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Laser Therapy Introduction

Laser Therapy is the application of red and near infra-red light over injuries or lesions to improve wound / soft tissue healing and give relief for both acute and chronic pain.

It is now officially referred to as (Low Level Laser Therapy) LLLT

Laser Therapy is used to:

- INCREASE THE SPEED, QUALITY and TENSILE STRENGTH OF TISSUE REPAIR

- GIVE PAIN RELIEF

- RESOLVE INFLAMMATION

- AN ALTERNATIVE TO NEEDLES FOR ACUPUNCTURE

The red and near infrared light (600nm-1000nm) can be produced by laser or high intensity LED.

The intensity of LLLT lasers and LED's is not high like a surgical laser*. There is no heating effect.

The effect is photochemical (like photosynthisis in plants)

Red light aids the production of ATP thereby providing the cell with more energy which in turn means the cell is in optium condition to play it's part in a natural healing process.

*LLLT devices are typically delivering 10mW -200mW (0.2 -> 0.01 Watts). The power density typically ranges from 0.05W/Cm2 -> 5 W/Cm2

Click here for further explanation of technical parameters

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LASER THERAPY IS POPULARLY USED FOR :

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SOFT TISSUE INJURIES

JOINT CONDITIONS

CHRONIC PAIN

NON HEALING WOUNDS AND ULCERS

POST-OP PAIN

ACUPUNCTURE

More uses_of_LLLT

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More on How_does_it_work

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More on Physiological_Changes

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CLINICAL EVIDENCE

LLLT is most popularly used for treatment of musculoskeletal disorders

Here are 3 summaries of double blind trials conducted with laser followed by links to pages with more than 30 other clinical trials of LLLT on musculoskeletal disorders, chronic pain and non-healing wounds.

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PAIN SCORES AND SIDE EFFECTS IN RESPONSE TO LOW LEVEL LASER THERAPY (LLLT) FOR MYOFASCIAL TRIGGER POINTS

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

A double-blind, placebo-controlled, random allocation study. 41 subjects, chronic myofascial trigger points in the neck and upper trunk region, five treatment sessions over a two week period, All groups demonstrated significant reductions in pain over the duration of the study.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.

6/97 Rep. US $8-10-12 copyright 1997 by LT Publishers, , U.K.' Ltd. Manuscript received:January, 1997 Accepted for publication: March, 1997

LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red laser

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Wave-length
Average
Power

Energy Density

Power Density

Energy

Pulses

Time
Beam
Spot size

820

25mW

5 J/Cm2
0.89
W/Cm2

0.14 J

5,000Hz

5.62 secs

0.89Cm2

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Calculating dosage

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Diode Laser in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l'Aggiornamento Scientif co, Padua, Italy

Double-blind, pulsed infrared, treatment of myofascial pain in the cervical region. 27 subjects, 12 LLLT sessions, alternate days, at each session the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated with 1J. Pain was monitored using McGill pain questionnaire andScottHuskisson visual analogue scale, pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

The Clinical journal of Pain 5:301-304 copyright 1989 Raven Press, Ltd., New York

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Wavelength

Power

Energy Density

Power Density

Energy per point

Pulses

904nm

5mW av (25Wpeak)

(not given)

(not given)

1 J

1KHz x 200nS

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Calculating dosage

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LOW LEVEL LASER THERAPY (LLLT) OF TENDINITIS AND MYOFASCIAL PAINS A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY

Mimmi Logdberg-Anderssont1, Sture Mutzell2, and Ake Hazel3

1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and

3: Vaxholm Health Care Centre, Stockholm, Sweden.

A double-blind study, laser therapy for tendinitis and myofascial pain,176 subjects, 6 treatments during a period of 3-4 weeks.Pain estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale. Laser therapy had a significant, positive effect compared with placebo. Laser treatment was most effective on acute tendinitis. 

Addressee for Correpondance, Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.

03/07 Rep US 10-12-14 , 1997 By LT Publishers, U.K., Ltd., LASER THERAPY, 1997:9: 79-86

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Wavelength

Power

Energy Density

Power Density

Energy per point

Pulses
Treatment
Time

904nm

8mW av (10Wpeak)

0.5-1.0 J/Cm2

(not given)

1J

4KHz x 180nS

2 mins

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Calculating dosage

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LLLT_musculoskeletal abstracts

LLLT_Clinical pain abstracts

LLLT clinical wound healing abstracts

LLLT lab wound study abstracts

LLLT Wound pictures

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SIMPLE TREATMENT TECHNIQUE

Example : Treating a muscle trigger point.

Example shown here is for a THOR Laser Therapy system with 100mW 850nm probe and a 69 diode cluster probe.

Having thoroughly palpated and assessed the area, set the timer to 20 seconds .

Set the Pulse frequency to one of the four following settings:

2.5 Hz - for acute injuries;

20 Hz - for wound healing;

150 Hz - for pain relief;

5 KHz - for chronic injuries and non-healing or infected wounds.

Treat each tender point with the THOR 100mW laser probe. Palpate for any changes (eg: reduction in pain, change in tissue texture, relaxation of muscle, etc). If there is no response, then treat the tender points again. Palpate for any changes and repeat once more if necessary. Then treat the surrounding soft tissue with the cluster probe for 1-2 mins per area depending on the build of the patient.

Be accurate during treatment, gapping and positioning joints appropriately to gain maximum exposure of the joint, treating 'around' tendons where possible and be as thorough as time permits. Use Laser Therapy as soon as possible after injury, treating daily for acute conditions and less frequently as resolution occurs. Treat chronic inflammatory conditions twice weekly and osteo-arthritis weekly or fortnightly. Treat as many points as necessary during one session; do not move the probe during each application. Treat with single, then cluster probe during one session.

WOUNDS. Treat recent wounds for 1 min 20 seconds per area with cluster probe at 20 Hz. Aim to treat surrounding soft tissues as well as the wound itself. It may take 2 - 4 'clusters' to treat the both wound bed and the surrounding soft tissues. Use transparent thin film (cling-film) over ulcers, pressure sores and wounds and, without causing undue pain, maintain contact with site to be treated if possible. Clean probe after use with a surgical spirit wipe.

There are normally no adverse effects from Laser Therapy, however, patients occasionally experience mild discomfort / ache after treatment. This is due to a restimulation of the inflammatory phase and should settle down after 24 - 48 hours.

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WHAT PHYSIOTHERAPISTS SAY ABOUT LASER THERAPY :

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Conclusion of a postal survey of 162 physiotherapists:

"Laser Therapy has become a relatively popular modality which physiotherapists rate highly against a number of other modalities.

In particular the high ranking assigned to Laser Therapy for pain relief suggests that laser is a potent analgesic modality, easily superior to most of the other modalities.

Ranking of modalities listed for stimulation of wound healing produced the most unequivocal responses, with Laser Therapy being represented as by far the most effective modality in this respect."

Baxter et al, CSP Journal, 1991
Biomedical Sciences Centre, University of Ulster

"In our opinion manual techniques and electrotherapies are not indicated for very acute soft tissue work. Laser however is not contra-indicated and seems to work extremely well, particularly when treating extreme muscle spasm. We find ultrasound is good at getting rid of swelling but the laser is much better at promoting healing and giving pain relief, especially on superficial injuries and releasing muscle trigger points. Unlike other electrotherapies, laser can be used over bony prominences, metal pins, plates and on patients with pacemakers."

Mark Sylvester and Warwick McNeil
Physioworks Physiotherapy Services
London
0171 409 1539

"As a partner in Meridian Sports Medicine and Sports Performance Centres I am responsible for the monitoring of equipment and facility usage. This information is kept to provide information on buying decisions for future equipment, development of treatment protocols and contributes to the quality control of our overall treatment management.

Laser therapy is our most commonly used electrotherapy apparatus, particularly in acute cases. we have used it in our support of over 300 players in the Student Rugby League World Cup with considerable success when compared against other electrotherapy and mechanical modalities. It is used as an adjunct to many of the manual therapies practised by our physiotherapists, all of whom appreciate the benefits of accuracy in application.

We currently have two laser units and it will be first on our purchasing list after plinths as we expand into new clinics."

Matt Jevon
Meridian Sports
Wigan
01257 421232

Laser can be used immediatly on acute injuries, it is a very useful adjunct to have at major sporting games, treating acute/chronic injuries alongside manual therapy for pain relief and reduction of inflammation.

Sarah Cooper MCSP
Oakfield Physiotherapy 01375 396 193
British Athletic Team physio

As Physiotherapist for the British National Paragliding Championships, I would not like to be faced with all the acute injuries we see without a laser. Since I've had a laser I can not be bothered with ultrasound and all that gel.

Sue Bunn MCSP
British National Paragliding Team, 01929 421 473

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More comments from laser users

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SAFETY GOGGLES MUST BE WORN BY PATIENT AND PRACTITIONER.

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CONTRA-INDICATIONS

DIRECT IRRADIATION OF THE EYES

Class 3b lasers are potentially harmful to the retina - though retinal damage is highly unlikely. Safety goggles must, however, be worn by both patient and practitioner.

PREGNANCY

Laser is contra-indicated for use over the pregnant uterus. It may be used on the pregnant woman as an adjunct to the other modalities being used for the treatment of back pain or other complaints.

CARCINOMA

Do not use laser over any known primary or secondary lesions. Laser treatment may be given for pain relief during the terminal stages of the illness - we recommend this be done only with the full consent of both patient and consultant involved.

THYROID

Laser should not be used over the thyroid gland.

HAEMORRHAGE

It is conceivable that laser-mediated vasodilation may worsen the haemorrhage.

IMMUNE SUPPRESSANT DRUGS

Laser Therapy is contra-indicated for patients on these drugs

TREATMENT OVER SYMPATHETIC GANGLIA, THE VAGUS NERVES & CARDIAC REGION IN PATIENTS WITH HEART DISEASE

Laser therapy may significantly alter neural function, and is therefore contra-indicated over these regions in patients with heart disease.

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PRECAUTIONS

STEROID INJECTIONS

Patients may suffer an exacerbation of symptoms after laser therapy in conjunction with a recent steroid injection. For this reason laser should not be used within 2-3 weeks of a recent steroid injection on or near the same site. After 2-3 weeks, you may then use the laser. We recommend one or two treatment points only at the minimum recommended dosage for that probe.

PHOTOSENSITIVITY REACTIONS

Some patients are on drugs known to cause photosensitivity reactions. It is unlikely that a combination of laser and drug will trigger this response. We recommend that "at risk" patients or patients with a history of such reactions be "patch tested" for the minimum recommended treatment time, for that probe, with each probe expected to be used on that patient.

ANTI COAGULANTS

It is possible that probe pressure may cause slight bruising after treatment

ANTI INFLAMMATORIES

Patients taking anti-inflammatories for acute soft tissue injuries will not respond as quickly to laser therapy as those who are not. Ideally, we would recommend laser and ice without the use of an anti-inflammatory.

N.S.A.I.D. AND STEROIDAL A.I.

Patients using topical or systemic steroids or N.S.A.I.D's for pain or skin conditions may experience a mild "flare up" of their symptoms. If such a reaction occurs, laser therapy should be stopped. The reaction should be allowed to settle. Laser treatment can then be recommenced at minimum or half-minimum treatment times - if necessary building up to an "effective dose" if the patient does not respond to the lowered treatment times. For patients with persisting treatment reactions, Laser therapy should be discontinued.

EPILEPSY

Take care when using laser therapy for these patients especially around the head and neck. Cover the area being treated with a towel draped over the probe.

REACTIONS TO TREATMENT

Some patients may suffer a slight increase in pain - patients should be warned of this possibility prior to laser therapy. In patients with persisting adverse reactions, laser treatment should be discontinued.

PINS, METAL PLATES, PLASTICS and PACEMAKERS ARE NOT CONTRA-INDICATED

Laser may be safely used over metal implants, plastics and stitches and on patients fitted with a pacemaker

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UK LASER SAFETY RULES

In some circumstances, the use of a class 3b medical laser device is regulated. Within the NHS there will be a Laser Protection Advisor for each Authority/Trust. You should contact this person and let them know you are using such a device. Outside NHS hospitals there may be a requirement to register the treatment premises with your local nursing homes registration office. They may want to inspect your premises, issue you with safety guidelines and send you a bill ! The following are exempt : Premises that are wholly or mainly a domestic dwelling, sports arenas, sports fields & industrial premises

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SUMMARY OF TECHNICAL PARAMETERS

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Wavelength

nm

Peak power

W

Average power

W/cm2

Peak power x pulse freq x pulse width

or peak power x duty cycle

Spot size (area)

cm2

(or m2 meters squared)

Pulse frequency

Hz

Pulse width

s

Duty cycle

%

(Pulse width x Frequency) x 100

Power Density

mW/Cm2

Power / Spot size

Time

s

Secs

Energy

J

Average Power x Time

Energy Density

J/cm2

Energy / Spot size

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Click here for further explanation of technical parameters

OTHER INCIDENTAL PARAMETERS

Lasing medium (eg : Ga.Al.As) or (HeNe)

Laser or LED

Coherent or not coherent

Beam profile (Divergent or collimated)

Pulsed, modulated pulse, or CW (continuous wave) ?

 

 

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