"Cold Lasers In Pain Management" - Practical Pain Management, Sept/Oct 2004
"The Light Stuff" - Washington Post, February 17, 2004
"ATCS ADVANCE TECHNOLOGY WITH NEW LASER THERAPY" - Nata News Magazine, October 2002
"HEALTH" - Sebastian Sun, October 9, 2003
"How laser light helps cells repair themselves CAN gentle doses of laser light help cells to heal?" - THE NEW SCIENTIST, October 11-15, 2003
"Seeing The Light" How Light Therapy is Surprising Skeptics and Gaining Converts - Physical Therapy Products - April/May 2004 (PDF Download).
Lightwave
of the Future The low-power laser for the treatment of carpal tunnel
syndrome is safe, painless, and completely noninvasive.
REHAB MANAGEMENT, JANUARY/FEBRUARY 2005 (PDF
Download).
Laser-Accelerated
INFLAMMATION/PAIN
REDUCTION AND HEALING - Practical
PAIN MANAGEMENT, Nov/Dec 2003
(click here to download
a pdf version of this article)
Low Level Laser Therapy (LLLT)
precipitates a complex set of physiological interactions at the cellular
level that reduces acute inflammation, reduces pain, and accelerates
tissue healing.
by Richard Martin, BS, CLT
Compromised cells and tissues
respond more readily than healthy cells or tissues to energy transfers
that occur between LLLT-emitted photons and the receptive chromophores
found in the various cells and sub-cellular organelles. Cells and tissues
that are ischemic and poorly perfused as a result of inflammation,
edema and injury have been shown to have a significantly higher response
to LLLT irradiation than normal healthy structures. Cell membranes,
mitochondria and damaged neurological structures exhibit less than
optimal metabolism and stasis conditions. Multiple studies have demonstrated
that under these compromised conditions, the introduction of energy
transfers and the resultant enhancement of metabolic activity is most
pronounced in biologically challenged components. While it may appear
that LLLT is thus selectively targeting compromised cells, in reality,
these cells exhibit a lowered reaction threshold to the effects of
laser light and are more easily triggered to energy transfer responses.
The result is that LLLT has a significant effect on damaged cells and
tissues while normative biological constituents are appreciably less
affected."
The cellular cascade effect — precipitated by the actions of enzymes
and having a significant in the presence of LLLT — has a significant
impact on cellular and tissue function. Since a considerable number of the
reactive proteins that respond to laser stimulation are enzymes, laser light
effects are amplified in the stimulation of beneficial enzymes and depression
of deleterious enzymes.
At the cellular level, cytochromes can be defined as electron or proton-transfer
proteins that act as energy producers for human biological functions. Both
of the cytochrome enzymes, Cytochrome c Oxydase and Nitric Oxide Synthase (NOS)
have been found to be particularly reactive to laser photon stimulation. The
particular affinity of these and other photoreactive enzymes to accelerate
their functions in the presence of LLLT provides critical increases in the
molecule ATPand Nitric Oxide (NO) which enhances cellular metabolism, circulatory
improvement and nerve function.
Although the various actions of LLLT in regards to inflammation, pain and healing
have been separated categorically here for the purpose of process identification,
their interactions are not so easily distinguished. In response to LLLT, the
reduction in inflammation, pain and healing time all compliment each other
and many of the processes are either simultaneous or overlapping.
Acute Inflammation Reduction
Immediately after an acute injury event, the body, in response to the disruption
of the integrity of vascular, soft tissue, connective tissue and neurological
processes, initiates a series of biological responses. The inflammatory reaction
consists of both vascular and cellular events. Injury responsive components
such as Mast cells, Bradykinins and Prostaglandins are activated along with
the vascular responses and cellular membrane reactions. All of these combined
processes and events are represented by the symptoms of edema, inflammation,
pain and functional debility. LLLT can be effective in mediating both the symptoms
and the underlying inflammatory process by the following actions:
1. Stabilization of cellular membrane — Ca++, Na+ and K+ concentrations
as well as the proton gradient over the mitochondria membrane are positively
influenced. This is accomplished in part by the production of beneficial Reactive
Oxygen Species (ROS) wherein triplet oxygen molecules absorb laser light producing
singlet oxygen molecules. These ROSmodulate intracellular Ca++ concentrations
and laser therapy improves Ca++ uptake in the mitochondria. 2,3,4
2. ATPproduction and synthesis are significantly enhanced, contributing to cellular repair, reproduction and functional ability. Laser stimulation of Cytochrome c Oxidase, a chromophore found on the mitochondria of cells, plays a major role in this rapid increase in production and synthesis of ATP. 3
3. Vasodilation is stimulated via Histamine, Nitric Oxide (NO) and Serotonin increases, resulting in reduction of ischemia and improved perfusion. Lasermediated vasodilation enhances the transport of nutrients and oxygen to the damaged cells and facilitates repair and removal of cellular debris. 5,6
4. Beneficial acceleration of leukocytic activity results in enhanced removal of non-viable cellular and tissue components, allowing for a more rapid repair and regeneration process.
5. Increased Prostaglandin synthesis, particularly in conversion of the prostaglandins PGG2 and PGH2 periossides into prostaglandin PGI2. PGI2 (Prostacyclin), has a vasodilating and antiinflammatory action with some attributes similar to Cox-I and Cox-II inhibitors. 7
6. Reduction in Interleukin 1(IL-1). Laser irradiation has a reducing effect on this pro-inflammatory cytokine that has been implicated in the pathogenesis of rheumatoid arthritis and other inflammatory conditions. 8
7. Enhanced lymphocyte response. In addition to increasing the number of lymphocytes, laser irradiation mediates the action of both lymphatic helper T-cells and suppressor T-cells in the inflammatory response. Along with laser modification of beta cell activity, the entire lymphatic response is beneficially affected by LLLT. 9
8. Increased angiogenesis. Both blood capillaries and lymphatic capillaries have been clinically documented to undergo significant increase and regeneration in the presence of laser irradiation. The resulting improvement in circulation and perfusion enhances all repair and healing processes. Laser induced increases in NO and the growth factors — in particular cytokine INF-g — are contributory to this process. 10,11
9. Temperature modulation. Areas of inflammation typically demonstrate temperature variations with the inflamed portion having an elevated temperature. Laser therapy has been shown to accelerate temperature normalization, demonstrating its beneficial influence on the inflammatory process.
10. Enhanced superoxide dismutase (SOD) levels. Laser stimulated increases in cytokine SODlevels interact with other anti-inflammatory processes to accelerate the termination of the inflammatory process. Interactions between SODand Reactive Oxygen Species (ROS) production subsequent to LLLT balance free radical activity and allows for the beneficial effects of ROSwhile inhibiting detrimental interactions. 12
11. Decreased C-reactive protein and neopterin levels. Laser therapy has been shown to lower the serum levels of these inflammation markers, particularly in rheumatoid arthritis patients. Decreased marker levels are indicative that the combined effects of all LLLT-induced anti-inflammatory actions are effectively reducing the inflammatory process.
A summary flowchart of the cellular cascade in reducing tissue inflamation is presented in Figure 1. The cumulative effect of these multiple inter-active processes and events is an accelerated inflammatory cycle with diminished symptoms and earlier normalization.
Since LLLT does not exacerbate the inflammatory process but rather condenses the time frame from onset to resolution through acceleration of processes, it can be used immediately post injury. This rapid initiation of therapy in acute inflammation will assist in limiting the scope and duration of the inflammatory event and minimize the pain and severity associated with it.
Most of the beneficial effects seen from LLLT in the treatment of acute inflammatory events will also have medical efficacy as LLLT is initiated inmore chronic
inflammatory conditions. While the treatment regimen and course of therapy may be modified in chronic situations, the physiological responses and interactions remain consistent. Chronic conditions may require longer treatment times and results will vary with the patient, condition and length of the chronic condition.
Pain Reduction
The unique pain reduction abilities of LLLT have been extensively researched
and documented in numerous clinical studies and medical papers. While there
remains much to learn in respect to the various processes through which
LLLT achieves its pain reduction characteristics, there is a wealth of
knowledge currently available to demonstrate the effectiveness of laser
therapy in this regard.
Because the pain amelioration capabilities of LLLT are accomplished via the combination of local and systemic actions — utilizing enzymatic, chemical and physical interventions — the process is very complex. However, there is a preponderance of medical evidence that justifies a conclusion that effective pain reductions can be achieved via LLLT. Following are processes and events that are promoted by LLLT therapy:
1. Increase in b-Endorphins. the localized and systemic increase of this endogenous peptide after LLLT irradiation has been clinically reported in multiple studies with subsequent pain reductions.
2. Blocked depolarization of C-fiber afferent nerves. The pain blocking effect of LLLT can be pronounced, particularly in low velocity neural pathways, such as non-mylenated afferent axons from nociceptors. Laser irradiation suppresses the excitation of these fibers in the afferent sensory pathway. 13,14
3.
Increased nitric oxide production. NO has both a direct
and indirect impact on pain sensation. 
As a neurotransmitter it is essential for normal nerve cell action potential in impulse transmission activity and, indirectly, the vasodilation effect of NOcan enhance nerve cell perfusion and oxygenation.
4. Increased nerve cell action potential.Healthy nerve cells tend to operate at about -70 mV and fire at about -20 mV. Compromised cells membrane potential approximates -20 mV thereby resulting in pain stimulus. LLLT can help restore the action potential closer to the normal -70 mV range. Both compound muscle action potential (CMAP) values and nerve latency values have shown improvement with laser therapy. 15
5. Axonal sprouting and nerve cell regeneration. Several studies have documented the ability of LLLT to induce axonal sprouting and some nerve regeneration in damaged nerve tissues. Where pain sensation is being magnified due to nerve structure damage, cell regeneration and sprouting may assist in pain decrease. 16,17
6. Decreased Bradykinin levels. Since Bradykinins elicit pain by stimulating nociceptive afferents in the skin and viscera, mitigation of elevated levels through LLLT can result in pain reduction. Laser-induced decrease in plasma kallikrein, increase in Kininase II, and increase in NOare considered the contributors to this Bradykinin decrease.
7. Increased release of acetylcholine.By increasing the available acetylcholine, LLLT helps in normalizing nerve signal transmission in the autonomic, somatic and sensory neural pathways.
8. Ion channel normalization.LLLT promotes normalization in Ca++, NA+ and K+ concentrations resulting in beneficial pain reduction results from these ion concentration shifts. Figure 2 presents a simplified representation of the effects of LLLT on pain improvement at the cellular level.
Tissue Healing
One of the truly unique characteristics of LLLT is that it has the ability to actually promote and enhance healing, not just treat symptoms. The irradiation by low-level laser light accelerates and enhances healing activities carried out by the body. Several of the unique characteristics of LLLT that work to alleviate pain and inflammation also play an important role in accelerating the healing process; the LLLT-mediated reduction in inflammation and pain frees the body’s natural ability to repair and heal itself.
As wound healing progresses through the stages of inflammation, proliferation, remodeling and maturation, laser therapy presents the opportunity to impact each of these phases in positive and beneficial ways. LLLT can provide the following beneficial impacts in both open surface wounds and closed connective or soft tissue injuries as follows:
1. Enhanced leukocyte infiltration. LLLT stimulates activity involving neutrophils, monocytes and lymphocytes.
2. Increased macrophage activity. LLLT accelerates macrophage activity in phagocytosis, growth factor secretion and stimulation of collagen synthesis.
3. Increased neovascularization. The significant angiogenesis that occurs with laser therapy promotes revascularization with subsequent improvement in perfusion and oxygenation. Endothelial cell regeneration is accelerated. 18
4. Increased fibroblast proliferation. LLLTstimulation increases fibroblast numbers and fibroblast-mediated collagen production. 19
5. Keratinocyte proliferation.The beneficial synthesis activities and growth factor ability of keratinocytes are enhanced by proliferation secondary to LLLT. 20
6. Early epithelialization. Laser-stimulated acceleration of epithelial cell regeneration speeds up wound healing, minimizes scarring, and reduces infection opportunities.
7. Growth factor increases. Two to five fold increases in growth-phase-specific DNAsynthesis in normal fibroblasts, muscle cells, osteoblasts and mucosal epithelial cells irradiated with IR light are reported. Increases in vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) secondary to IR light irradiation have also been reported.
8. Enhanced cell proliferation and differentiation.Laser-induced increases in NO, ATPand other compounds that stimulate higher activity in cell proliferation and differentiation into mature cells. Increased numbers of myofibroblasts, myofibrils, myotubes etc., as well as bone cell proliferation, have been clinically documented after LLLT. Satellite cells, the precursor cells in the process of muscle regeneration, show significant increase in proliferation when irradiated with LLLT. 21,22,23
9. Greater healed wound tensile strength.In both soft tissue and connective tissue injuries, LLLT can increase the final tensile strength of the healed tissue. By increasing the amount of collagen production/synthesis and by increasing the intra and inter-molecular hydrogen bonding in the collagen molecules, laser therapy contributes to improved tensile strength. 24,25,26,27 The preceding effects combine to achieve an accelerated healing rate (see Figure 3). The time from onset of injury to mature healed wound is reduced. 28
Conclusion
The FDAhas recently cleared multiple laser and LEDdevices for treatment of
a variety of medical conditions including carpal tunnel syndrome, cervical
neck pain, low back pain, joint pain, generalized muscle pain and acceleration
of wound healing. Governmental agencies such as NASAare currently using
technical light therapy for medical conditions in space applications. The
U.S. Olympic training facilities have just released statements of endorsement
for laser therapy for athletes. All of these events validate the growing
acceptance in mainstream medicine for the medical efficacy of laser therapy
as a viable, often superior therapeutic treatment modality.
With over 200 clinical studies — many of which are double-blind, placebo-controlled — and in excess of 2000 published articles on LLLT, this innovative new technology has a well-documented research and application history. Having grown far beyond its distant Institutional Review Board (IRB) and experimental treatment status, LLLT is now being considered a therapy of choice for many difficult pain management challenges such as fibromyalgia and myofascial pain. New and ongoing clinical investigations offer growing potential for even more widespread applications of this truly unique light therapy.
Richard Martin, BS, CLT is a photobiologist specializing in laser therapy and holds the position of Director of Science at MicroLightLaser, a subsidiary of Innovative Medical Group Corporation in Santa Monica, CA. He has taught laser physics and photodynamics for eight years. He has served as manager for several biomedical design and service facilities and participated as lead researcher for biomedical devices involved in emergency cardiac care, warmed intravenous fluid therapy and laser therapy. Richard has participated in medical clinical trials for 15 years as a clinical trial analyst and contributing clinician.
References
1. Almeida-Lopes L. Human gingival fibroblast proliferation enhanced by LLLT.
Analysis in vitro of the cellular proliferation of human gingival fibroblasts
with low level laser. Dissertation at Universidade do Vale do Paraíba,
São Paulo, Brazil. 1999.
2. Lubart R, Friedman H, and Lavie R. Photobiostimulation as a function of different wavelengths. bone regeneration. The Journal of Laser Therapy. Vol 12. World Association of Laser Therapy. 2000.
3. Karu T. et al. Changes in absorbance on monolayer of living cells induced by laser irradiation. IEEE Journal of Selected Topics in Quantum Electronics. IEEE Lasers and Electro-Optical Society. December 2001. 7(6):982.
4. De Castro E Silva Jr. O, et al. Laser enhancement in hepatic regeneration for partially hepatectomized rats. Lasers in Surgery and Medicine. 2001. 29(1):73-77
5. Silveira LB, et al. In vivo study on mast cells behaviour following low-intensity visible and near infrared laser radiation. Laser Surg Med. Abstract issue. Abstract 304. 2002.
6. Trelles MA, et al. LLLT in vivo effects on mast cells. Department of Tissue Pathology, University Hospital, Tarragona, Spain. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
7. Tam G. Action of 904 nm diode laser in orthopedics and traumatology. Laser Center, Tolmezzo, Italy. Meridian Co, Ltd. Website:http://www.meridian.co.kr/ product1_8.htm. Last visited 10/27/03.
8. Bjordal JM, and Couppe C. What is optimal dose, power density and timing for low level laser therapy in tendon injuries?A review of in vitro and in vivo trials. Department of Physiotherapy Science, University of Bergen, Norway. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
9. Stadler I, et al. In vitro effects of low level laser irradiation at 660 nm on peripheral blood lymphocytes. Lasers Surg Med. 2000. 27(3):255-61
10. Kubota J. Laser and sports medicine in plastic and reconstructive surgery. Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan. Abstract from II Congress of the Internat. Assn for Laser and Sports Medicine, Rosario, Argentina, March 10-12, 2000.
11. Lievens P and Van der Veen PH. Wound healing process: influence of LLLT on the proliferation of fibroblasts and on the lymphatic regeneration. Department of Rehabilitation research, Vrije University, Brussels, Belgium. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
12. Karu TI. Mechanisms of low-power laser light action on cellular level. In Lasers in Medicine and Dentistry. Ed. by Z.Simunovic. Rijeka. Vitgraph. 2000. pp. 97-125.
13. Ohno T. Pain suppressive effect of low power laser irradiation. A quantitative analysis of substance P in the rat spinal dorsal root ganglion. J Nippon Med Sch. 1997. 64 (5):395-400.
14. Tsuchiya K et al. Diode laser irradiation selectively diminishes slow component of axonal volleys to dorsal roots from the saphenous nerve. Neuroscience Letters. 1993. 161:65-68.
15. Rochkind S, et al. Laser therapy as a new modality in the treatment of incomplete peripheral nerve injuries: Prospective Clinical Double-Blind PlaceboControlled Randomized Study. Department of Neurosurgery, Rehabilitation and Physiotherapy, Tel Aviv Sourasky Medical Center, Israel. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
16. Byrnes KR, et al. Cellular invasion following spinal cord lesion and low power laser irradiation. Lasers Surg Med. 2002. S14:11.
17. Rochkind S, Shahar A, and Nevo Z. An innovative approach to induce regeneration and the repair of spinal cord injury. Laser Therapy. 1997; 9 (4):151.
18. Schindler A, et al. Increased dermal neovascularization after low dose laser therapy. 2nd Congress, World Association for Laser Therapy. Kansas City. 1998.
19. Almeida-Lopes L, et al. Comparison of the low level laser therapy effects on cultured human gingival fibroblasts proliferation using different irradiance and same fluence. Lasers in Surgery and Medicine. 2001. 29(2):179-184.
20. Samoilova KA, et al. Enhancement of the blood growth promoting activity after exposure of volunteers to visible and infrared polarized light. Part I: stimulation of human keratinocyte proliferation in vitro. Advance Article of 2004 Photochemical & Photobiological Sciences. Published on the web at http://www.rsc.org/is/journals/current/PPS/ppAdvArts.htm. Sept 1, 2003.
21. Barber A, et al. Advances in laser therapy for bone repair. The Journal of Laser Therapy. Vol.13. World Association of Laser Therapy. 2000.
22. Antonio L, et al. Biomodulatory effects of LLLT on bone regeneration. The Journal of Laser Therapy. Vol. 13. World Association of Laser Therapy. 2000.
23. Shefer G, et al. Low energy laser irradiation promotes the survival and cell cycle entry of skeletal muscle satellite cells. Journal of Cell Science. 2002. 115:1461-1469.
24. Enwemeka CS and Reddy GK. The biological effects of laser therapy and other modalities on connective tissue repair processes. The Journal of Laser Therapy. Vol. 12. World Association of Laser Therapy. 2000.
25. Reddy GK, Stehno-Bittel L, and Enwemeka CS. Laser photo stimulation accelerates wound healing in diabetic rats. Wound Repair and Regeneration. 2001. 9:248-255.
26. Stadler I, et al. 830 nm irradiation increases the wound tensile strength in diabetic murine model. Lasers in Surgery and Medicine. 2001. 28 (3):220226.
27. Parizotto N, et al. Structural analysis of collagen fibrils after He-Ne laser photostimulation. 2nd Congress, World Association for Laser Therapy. Kansas City. 1998.
28. Simunovic Z, et al. Low level laser therapy of soft tissue injuries upon sport activities and traffic accidents: a multicenter, double-blind, placebo-controlled clinical study on 132 patients. Pain Center-Laser Center, Locarno, Switzerland. Abstract from II Congress of the Internat. Assn for Laser and Sports Medicine, Rosario, Argentina. March 10-12, 2000.
The
Light Stuff - Washington
Post, February 17, 2004
By
Lois Lindstrom
The New England Patriots won Super Bowl XXXVIII with some help from a little-known
form of laser technology that could change the way athletic injuries and
chronic pain are treated.
The treatment, known as "cold" laser therapy or low-level laser therapy
(LLLT), has been used internationally for 18 years to treat soft tissue injuries,
cervical neck pain, carpal tunnel syndrome, repetitive stress injuries, tendinitis,
hamstring injuries, arthritis and wound healing, among others.
The lasers -- hand-held, flashlight-like devices that direct a beam of narrow-spectrum
(but not hot) light at injured tissue beneath the skin -- have been integrated
into medical practice in Japan, Russia and the United Kingdom. In the United
Kingdom, cold laser therapy has become a preferred treatment for "whiplash" injuries,
neuralgia and shingles. In Japan, the lasers were approved in 1987 and are
in widespread use today.
In the United States, the technology received marketing clearance from the
Food and Drug Administration (FDA) in 2002 for treating carpal tunnel syndrome,
a painful inflammation of the wrists and hands that results from repetitive
motion. But the mainstream medical establishment still considers the cold laser's
benefits unproven. Most U.S. users are athletic trainers, chiropractors and
practitioners of alternative medicine.
" The medical community needs more scientific studies done in the United
States," said Wayne Good, a general surgeon in Waterford, Mich., who participated
in the clinical trials that led to FDA clearance of the laser device. Good worked
with General Motors Corp., which hosted the double-blind, placebo-controlled
trials on serious carpal tunnel sufferers as a way to seek more cost-effective
treatment for the condition, which affects many auto workers.
Good said the treatment proved about 70 percent effective in getting injured
workers, most of whom had failed to respond to other treatments, back on the
job. GM offers the treatment to injured workers in its in-plant medical clinics.
But insurance payment for the procedure is also an issue holding doctors back,
Good said. Many U.S. insurers will not pay for cold laser treatment, citing
the need for further research proving its benefits.
" If the major insurance companies . . . do not pay for the technology," Good
said, "the doctor cannot be reimbursed for treating his patients."
Sport and Health
While mainstream medicine remains on the sidelines, practitioners of sports
medicine, who are highly motivated to find new ways to heal soft-tissue injuries
and bruises, are getting right into the cold laser game.
In the week preceding the Super Bowl, Boston based registered nurse Ellen Spicuzza
treated more than 10 Patriot players with cold laser therapy for tendon and
muscle injuries.
"A couple of days prior to the Super Bowl weekend, I treated [Patriot wide
receiver] David Givens, who had a locked-up hamstring," she said. She rotated
the $4,000, pen-like laser over the "belly" of his hamstring muscle
for about five minutes, she said. "The laser released it."
Spicuzza, an independent nurse/physical therapist in Boston, usually treats
Patriot players' injuries with medical massage. For the big game, she for the
first time used low level laser therapy on the athletes' most troublesome pain
spots. Before using the cold laser, Spicuzza was skeptical.
"I am not into gimmicks," she said. "I didn't think it would help."
But she changed her mind after seeing how the laser expedited healing of some
players' soreness and pain.
"I don't think [the improved recoveries were] a coincidence," Spicuzza
said. "It did help. I used it on a flared-up sciatic nerve, and the player
had relief soon after treatment."
The Light and the Tunnel
Spicuzza was trained by Michael Barbour, president of MicroLight Corp., a Houston-based
company that in 2001 acquired rights to manufacture the ML830 cold laser device.
It was his company's laser that received market clearance from the FDA in 2002
for the non-surgical treatment of carpal tunnel syndrome.
Carpal tunnel syndrome occurs when tendons or ligaments in the wrist become
enlarged, often from inflammation. Nearly 500,000 Americans have surgical treatment
for carpal tunnel syndrome each year; surgery costs $8,000 to $10,000 per patient,
according to the American College of Orthopedic Surgeons.
Unlike surgery, treatments involving low level laser therapy are non-invasive
and require no healing time. There are no gels or ointments applied prior to
the treatment. The most notable sensation is the pressure of the head of the
laser on the skin, though some patients report a small tingling.
Cold laser treatments usually cost $25 to $50, with a typical course of treatment
involving 10 to 15 sessions over time.
Barbour said that while the FDA cleared the laser only for carpal tunnel syndrome
treatment, "medical clinicians have the option of using it for adjunctive
use for pain therapy if in their medical opinion it is indicated." Such
off-label uses are common in the world of drugs.
Proposed by Albert Einstein in 1917, low level light therapy was not developed
until 1960. A Hungarian surgeon, the late Endre Mester, first reported his
experience using laser light to treat non-healing infections and inflammations
in rats. Mester's reported 70 percent success rate in treating these infections
led to the development of a science he labeled "laser biostimulation," or
the stimulation of the local immune system.
According to Richard Martin, a Santa Monica, Calif., photobiologist specializing
in laser therapy, cells and tissues subjected to inflammation, edema and injury
have been shown to have a significantly higher response to low level laser
irradiation than normal healthy structures. There is no evidence the light
damages the cells.
Since 1967, more than 2,000 clinical studies have been published worldwide
on cold lasers. Supporters of the technology cite the fact that most are positive,
showing the devices safe and effective in a variety of clinical uses.
Others come to different conclusion, saying most of the studies are small and
poorly controlled and lack a standardized treatment that could let researchers
compare results equally. The Cochrane Collaboration, an international nonprofit
group that evaluates research about clinical practices, has published several
reports on low level laser therapy; the most recent were issued this year.
The researchers found that data from several studies showed no benefit in treating
osteoarthritis pain -- but two of the studies in particular showed very positive
results. The group concluded there is an "urgent need" for large-scale
clinical trials for this use.
Another research summary concluded that low level laser therapy was effective
in reducing pain and morning stiffness for those with rheumatoid arthritis.
But there were no differences in the treated subjects in overall disability,
swelling or range of motion. And no data was available for effects beyond 4-10
weeks of treatment.
Other Cochrane reports show some benefits from low level laser therapy for
frozen shoulder, but no benefits when used on rotator cuff tendinitis.
Swedish physicist Lars Hode, president of the Swedish Laser-Medical Society,
says the safety and efficacy of low level laser therapy is better documented
than that for ultrasound therapy, which is well accepted medically. However,
he says, there were some negative articles about cold lasers 20 years ago.
" In the '80s, the medical industry had inferior lasers," he said. "With
the advent of stronger lasers at reasonable prices, the situation today has changed
considerably."
Olympian Ambitions
The U.S. Olympic training centers in Colorado Springs and Chula Vista, Calif.,
are using cold lasers. The Olympic training center in Lake Placid, N.Y., plans
to offer the therapy within a few months.
According to Edward Ryan III, director of Sports Medicine for the U.S. Olympic
Training Center, the cold laser has given athletes significant relief from
pain and increased their range of motion. Because the device is hand-held and
portable, he said, it can even be used in competition venues.
Chadwick Smith, clinical professor of orthopedics and bioengineering at the
University of Southern California Medical School, has mainstream medical credentials
and is enthusiastic about cold lasers.
" Cold lasers speed the healing process," said Smith, who uses the
device in his clinical practice. "It used to take at least seven to ten
days for a hamstring injury to heal. Cold laser therapy cuts it down to two to
three days."
As for Ellen Spicuzza, she said the Super Bowl experience led her to use the
cold laser on her own neck, which she injured in a skiing accident 10 years
ago.
"I used it in my hotel in Houston during Super Bowl weekend," she said
happily. "It brought me quick relief of my muscle spasms."
Lois Lindstrom is author of "Memoirs of a Swedish War Nurse" (Goose
River Press, 2002). She is based in Stockholm and is co-writing a book about
cold laser therapy with a Swedish clinician.
ATCs
Advance Technology with New Laser Therapy - Nata
News Magazine, October 2002
Bv Valerie
Hunt
Two certified athletic trainers are among a handful of people in the United
States comprising an initial group of professionals certified to use a new
low-Ievel laser. The device, they say, offers amazing relief for people with
carpal tunnel syndrome, and it also represents a wealth of research opportunity.
Doug Johnson, ATC, co-owner of Sports and Industrial Rehab in Taylor, MI, and
Ray Maleyko, ATC, a Sports and Industrial Rehab employee, both are certified
to use the Microlight 830 low- level laser, which gained FDA approval in February
for treatment of carpal tunnel syndrome.
The ML 830 remains the only laser with FDA approval for CTS, and fewer than
30 of the machines exist currently, although the Texas-based manufacturer is
working to fill a growing demand for the tool. "Canada has had this technology
since 1994, but the United States is just now getting it," Johnson said. "It
is scary how well this laser works. It's the first thing in therapy that can
actuallv help heal the tissue."
Getting results - Johnson began following the development of the Microlight
830 laser after its clinical trials years ago. General Motors and one of Baylor
University's medical centers both tested the device.
GM in 10 years spent $2 billion on carpal tunnel syndrome alone, between lost
production, re-education of employees, medical costs and employee replacements," Johnson
said. "They conducted trials of the laser and found it to be 70 to 80
percent effective -nearly 80 percent of the people in the study went back to
work full-duty, while the other 20 percent had some improvement but did not
have full resolution. "They considered full resolution to be total elimination
of pain and limitations, and 80 percent of the people achieved that," he
added. "That's a big deal. They weren't testing a small group -they tested
every employee who was diagnosed with carpal tunnel syndrome." Johnson
said he and Maleyko have already seen encouraging results from the low-Ievel
laser therapy conducted at Sports & Industrial Rehab. "We had a client
who suffered carpal tunnel for 14 years as a result of cutting hair and working
at Target," Johnson said. "She was seriously debilitated. After two
treatments, she had full range of motion and was sleeping through the night
again.
"[Another] patient in our building went from 30 pounds of grip strength
to 60 pounds of grip strength in three treatments. We also treated a guy who
had flexor tendinitis, and he went from 40 pounds of grip strength to 130 pounds
in three treatments."
Because they wanted to test the laser's capabilities, Johnson and Maleyko both
underwent laser therapy themselves. They were eager to experience the laser
from a patient's point of view. "It's a lot like ultrasound -you don't
feel it," Johnson said. "Occasionally you can feel a tingle. There's
no heat. It's very comfortable. I had tendinitis in my elbow horribly bad,
from keyboarding because of a big proposal I'd been working on. The laser eliminated
the pain. Ray had tendinitis from playing guitar and baseball, and it worked
with him, too."
Although the laser is approved by the FDA only for treatment of CTS, patients
can opt to take part in clinical investigation and undergo low-Ievel laser
therapy on other parts of their body. Johnson said he has used the laser on
nearly every part of himself and found positive results each time.
Maleyko pointed out what he feels is one of the laser's most significant achievements:
it works on diabetic patients as quickly as non-diabetic patients.
"There's so much potential here," he said. "Our short-term and
long-term goals are to do solid research on other applica- tions, including lateral
epicondylitis as well as the effects of low- level laser therapy on diabetic
wound healing." "This laser is not a cure-all," Maleyko added. "But
it is certainly doing amazing things." Johnson said the therapy does more
than simply relieve pain. "Like any modality, if you continue the insulting
activity, you're going to continue to have the problem," he said. "But
laser causes healing rather than pain blockage. This does have a lasting effect.
The problem is if you continue to do the activity that led to your problem and
you don't modify it through ergonomics, you'll develop it again."
How it works - Simply put, low-Ievel laser therapy is the application of infra-
red light over injuries to improve soft tissue healing and relieve acute and
chronic injuries. The light stimulates the cell's mitochondria into hyperactivity.
The Krebs Cycle of metabolism occurs on the inner membrane of this structure,
liberating energy from the chemical bonds present in ATP molecules. The cell
is provided with more energy and is now in an optimum con- dition to play its
part in the healing process. The laser's effect on the tissue has been termed "photobiostimulation," a
chain of chemical reactions triggered by exposure to light.
"When a cell is actively working to repair itself (and its neighbors), it
needs a great deal of energy," Johnson explained. " Unfortunately,
most cells will continue to plug along at their usual rate, which is why repair
of some tissues takes so long. In some instances, the cells stay so busy dealing
with the imflammatory cells and products that are present in the injured tissue,
they don't have energy enough left to provide effective repair.
"By stimulating the cells with this specific light source, their activity
is hyper activated -sped up -so that they can perform better, faster and more
effectively," Johnson said. "The result is wound and injury healing
that is vastly enhanced and that takes dramatically less time to complete. Also
stimulated is the function of immune cells and the lymphatic and vascular systems."
The three Gallium-Aluminum- Arsenide laser diodes in the head of the ML 830
produce a combined output of three joules of energy per 33 second treatment
cycle. Driven by 30 milliwatts of power (combined power is 90mW), the 830 nanometer
laser can reach tissues at depths of up to five centimeters.
The risks, Johnson added, are minimal. "It has fewer contra-indications
than ultrasound and e-stim combined," he said. "It's only a 30-milliwatt
laser, so it's a cold laser. It can't pass through the bone."
Currently, contra-indications include pregnancy, carcinoma, patients taking
immune suppressant drugs, hemorrhages, and direct application to the eyes and
thyroid and the ganglia, vagus nerves and cardiac region in patients with heart
disease.
Johnson said the laser's head is applied directly to the skin, and the clinician
conducts a trigger-point grid, radiating every half-centimeter. A treatment
takes about 15 minutes.
"Individual treatment protocols depend on what's causing the carpal tunnel." he
said. "You have to have the clinical skills to determine the treatment protocol,
to know if you're treating the muscle, the tendon, the nerves. You have to constantly
evaluate." Patients and clinicians alike wear goggles to protect their eyes.
With a $10,000 price tag and years of research and development behind it, Johnson
and Maleyko expected the Microlight laser to look larger than life. Instead,
it closely resembles a flashlight. "It's hand-held and portable, and it
runs off a small rechargeable battery," Johnson said. "It doesn't
look that impressive, but it can work wonders"
Clinicians are not allowed to use the ML 830 laser until they complete a day-
long certification course to explain the use, documentation and billing behind
low-Ievellaser therapy. With a growing number of companies producing and trying
to market lasers, education is important.
"There are several lasers out there, and I've used others," Johnson
said. "No matter what you're using, you really need to know evervthinq vou
can about it."
Cost and reimbursement - Maleyko said the low-Ievel laser therapy falls under
physical therapy modality in Michigan. "You do need a doctor's prescription
for the laser," Maleyko said. "It's like a typical PT prescription.
I'm sure it varies state to state, but most of the prescriptions we get are
to evaluate and treat." Johnson -who has worked hard to develop a good
relationship with various insurance companies in the area - said his clinic
is reimbursed for the low- level laser therapy, which he bills under the miscellaneous
code. The cost is $22.56 for each 15-minute treatment. Because most cases require
fewer than 12 treatments, the overall cost is extremely low, compared to alternatives
such as surgery.
"We follow fee schedule here in Michigan," he said. "We bill everybody
the same as worker's comp. There's no reason to charge much. It doesn't take
that long. We don't have to stretch the patients. We have them do the Minnesota
dexterity test and pain level testing so we have good baseline information to
make sure they improve, to make sure we've got measurable outcomes."
Growing clientele - Johnson and Maleyko have been interviewed by numerous television
stations and print media. Each day brings an increase in the number of calls
from people interested in low-Ievel laser therapy.
"We average between three and five calls a day from people interested in
the laser," Maleyko said. "It's really keeping us on our toes. We've
been getting a mix of individuals and companies. We have a lot of automotive
companies starting to show interest." CTS is one of the most prevalent repetitive
stress injuries. In 1988, a survey found carpal tunnel syndrome affected approximately
1.3 million people, and the number had risen to nearly 2 million by 1995. Since
1991, more than 60 percent of all non-trauma related work injury claims were
for CTS, totaling $51 billion, Johnson said. "This laser is a safe, effective
alternative to other methods that don't have as high a success rate," he
said. "There's a lot of great potential here, both for patients and for
clinicians who want to help people."
Other research - Johnson said his clinic is now becoming involved in the next
generation of low-Ievellasers as well. "We're starting to formulate research
with the Powerlaser 500, which is the next step after the Microlight 830," he
said. " We're starting research funded by the National Medical Alliance,
and we'll be studying the effects of low-Ievel laser therapy on joint sprains
in college athletes, particularly the knee, ankle, wrist and elbow."
11; I NATA News
"HEALTH" - Sebastian
Sun, October 9, 2003
By Rachael Jackson, staff writer
Cold, hard facts: New laser
treats various illsFor years, the pain was so great Pat Ground couldn't
stand on her tiptoes. There were times when she could hardly walk.
The Sebastian banker tried doctor after doctor, endured several types of treatments,
but nothing seemed to make a real lasting difference in the swollen nerves
in her feet.
But now, after only a month of a new laser treatment by chiropractor Jeff Stepanek
at Sebastian Chiropractic, Ground, 58, happily reports she can retrieve items
from a top shelf without enduring tremendous pain from a condition called Morton's
Neuroma.
Stepanek recently obtained the Microlight cold laser, which can treat a wide
range of ailments. The laser offers a non-invasive treatment alternative for
soft and connective tissue disorders such as athletic injuries, Morton's Neuroma
and Carpal Tunnel Syndrome, a stress injury caused by repetitive movements
such as typing or working on an assembly line that can cause progressive loss
of function in the hand.
MicrolightLaser™, the company that manufactures the handheld, battery-operated
device claims its laser can make the difference between partial and full recovery
in Carpal Tunnel sufferers.
"It's been wonderful with my patients," Stepanek said. "Every
single person has responded."
Although hot lasers are used for procedures such as correcting vision and removing
tumors, the heat can destroy tissue as the laser penetrates. Stepanek said
the cold lasers work by using frequencies of energy that are the same frequencies
the body uses when healing. The laser, which has been approved by the Food
and Drug Administration, stimulates parts of the cell to accelerate healing
in injuries that do not seem to respond to other treatments.
Stepanek 35, who lives in Sebastian, even tested the laser on his girlfriend
when she accidentally cut herself with a kitchen knife. Stepanek said the cut,
which went through to the muscle, normally would have taken at least three
weeks to heal. After four days of laser treatments the wound was reduced to
a red line. After a week it had healed completely.
The schedule of laser treatments varies for different conditions, but Stepanek
said most people require three 15-minute visits a week for two to four weeks.
A daily regime of laser treatments can accelerate healing and minimize scarring
from post-surgical wounds.
He has also used the laser to treat arthritis, chronic joint pain and ankle
sprains. Stepanek learned about the cold laser from his brother, Chris Stepanek,
a Vero Beach chiropractor.
Jeff Stepanek said research on the laser suggests it speeds healing by 30 to
50 percent. After using the laser for about a month, and very positive responses
from his patients, he said that seems like a conservative estimate.
"With the laser I noticed a difference in the pain the day after the first
treatment," Ground said. "It definitely was a marked difference from
the other things I tried."
Ground said she is waiting to see how long the laser’s effects will last.
- Rachael.jackson@scripps.com
AT A GLANCE
A new cold laser treatment can provide a surgery alternative for sufferers
of Carpal Tunnel Syndrome, athletic injuries; and other soft and connective
tissue disorders. The treatment is painless and non-invasive and, according
to MicrolightLaser™, its manufacturer, it can make the difference in
full and partial recovery for Carpal Tunnel patients.
Jeff Stepanek of Sebastian Chiropractic reported extremely positive results
after using the laser for about a month. Sebastian Chiropractic is at 13250
U.S. 1 and can be reached at 772-388-1148.Please call Rick Martin at 775-884-1615
for more information.
"How laser light helps cells repair themselves CAN gentle doses of laser light help cells to heal?" - THE NEW SCIENTIST, October 11-15, 2003
How laser light helps cells repair themselves CAN gentle doses of laser light
help cells to heal? The technique is sometimes used to treat problems such
as tinnitus and joint pain, but with no explanation for how these therapies
work, there is scepticism over whether the effect is real. Now a physicist
has come up with evidence that the physical forces generated by low-energy
laser beams may switch on cells' repair mechanisms.
This will support the growing body of evidence that laser therapy is beneficial.
At the Joint International Laser Conference in Edinburgh, UK, last month, researchers
reported promising results for fields as diverse as IVF and spinal injury.
For example, rats with damaged spinal cords made a better recovery if their
wound was illuminated with near-infrared laser light, reported Kimberly Byrnes
of the Uniformed Services University of Health Sciences in Bethesda, Maryland.
Her team found that in light- treated rats, levels of interleukin-6, which
is involved in inflammation, were only 1 per cent of the levels in a control
group of rats. But Byrnes does not know how to explain the result. .'There
are a million different theories," she says.
One popular idea is that molecules within cells absorb the light, and the extra
energy drives chemical reactions. Although this may be part of the answer,
it does not explain why some studies have shown effects that are specific to
laser light.
Anatoly Rubinov of the Stepanov Institute of Physics in Minsk, Belarus, is
convinced that the unique properties of lasers offer an explanation. Unlike
ordinary light, laser light is strongly ordered: its electromagnetic waves
oscillate in step, with the peaks and troughs aligned. When a laser beam passes
through a layer of cells, it splits into many components, which interfere with
each other as they bounce about, creating a mottled pattern of light and dark
regions.
To show the physical effect this might have on cells, Rubinov illuminated some
cell-sized plastic beads with various interference patterns (Journal of Physics
D: Applied Physics, vol 36, p 2317). The beads were moved around by the light,
and became trapped in the bright regions. Rubinov says cells should be affected
in the same way. It is well known that light can exert significant forces on
small objects, but the effect of these forces in laser therapy has not been
considered before.
Rubinov believes it is these forces that trigger a biological effect within
the cells. When he exposed human white blood cells to uniform laser radiation,
the number of cells that underwent apoptosis -a form of programmed death that
eliminates mutated cells -increased with exposure time. When he used an interference
pattern of the same laser light, the number of cells undergoing apoptosis also
rose for a few minutes, but then dropped off sharply.
Rubinov concludes that while radiation itself can damage DNA, the forces exerted
by the interference pattern trigger a repair mechanism within the cells. In
another set of experiments, he showed that cells exposed to certain interference
patterns showed fewer signs of DNA damage than those exposed to uniform radiation. "The
gradient forces activate the repair system of the cell and increase the resistance
of its genome to external factors and increase the resistance of its genome
to external factors," he says.
Harry Mosely, president of the British Medical Laser Association, says Rubinov's
work represents an important first step towards understanding the potential
medical effects of lasers. "It is moving us on in our thinking, which
is excellent," he says.
Jenny Hogan .
www.newscientist.com
Lightwave of the Future The low-power laser for the treatment
of carpal tunnel syndrome is safe, painless, and completely noninvasive.
By John S. Soet
REHAB MANAGEMENT; JANUARY/FEBRUARY 2005; PP. 24-30.
(click
here to download a pdf version of this article)
It was the late 1960s. The Beatles were still the rage, the Vietnam
War was in full swing, and Star Wars was a decade away. Theodore
Maiman, utilizing a technique of concentrating and amplifying monochromatic
light originally developed by two teams of researchers,
produced a device known as LASER, light amplification by stimulated
emission of radiation. Immediately, the term “ray gun” came
to mind. The development of weapons-grade lasers became a priority.
Because the
beam could be concentrated to cut a minute surface area, surgical applications
were also developed.
But while governments and researchers were concentrating on military
applications, a Hungarian physician named Endre Mester suspected that
the laser might have a more humane application—the destruction
of malignant tumors. Malignancies were traditionally treated with the
cut/burn/poison strategy—surgery, chemotherapy, and radiation.
If, indeed, the new addition to the scientific arsenal could destroy
carcinomas with a minimum of damage to surrounding tissue, it would be
an incredible breakthrough in cancer treatment. However, Mester concluded
his research with good news and bad news.
LASER SERENDIPITY
The bad news was that his treatment was ineffective against malignancies.
The good news was a curious observation in the test animals. He observed
that in many cases the skin incisions he made to implant malignant
cells in test animals appeared to heal faster in treated animals compared
to
the incisions of control animals that were not treated with light.
Curious about this unexpected and unanticipated result, he designed
many follow
up experiments on skin defects, diabetic ulcers, burns, infections,
and decubiti. He was baffled by the discovery that they all healed
more quickly
when exposed to the light of his laser. Eventually, Mester discovered
that his laser was underpowered, which was why it did not have a destructive
effect on cancerous tissue. This led him to conclude that, just as
sunlight is destructive in high amounts but beneficial in small amounts,
the laser,
at low power, stimulated healing in tissue.
In the decades
that followed, Mester’s work was adapted to numerous
benign laser applications the world over. However, one of the fields
where the laser is one of the most beneficial, yet noninvasive, treatments
available is also one of the slowest to capitalize on its advantages.
This is the field of physical therapy. Chukuka Enwemeka, PhD, PT, is
one of the world’s foremost authorities on and advocates of low-power
laser therapy. The former chair of the University of Kansas Department
of Physical Therapy and Rehabilitation and current dean of the School
of Health Professions, Behavioral and Life Sciences at the New York Institute
of Technology, Enwemeka is also former president of the World Association
for Laser Therapy. “Almost every other field of the healing professions
is picking up on laser technology faster than PTs,” he says. “Chiropractors,
oriental medicine doctors, everyone except orthopedic surgeons, who
are even slower.”
Enwemeka expands
his comments to include the fact that the United States, in general,
is “last on the block” as far as utilization
of laser therapy. “It’s been utilized much longer just about
everywhere,” he states, “Europe, South America, Asia … processes
are much slower to catch on here. Part of this is because the approval
process takes so long, and part of it is that we PTs seem to be
skeptical about anything new. The other problem is that there are
so many innovations
being developed in the United States, anything developed here gets
priority in the approval process and anything developed in other
countries gets
moved to the back of the line.”
Ironically, a staple of the physical therapy profession is one
single area where the laser has proven to be highly effective:
the treatment
of carpal tunnel syndrome (CTS). “It was the first physical therapy
protocol for which the low-power laser, or ‘cold’ laser,
was approved by the FDA,” Enwemeka says. “In fact, it’s
one of the most effective interventions in the PT’s arsenal.
In many cases, lower power laser treatment has been effective when
even
surgery has failed.
HEALING MECHANISM
“
All cells, or should I say most cells, have chromophores,” says
Enwemeka, “which are like chlorophyll. They absorb light and
transform it to ATP, which can be used, for example, to create more
collagen or
induce homeostasis to reduce inflammation. The light, basically,
supplies energy to the cells. Cells absorbing light stimulate the
metabolic process
on the cellular level.
“ ATP is used to power many metabolic processes; synthesize DNA, RNA, proteins,
enzymes, and other
biological materials needed to repair or regenerate cell and tissue
components; enhance mitosis or cell proliferation;
and/or restore homeostasis. The result is that the absorbed energy
is used to repair the tissue, reduce pain, and/or restore normalcy
to an
otherwise impaired biological process. We experience this ourselves.
When it is overcast or dark, you don’t feel as good as you
do when the day is bright and sunny. If you are out of the light
for a while,
you feel lethargic and depressed. It demonstrates the role light
plays in stimulating ATP production.
“ An additional benefit for employing the cold laser in treating carpal
tunnel is pain relief. Reports indicate that light therapy can modulate
pain through its direct effect on peripheral nerves as evidenced
by measurements of nerve conduction velocity and somatosensory evoked potential.
Other
reports indicate that light therapy modulates the levels of prostaglandin
in inflammatory conditions such as osteoarthritis, rheumatoid arthritis,
and soft tissue trauma.”
Additionally, other forms of light therapy have been found to be
extremely effective in carpal tunnel treatment. “Light
technology continues to advance. Other monochromatic light sources
with narrow spectra and the same therapeutic value as lasers are now
available.
These include light-emitting diodes (LEDs) and superluminous diodes
(SLDs). As the name suggests, SLDs are generally brighter than LEDs;
they are
increasingly becoming the light source of choice for manufacturers
and researchers alike. The light source does not necessarily have to
be a
laser in order to have a therapeutic effect. It does have to be light
of the right wavelength. It has been demonstrated that lasers, LEDs,
SLDs and other monochromatic light sources all produce beneficial
effects. Preferences vary from therapist to therapist. However, it
is the dose
and wavelengths that are critical. At present, it is believed that
appropriate doses of 600 to 1,000 nm light promote tissue repair
and modulate pain,” Enwemeka
says.
CARPAL TUNNEL PROCEDURES
“ It should be pointed out that, while it certainly is one of the most
exciting advances in the history of physical therapy,
light therapy is not a panacea,” says Enwemeka. “Certain
cases of CTS do not respond. However, the most common
forms of repetitive strain injuries are very responsive to light
therapy. Because it is completely noninvasive, clinically, the
PT really should
give serious consideration to this procedure.” Enwemeka also
believes light therapy is contraindicated in certain cases, including
the following:
- The presence of any malignancies.
- Irradiation of the eyes.
- Patients with a high degree of light sensitivity.
- Patients who have been pre-treated with photosensitivity-enhancing agents, for example, patients undergoing photodynamic therapy.
- Patients on medications that may enhance photosensitivity or patients using the herb Saint-John’s-wort.
- Irradiation over the uterus during pregnancy.
- Irradiation of the thyroid gland.
Since light is destructive at high doses but very therapeutic at appropriately low doses, it is important to use the right dose (fluence or energy per unit area treated), and frequency of treatment appropriate for each condition. The dosage is, of course, determined by a ratio of power to duration. Generally, according to Enwemeka, the dosage is at 3 J/cm2 to 5 J/cm2 two to three times a week. Often, patients begin to note rapid improvement within three to five visits. The entire course of treatment ranges from eight to 10 visits.
TIME TO SEE THE
LIGHT
Many practitioners in Europe believe that light therapy will eventually
replace most other forms of carpal tunnel treatment. However,
as previously stated, Enwemeka still believes many American PTs need
some urging
to move in this direction. “A mind-set has developed in
our profession that is what I can best describe as a resistance
to anything new.
There is a certain
skepticism about newer treatment protocols. While this is good in the
fact that it has helped physical therapists
avoid quackery and maintain a reputation as the most reliable rehabilitation
specialists, it’s a double-edged sword because it also
allows other countries and practitioners to get a head start
on us.
“
The low-power laser has received a lot of press and news coverage.
It has established a reputation with the public for being quick
and painless, so a patient who is able to make his or her own determinations
might
seek out a rehab specialist who uses light therapy. The PT
who does not
utilize light therapy may soon, if not already, be losing business
to chiropractors and acupuncturists. Aside from a business
standpoint, the treatments really are in the patient’s
best interest for the same reasons.
“
A lot of PTs also balk at the thought that they have to purchase the
equipment. But the truth is that while the equipment can be
over $20,000, the light equipment used in physical therapy begins at around $5,000
or $6,000. And there’s almost never a problem with insurance
providers as long as the treatments are coded properly.
“
The low-power laser could revolutionize treatment of carpal tunnel syndrome,” concludes
Enwemeka. “It would be a shame if PTs continue to take
a ‘wait-and-see’ attitude
toward this therapy and allow other professionals to continue to
take the lead.” _
John S. Soet is a contributing writer for Rehab Management.
SportLaser®
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