laser therapy has its strongest published support. A 2022 BMJ Open systematic review of randomised controlled trials found pain fell by 13.15 mm on a 100 mm scale at the end of a treatment course, and disability improved with a standardised mean difference of 0.39. The benefit was still present four to twelve weeks after treatment finished.
Does laser therapy help plantar fasciitis?+
Plantar fasciitis was included alongside lower-limb tendinopathy in the 2022 BMJ Open meta-analysis that found significant reductions in both pain and disability from laser therapy. In clinic we use laser for plantar fasciitis to reduce first-step morning pain enough that calf and foot loading becomes tolerable, because that loading programme is what changes the tissue over months.
Which tendons respond best to laser therapy?+
The trials pooled in the 2022 BMJ Open review covered lower-extremity tendinopathy, which in practice means Achilles and patellar tendons, plus the plantar fascia. Shoulder tendinopathy has its own separate body of evidence. Tendons that sit closer to the surface receive a more predictable dose than deep ones, since less tissue sits between the handpiece and the target.
Is laser better than eccentric exercise for Achilles tendinopathy?+
No, and the research frames them as partners rather than rivals. In the 2022 BMJ Open review, the largest effect measured anywhere was laser added to exercise therapy compared against exercise alone, at 18.15 mm of pain reduction. Progressive loading remains the treatment that changes a tendon. Laser lowers the pain that stops people completing that loading properly.
How many laser sessions does tendinopathy need?+
A course for tendinopathy at Medstar generally runs 6 to 10 sessions, starting at two to three per week and spacing out as symptoms settle. We reassess after the first block against measurable markers: morning pain, tendon load tolerance, and how you manage stairs or hills. If those have not moved, we change the plan rather than booking another block.
Why did laser therapy not work for my tendon at another clinic?+
Dose is the most common explanation. The 2022 BMJ Open review split its trials by whether they followed World Association for Laser Therapy dose recommendations, and the correctly dosed trials outperformed the pooled average, reaching 14.98 mm of pain reduction against placebo. An underdosed session delivers too little energy to the tendon to produce a measurable change.
Can laser therapy make a tendon heal faster?+
Laser therapy reduces pain and supports the local tissue environment, and the published trials measure pain and disability rather than tendon structure. So the honest claim is that laser makes a painful tendon more comfortable and more loadable, which lets rehabilitation progress sooner. Claims that laser directly regenerates tendon tissue in humans go beyond what these trials measured.
Is laser or shockwave better for tendinopathy?+
It depends on how irritable the tendon is. Laser is comfortable and suits an acutely painful, reactive tendon that will not tolerate provocation. Shockwave is deliberately more provocative and suits a long-standing, stubborn tendinopathy that has stopped responding to loading alone. A tendon that is furious right now usually does better with laser first and shockwave later, if at all.
Does laser therapy help tennis elbow?+
Tennis elbow is an upper-limb tendinopathy, so it sits outside the lower-extremity trials pooled in the 2022 BMJ Open review, and the evidence base for it is separate and thinner. We do use laser for an irritable tennis elbow to make grip loading tolerable. Being clear about the evidence: the strong meta-analytic numbers quoted on this page are for lower-limb tendons and plantar fascia.
Are there side effects to laser therapy for tendon pain?+
The 2022 BMJ Open systematic review reported no adverse events across the trials it included. In clinic the common experiences are short-lived warmth or mild redness over the treated skin. Eye protection is the one non-negotiable safety measure, worn by everyone in the room, because a Class 4 laser can injure the retina if the beam reaches an unprotected eye.
Sources.
Sources checked 4 September 2026.
Not sure laser is the right tool?
Book an assessment. We'll tell you honestly whether the laser helps your injury, or whether something else will do more.
Reviewed by Sanaz Davarian, PT, MSc, Owner & Director, Registered Physiotherapist, College of Physical Therapists of British Columbia (CPTBC). Medstar was the first physiotherapy clinic on the North Shore to install a Class 4 high intensity laser.
This page is for general information only and does not constitute medical advice. High intensity laser therapy is one tool among several, and it is not appropriate for every injury or every person. Nothing here is a promise of a particular outcome. Treatment suitability is determined case-by-case during clinical assessment. Physiotherapy at Medstar Sport Physio & Health is provided by physiotherapists registered with the College of Physical Therapists of British Columbia (CPTBC).