Cold Laser
PERSPECTIVE
By
Jeffrey Tucker
Dc
I have been experimenting with the Multi Radiance MR4 Super Pulsed Laser (Class 1B) in my practice and I find that it compliments other therapies I use every day, such as Class 3B lasers, Class 4 lasers, shock wave, fascial manipulation, movement therapy, and the use of topicals such as CBD. The Class IB laser generates no excess heat, making it safe for all patients, and treatments can be done in just minutes. The Class IB (Multi Radiance MR4 Super Pulsed Laser) is another great tool for getting my patients back to where they need to be.
My overall treatment of late includes combining movement therapy, oral peptides, herbals, other supplements, along with CBD serums or counter-irritant topicals with laser therapy because this helps pain levels between sessions. I recommend Phyto-Zol topical CBD serum along with Integrative Peptides BPC 157 (oral) to my patients for the maximum benefit when they can’t get to the office each day.
How laser works on enzymes
Low-level laser therapy (LLLT) has been studied and used in various medical professions for over 50 years. Laser therapy not only inhibits certain enzymes, but it also stimulates certain enzymes. One might say it is both a “perpetrator” and a “victim.” Low-level laser therapy exposure can inhibit the polarization of Ml bone marrow-derived macrophages (BMDMs) in neuronal axons of dorsal root ganglion (DRG) and the secretion of pro-inflammatory factor including Tumor necrosis factor alpha (TNF-a) and interleukin-1 p (IL-lp). Low-level laser exposure could contribute to the secretion of neurotrophic factors including brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) and promote the growth of DRG axon.
The potential for laser is related to the target tissues of laser, its photobiomodulation and dynamic effects, and its impact on the metabolism, absorption, and elimination of other chemicals. Every cell in the body has at least one Transient Receptor Potential (TRP) channel. These are calcium-permeable ion channels. One TRP in particular is called TRP Vanilloid 1 (TRPV1). Super pulsed laser can indirectly suppress or activate TRPV1 effects on pain and inflammation. Turning down excited TRPV1 nerves creates analgesia to reduce pain both locally and systemically. The opposite can upregulate or stimulate nerve conduction velocity.
How I use LLLT and fascial stretch therapy
I’ve been using Class IB (Multi Radiance ACTIV PRO Laser Stim), Class 3B (TheraLase) and Class 4 (LightForce) lasers on patients with complex health conditions, like fibromyalgia, chronic fatigue syndrome, and neurodegenerative disease, as well as osteoarthritis and sports injuries. Laser therapy provides an upgrade to standard soft tissue and manipulative therapy.
I have found that combining low level laser therapy (LLLT) with fascial stretching greatly benefits those with chronic fascial distortions. Therefore, those who have
undergone surgery and have visible scars, experienced residual motor vehicle trauma, or have sports injuries will benefit from low level laser therapy and fascial stretching combinations. Fascia can be disrupted at the superficial fascia, the deep fascia, the visceral fascia and the meningeal fascia. Fascia is rich in sensory nerves - fascia gives us proprioception information, creates motor unit activation, and peripheral motor coordination. Lack of fascial gliding is one of the one most diagnostic suggestions of a fascial issue. I suspect the low level laser stimulates certain enzymes, combined with the in-office and at-home movement therapy I prescribe stimulates collagen production, allowing for patient-engaged pain management.
Laser therapy not only inhibits certain enzymes, but it also stimulates certain enzymes.
I suggest trying low level laser therapy (Class IB) on individuals who have a high risk of adverse effects from manipulation, since the laser is safe, painless, and non-invasive. Older, frail patients taking osteoporosis medications, or those patients with cognitive disorders or conditions like multiple sclerosis or insomnia could benefit greatly from laser therapy treatments.
Delivery of LLLT for inflammation
Studies are being conducted by Nexzol Pharma makers of Phyto-Zol, to answer the question of whether to apply laser first before using an anti-inflammatory CBD serum, or vice versa. Preliminary data demonstrate that Phyto-Zol does not inhibit the laser. I look forward to writing about this in a future article. The laser therapy delivery route (static holding vs scanning) has a profound impact. Static delivery over a target area helps to accurately measure the amount of the delivered dose to the target and reduce the overall treatment time necessary to do so. Super pulsed laser therapy has demonstrated positive effects from immediate up to 48 hours after application. This generally peaks about 4 hours after the initial treatment and increases as the therapy progresses. Starting with a lower dose of therapy, allows the clinician to adjust the dose to ensure that a stimulatory effect can be delivered to modulate the inflammatory process.
For managing inflammation, we generally want to provide a lower, more concentrated dose to the joint area, capsule and ligaments. Modulation of the cytokines is necessary to reduce the pain and can resolve within a few days. For muscle spasms and nerve root irritations, we do need to cover more area, therefore, it may be necessary to increase the power output (increasing the frequency of the laser emission) to activate the inhibitory effects on both muscle and nervous tissue. This will reduce spasticity and induce analgesia in the affected area.
What dose would you recommend?
Dose is extremely important, and less is more with super pulsed laser. The old adage, “start low, go slow” is a good approach. If laser is ineffective, I recommend that practitioners increase the dose in small increments so long as the patient does not feel adverse effects, and then continue increasing until the laser is effective. This is what medical doctors do with prescription products—titrate the dose upwards. I assess range of motion and pain, before and after treatment, and then raise the dose again if necessary. The caveat is that higher doses may cause adverse effects at any time during use, not necessarily immediately.
In conclusion, super pulsed laser therapy with fascial stretching is a non-invasive way to manage patient pain in a new way. Patients who are looking for an alternative method for resolving their pain will appreciate the inherent safety and efficacy of the technology.
References
1. M. H. Niemz, “Laser-Tissue Interactions: Fundamentals and Applications, ” Springer-Verlag, Berlin, Heidelberg, 2004.
2. M. H. Niemz, “Laser-Tissue Interactions: Fundamentals and Applications, ’’Springer, Berlin, 1996, p. 297.
3. K. C. Smith, “Light and Life: The Photobiological Basis of the Therapeutic Use of Radiation from Lasers, ” In: T. Oshiro and R. G. Calderhead, Eds., Progress in Laser Therapy Selected Papers from the 1st Meeting of the International Laser Therapy Association, Okinawa, 1990, pp. 11-18.
4. T. Dai, B. Pikkula, V. Wang and B. Anvari, “Comparison of Human Skin Opto-Thermal Response to Near-Infrared and Visible Laser Irradiations: A Theoretical Investigation, ” Physics in Medicine and Biology, Vol. 49, No. 21, 2004, pp. 4861-4877. doi: 10.1088/0031-9155/49/21/002
5. Peters J, Chien J. Contemporary Routes of Cannabis Consumption: A Primer for Clinicians. J Am Osteopath Assoc. 2018 Feb 1; 118(2):6770.
6. Brown JD, Winterstein AG. Potential Adverse Drug Events and DrugDrug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019:8(7):989.
7. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US): Jan 12. Available at: https://www. ncbi. nlm. nih. gov/ books/NBK4257577. Accessed: September 2, 2019.
8. Conversations with Tom Scarlata, Nexzol Pharma January 2020. 9. https://www. multiradiance, com/
Dr. Jeffrey Tucker is the current president of the ACA Rehab Council. The Rehab Council will have its annual conference March 13-15, 2020 in Tempe, AZ. The website to register is www.ACARehabCouncil.org. Dr. Tucker practices in Los Angeles, CA. His website is www. D r J eff reyTu c ke r. co m
