Laser Therapy: An Indispensable Modality
FEATURE
Jerome True
DC, FIACN
Laser therapy should be the first therapy consideration in the doctor’s office. Because of its ability to rapidly accelerate healing and inhibit pain, it also has the potential to increase patient satisfaction and promote the growth of your practice. Rapid pain relief does more than just satisfy the patient’s need to be pain-free—it creates excitement. This excitement can be the motivation that generates new referrals to your practice. In the arsenal of device technologies available for treatment of musculoskeletal injuries, laser therapy supersedes all other conservative treatment options in the chiropractic office.
Although laser does not replace the standard recommendation for treatment of acute injuries, it will dramatically improve most injuries and reduce their morbidity and duration. The efficacy of laser therapy has been demonstrated in multiple studies to be better than other modalities for treatment of many types of musculoskeletal injuries. With respect to treatment of acute moderate-severe injuries, laser also provides a treatment option when other modalities may not be appropriate. A patient presenting with acute injuries, such as joint effusion, tendinopathies, broken ribs, bruising, or abrasions, can be treated easily with laser therapy.
Laser is an acronym that stands for “light amplification by stimulated emission of radiation.”
Laser therapy is a relatively new modality compared to ultrasound, electrical stimulation, or diathermy. Laser as a technology was discovered in the 1960s, and it was quickly realized that laser could be used in surgical applications and tattoo removal. The use of low-power laser devices for biostimulation and wound healing was first discovered by Endre Mester, MD, a researcher and professor in Hungary in the late 1960s.1 This research was discounted by Western medicine for decades. Consequently, it took considerable time for laser research in the United States to replicate similar findings. Although European lasers have been available for decades, laser therapy devices cleared for use in the US have only been FDA-cleared since 1999.
Laser therapy utilizes wavelengths of light to stimulate normal cellular repair and physiologic processes. This mechanism of action is termed photobiomodulation (PBM). This process is defined as: “A form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events
at various biological scales. This process results in beneficial therapeutic outcomes, including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.”2
The most common wavelengths of light utilized are infrared and red wavelengths. PBM causes dozens of different biochemical cascades and physiologic cell-repair processes, such as upregulation of DNA synthesis, nerve myelination and regrowth, macrophage migration, bone formation, and collagen formation. Infrared and red light have been scientifically demonstrated to inhibit inflammatory chemicals associated with pain production and tissue injury. These are only a few of the mechanisms and cellular processes influenced by light.
Within cells and organelles of cells are specific complex molecules that have the ability to absorb certain wavelengths of light. These molecules are called chromophores. The most significant chromophore for infrared and red light appeal s to be cytochrome C oxidase, a terminal in enzyme in cellular energy production. Infrared light has also been demonstrated to release nitric oxide from the endothelium of blood vessels, causing localized vasodilation and increased oxygenation to tissues.
It should be noted that regardless of the source of infrared light, whether it be LED (light emitting diode) or laser, photobiomodulation will still occur. However, light generated by a
laser source is preferable to LED-generated sources for deeper penetration. Light generated by a laser source is highly coherent and monochromatic. The wavelengths of light are tightly organized peak to trough, resulting in a greater degree of energy fluence per unit square area. This high degree of parallel coherent organization is thought to improve penetration and cell stimulation. Fig. 1 Laser therapy devices may use multiple output wavelengths for a combined effect, possibly improving PBM and treatment outcomes.
* * Other than the universal contraindication of direct retinal exposure, laser therapy is extremely safe. 5 5
Laser therapy devices are classiAed by their power output, which is organized on a scale of 1 to 4 based on the maximum output power level. The class divisions are class 1, class 1M, class 2, class 2M, class 3, class 3R, and class 4. Eye safety is the number one issue with all class 3 and class 4 therapy lasers, which means it is mandatory that everyone in the room or hazard zone wear protective laser goggles. Personal protective eyewear is supplied by every manufacturer of therapy lasers, and these goggles are speciAc for the type of laser and wavelengths of light emanating Aom the laser. There are other patient-speciAc contraindications, such as not using a laser over a pregnant uterus and directly over cancers. Other than the universal contraindication of direct retinal exposure, laser therapy is extremely safe.
The interpretation of scientiAc literature is not always straight forward when comparing different laser devices. This difficulty certainly holds true for a side-by-side comparison
of different devices when looking at efficacy and treatment outcomes. Because of the variance in power level, wavelength, and delivery technique, each laser device may have features that are unique for that given device and thereby improve the treatment efficacy of that device. For example, one device may utilize a different pulsing frequency or wavelength combination that improves treatment outcomes for some types of musculoskeletal disorders. However, another device may have a probe that allows for highly directional treatment for specific use, such as acupuncture-point stimulation, trigger-point work, or cranial suture treatment. Some devices have a standalone feature where the laser operates unattended and treatment is performed over a generalized area in the region of complaint. These three types of devices have unique features that are very desirable for their given use, but using these lasers outside of their intended use may result in less than optimum results. A solid comparison can be made between device technologies, but only when the lasers have similar wavelengths, power output, beam size, and pulsing frequency.
Questions to ask yourself prior to buying a laser:
1. How will you utilize laser therapy? Sports injuries? Acute sprain strains? Rehabilitation?
2. Do you need an unattended therapy because of lack of staff to operate the laser?
3. Can you dedicate five to 10 minutes of staff time to operate the laser?
4. Will you use laser as a stand-alone therapy and charge a cash fee?
5. Can you budget at least $15,000 for a quality laser device?
6. Do you practice energy medicine or energy-balancing techniques?
7. Do you practice acupuncture?
8. Do you mainly treat backand neck-pain patients?
Depending on the type of practice, an office may need at least three different types of lasers with features similar to those previously described to meet all of the needs of a typical chiropractic clinic or musculoskeletal practice.
References:
1. Mester E, Szende B, Gartner P. The effect of laser beams on the
growth of hair in mice. Radiobio! Radiother (Berl) 1968;9:621-626.
2. Anders .1.1, Lanzafame RJ, Arany PR. Low-Level Light/Laser
Therapy Versus Photobiomodulation Therapy. Photomedicine and
Laser Surgery. 2015;33(4): 183-184. doi:10.1089/pho.2015.9848.
Dr. Jerry True is a chiropractic neurologist in Stuart, Florida with extensive experience in laser therapy. Over the past decade, he has lectured on the topic of laser therapy and laser safety for many continuing-education venues in multiple states. For six years, he was on the board of directors of the North American Association for Light Therapy (NAALT), a highly respected multidisciplinary organization for the study of laser and light therapy. He recently coauthored a chapter on laser therapy in the textbook The Handbook of Low Level Laser Therapy published by Pan Stanford in 2016. Dr True can be reached at 772-219-9983 ifyou have any questions concerning therapy lasers, docirueff corneas/. net
