Electrical Stimulation, Ultrasound, and Laser Light Handbook

Copyright © 2018, Elsevier Inc. All rights reserved.
Introduction
This quick-reference manual is based on information
presented in Physical Agents in Rehabilitation: An
Evidence-Based Approach to Practice, 5e by Michelle H.
Electrical Stimulation, Ultrasound, and Cameron.
Laser Light Handbook
The information in this handbook is intended for use by
Michelle H. Cameron, MD, PT, OCS
qualified clinicians with prior training in the use of
Jennifer A. Rohl, BS
physical agents in rehabilitation and for students
practicing under qualified supervision.
The outline format of the handbook is meant to make the

information easily accessible to rehabilitation
professionals during clinical practice. For more detailed
Notice: Knowledge and best practice in this field are constantly
changing. As new research and experience broaden our knowledge,
information and complete references please refer to
changes in practice, treatment and drug therapy may become necessary Physical Agents in Rehabilitation: An Evidence-Based
or appropriate. Readers are advised to check the most current Approach to Practice, 5e.
information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administra- How to use this handbook
tion, and contraindications. It is the responsibility of the practitioner, For ultrasound treatment
relying on his or her own experience and knowledge of the patient, to
make diagnoses, to determine dosages and the best treatment for each 1. Read Chapter 9 on ultrasound in Physical Agents in
individual patient, and to take all the appropriate safety precautions. To Rehabilitation: An Evidence-Based Approach to Practice,
the fullest extent of the law, neither the Publisher or Authors assumes 5e to review how this modality works and what the
any liability for any injury and/or damage to persons or property arising
out or related to any use of the material contained in this book. adjustable treatment parameters are.
2. Select appropriate treatment parameters for increas-
ing tissue temperature or promoting tissue healing from
the ultrasound parameters section in this handbook.
3. Determine ultrasound treatment location by referring
to the ultrasound section in this handbook concerning
your patient's problem.
4. These are treatment suggestions only. Adjust
parameters based on clinical judgment.

For electrical stimulation treatment Ultrasound
1. Read Chapters 11-14 on electrical currents in What is ultrasound?
Physical Agents in Rehabilitation: An Evidence-Based Ultrasound is a type of sound. It is similar to audible
Approach to Practice, 5e to review how this modality sound, except that it has a higher frequency. Ultrasound
works and what the adjustable treatment parameters are. has a frequency of greater than 20 kHz (20,000
2. Select appropriate stimulation parameters for muscle cycles/second). The human ear can hear sounds with a
contraction, pain control, or soft tissue healing from the frequency of up to 20 kHz. Therapeutic ultrasound
appropriate electrical stimulation parameters section in generally has a frequency of between 1 and 3 MHz
this handbook. (millions of cycles/second) in order to achieve a depth
3. Determine electrode placement by referring to the of penetration through soft tissue of between 1 and 5 cm
electrode placement section in this handbook concern- (with 1 MHz penetrating deeper than 3 MHz).
ing your patient's problem.
4. These are treatment suggestions only. Adjust
How therapeutic ultrasound works
parameters based on clinical judgment.
When ultrasound passes through tissue some of it is
absorbed by the tissue producing molecular motion.
For laser light treatment This motion causes friction between particles and thus,
1. Read Chapter 16 on lasers and light in Physical with sufficient ultrasound intensity, an increase in tissue
Agents in Rehabilitation: An Evidence-Based Approach to temperature. The tissue heating produced by ultrasound
Practice, 5e to review how this modality works and what can increase local blood flow and collagen extensibility,
the adjustable treatment parameters are. reduce pain and muscle spasm, increase local circulation
2. Select appropriate parameters for pain management and enzyme activity and produce a mild inflammatory
or promoting tissue healing from the appropriate laser response.
light parameters section in this handbook.
3. Determine laser light treatment location by referring It has also been found that ultrasound has a range of
to the laser light section in this handbook concerning effects that are not related to its ability to increase tissue
your patient's problem. temperature. These effects are known as non–thermal or
4. These are treatment suggestions only. Adjust mechanical effects and include stable cavitation,
parameters based on clinical judgment. microstreaming and acoustic streaming. Research
indicates that these non–thermal effects may promote
soft and bony tissue repair and increase cell and tissue
membrane permeability.
2 3

Ultrasound parameters
Intensity: The amount of power per unit area, generally
measured in W/cm2. This measure of dosage should be 1 MHz 3.3 MHz
used when selecting ultrasound treatment parameters.
Effective Radiating Area (ERA): The area of the

crystal where the intensity of the ultrasound is 5% or
greater than the measured maximum.
Power: The amount of acoustic energy per unit time,

generally measured in Watts. This measure of dosage is
only used during calibration of the ultrasound machine.
It should not be used when selecting ultrasound
treatment parameters.
Frequency: Number of cycles per unit time. Ultrasound

frequency is usually measured in Megahertz, (MHz,
millions of cycles/second). Increasing the frequency
decreases the depth of penetration. (These drawings are not actual size, but are drawn to
scale. Light beige represents E.R.A. while darker beige
represents actual crystal surface area.)
4 5

Beam Nonuniformity Ratio (BNR): The ratio of the Duty cycle: The proportion of the total treatment time
highest intensity in the field to the spatial average during which ultrasound is being delivered. The duty
intensity. cycle may be expressed as a percentage or the ratio of
Peak the on time to the total cycle time.
Average
e.g. 1:1 = 100% = continuous
1:2 = 50% = 5ms on: 5ms off
1:5 = 20% = 2ms on: 8ms off
100%
E.R.A diamter
Pulsed: Ultrasound can be delivered either continuously

or in a pulsed mode. Pulsed ultrasound is on some of the
time and off some of the time. 50%
100% 5 ms 5 ms 5 ms
20%
2ms 8 ms 2ms
50%
5 ms 5 ms 5 ms
20%
2ms 8 ms 2ms
6 7

Clinical application of ultrasound Contact
Transmission medium Complete contact should be maintained between the
When applying therapeutic ultrasound to a patient, a entire transducer surface and the patient's skin through-
transmission medium must be placed between the out treatment.
patient's skin and the ultrasound transducer. This Area of treatment
transmission medium ensures effective ultrasound Ultrasound should generally be used to treat areas
transmission to the patient. Good ultrasound transmis- equal to twice the ERA of the transducer. Treatment
sion media include manufactured ultrasound gel, recommendations are based on treating areas of this
ultrasound lotion and water. Other topical preparations, size. If treatment of a larger area is required the
such as creams or ointments, not intended for ultrasound treatment time should be increased proportionately.
transmission should not be used since many of these
transmit ultrasound poorly.
Since air is a poor transmitter of ultrasound the
amount of transmission medium applied must be
sufficient to eliminate any air between the transducer E. R. A.
and the patient's skin. = 2x E. R. A.
Motion of transducer
Ultrasound
The transducer should be moved throughout the
gel or lotion
treatment. It may be moved in a circular or stroking
manner.
The speed of transducer movement should be

sufficient to maintain constant motion while avoiding
increasing the treatment area or losing consistent and
constant contact with the skin.
8 9

Contraindications for the application of therapeutic Recommended ultrasound treatment parameters
ultrasound
1. Over malignant tissues or space occupying lesions Increase tissue temperature
2. Over a pregnant or possibly pregnant uterus. Duty cycle Continuous Continuous
3. Over the stellate ganglion, the spinal cord after Tissue depth ≤ 5 cm 1- 2 cm
laminectomy, subcutaneous major nerves and the Frequency 1 MHz 3 MHz
cranium Duration
4. Over a cemented prosthesis or in areas where plastic (2 x ERA) 5 – 10 min 5 – 10 min
components are used Intensity 1.5 – 2.0 W/cm2 0.5 W/cm2
5. Over a cardiac pacemaker or its lead wires
6. Over or adjacent to vessels containing arterial or Nonthermal effects
venous thrombi or with thrombophlebitis Duty cycle 20% 20%
7. To the eyes Tissue depth ≤ 5 cm 1-2
8. Over the male or female reproductive organs. cm Frequency 1 MHz 3 MHz
Duration
Precautions for the application of therapeutic (2 x ERA) 5 – 10 min 5 – 10 min
ultrasound Intensity 0.5 – 1.0 W/cm2 0.5 – 1.0 W/cm2
1. Areas of acute inflammation
2. Over unclosed epiphyseal plates in skeletally
immature individuals
3. Only low-dose ultrasound, such as that used in
fracture healing, should be applied over the area of a
fracture.
4. Over breast implants
5. The ultrasound applicator should be moved through-
out the treatment.
6. Areas of reduced sensation or circulation.
NOTE: It has been shown that ultrasound does not

adversely effect the mechanical properties of silastic
(the plastic commonly used in finger joint arthroplasty)
or the fixation of metal pins, screws or plates.
10 11

Recommended ultrasound treatment Finger contracture
sites and parameters
Knee contracture
Duty cycle Continuous Duty cycle Continuous

Frequency 1 MHz Frequency 3 MHz
Duration (2 x ERA) 5 – 10 min Duration (2 x ERA) 5 – 10 min
Intensity 1.5 – 2.0 W/cm2 Intensity 0.5 W/cm2
12 13

Low back pain: Increase circulation Lateral collateral ligament (LCL) sprain
Duty cycle Continuous Duty cycle 20%

Frequency 1 MHz Frequency 3 MHz
Duration (2 x ERA) 5 – 10 min Duration (2 x ERA) 5 – 10 min
Intensity 1.5 – 2.0 W/cm2 Intensity 0.5 – 1.0 W/cm2
14 15

Sacral pressure ulcer Electrical stimulation
What is electrical stimulation?
Electrical stimulation is the application of an
electrical current to the body via transcutaneous
electrodes for therapeutic benefit.
How electrical stimulation works
Electrical stimulation works primarily by stimulating
peripheral nerves to produce action potentials which are
transmitted along these nerves. Sensory nerves transmit
action potentials from the periphery towards the central
nervous system to produce a sensation frequently
described as tingling. Motor nerves transmit action
potentials towards the periphery to cause contraction of
the muscles they innervate. When nociceptive (pain
transmitting) nerves transmit action potentials towards
the central nervous system the individual feels pain.
The different types of nerves, sensory, motor and
nociceptive, have different minimum thresholds for
responding to electrical stimulation. These thresholds
depend on the duration and amplitude of the applied
pulse of electrical current. Sensory nerves respond to
shorter and lower amplitude pulses than motor nerves
and motor nerves respond to shorter and lower ampli-
tude pulses than pain transmitting nerves. The minimum
threshold for stimulation of these types of nerves is
most readily demonstrated by the amplitude duration
Duty cycle 20% curves on the following page.
Frequency 3 MHz
Duration (2 x ERA) 5 – 10 min
Intensity 0.5 – 1.0 W/cm2
16 17

Electrical stimulation devices are designed to produce Electrical stimulation parameters
pulsed currents where the pulse amplitude and duration Waveform
can be selected to optimally stimulate sensory nerves The waveform may be one of three general types-
only (using short pulses of 25 to 40 µs (microsecond) direct current, alternating current or pulsed current.
phase duration or 50 to 80 µs pulse duration) or sensory Direct current (DC) : A continuous unidirectional
and motor nerves (using longer pulses of 75 to 175 µs flow of charged particles. DC is used for iontophoresis,
phase duration or 150 to 350 µs pulse duration) while, for stimulating contraction of denervated muscle, and
in both cases, not stimulating nociceptive fibers (which also occasionally to facilitate wound healing.
would require longer pulse durations or pulse ampli-
tudes). + polarity
200
Aβ Sensory Current amplitude
C Dull pain 0
180
Current strength (mA)
Motor
160 Denervated
Time
- polarity
Alternating current (AC) : A continuous bidirec-

tional flow of charged particles. AC is generally used
for interferential, premodulated, and Russion protocol
20 stimulation.
0 10 40 100 300 600 1.0 10 100 + polarity
Current amplitude
Microseconds Milliseconds
( sec) (msec)
Pulse duration (pulse width)
0
Time
- polarity
18 19

Interferential current: The waveform produced by Premodulated current: An alternating current with
the interference of two medium frequency (1,000 to a medium frequency and sequentially increasing and
10,000 Hx) sinusoidal ACs of slightly different decreasing current amplitude produced with a single
frequencies. These two currents interfere to produce a circuit and only two electrodes. The beat frequency of
beat current with a frequency equal to the difference this current, to which the body responds, is equal to the
between the two applied currents and an amplitude frequency of the variation in pulse amplitude.
equal to the sum of the amplitudes of the two applied
currents. This form of stimulation is thought to be more +4
comfortable than other types of current because the
Amplitude
current which passes through the skin has a low
amplitude. Interferential stimulation is most commonly 1
used for pain management and in such applications is a 0
form of TENS.
-4 100 Hz
1 2 5,100 Hz
Russian protocol: A form of stimulation designed to
stimulate motor nerves to optimize muscle strengthen-
ing. It is comprised of fifty 10 ms bursts per second
with a 2500 Hz alternating current within each burst.
100 Hz + polarity
Current amplitude
Carrier frequency
10 msec 10 msec 10 msec
2,500 Hz
0
2 1 5,000 Hz
Time
- polarity
20 21

Pulsed current: A flow of current that stops and Pulsed currents have a number of adjustable features
starts, being made up of pulses. Pulsed current may be including: phase duration, pulse duration, pulse
monophasic (unidirectional) or biphasic (bidirectional). amplitude and pulse frequency.
+ polarity + polarity
Phase duration: The duration of one phase of a
Current amplitude
pulse. Phase duration is generally expressed in micro-

0 0
seconds).
Time
- polarity - polarity
in microseconds (µs = 10-6 seconds).
The most common monophasic pulsed current has the
waveform shown below and is known as “high volt” Amplitude (intensity): The magnitude of current or
current because of its high peak voltage (and current). voltage.
+ polarity
Pulse frequency (rate): Number of pulses per
Current amplitude
second. Pulse frequency is expressed in pulses per

second (pps) or cycles per second (hertz, or Hz).
0
Time
- polarity
Modulation: Any pattern of variation in one or more
Biphasic pulses may be symmetrical (and balanced), of the stimulation parameters. Modulation is used to
asymmetrical and balanced, or asymmetrical and limit neural adaptation to an electrical current. Modula-
unbalanced. Most pulsed currents used are balanced. tion may be cyclic or random.
Some are symmetrical and some are asymmetrical.
Current amplitude
+ polarity + polarity + polarity
x x=y x x=y
0 0 0 y
y
Time Time
Time
- polarity - polarity - polarity
22 23

When using interferential current, modulating the Electrode selection
current amplitude moves the area of maximal stimula- Most electrodes used clinically at this time are
tion within the treatment area. On most devices this is self-adhesive.
called vector or scan. Self-adhesive electrodes can be applied directly to the
patient's skin. This type of electrode can be reused as
long as it maintains its adhesive property. The length of
time this type of electrode maintains its adhesive
property varies with manufacture. Keep these electrodes
in a sealed plastic bag between uses and slightly
moisten the adhesive surface prior to use in order to
maximize longevity.
General guidelines for electrode placement

Specific guidelines for electrode placement for
specific applications are given in the sections on these
applications.
Place electrodes at least 2″ (5 cm) apart. The further
apart the electrodes the deeper the current flow. The
closer together the electrodes the more superficial the
current flow.
Skin Electrodes closer together Electrodes farther apart
Current
24 25

For motor stimulation, one electrode should be placed Contraindications for the use of electrical
on the motor point for the muscle (generally in the stimulation
middle of the muscle belly) and the other electrode 1. Demand cardiac pacemaker, any implanted
should be placed elsewhere on the muscle so that the electronic device or unstable arrhythmia
current flows parallel to the muscle fibers. 2. Placement of electrodes over carotid sinus (anterior
neck)
3. Areas of venous or arterial thrombosis or thrombo-
phlebitis
Motor point 4. Pregnancy – over or around the abdomen or low back
biceps brachii
Precautions for the use of electrical stimulation

1. Cardiac disease
2. In patients with impaired mentation or in areas with
impaired sensation
3. Malignant tumor
4. Areas of skin irritation or open wounds.
5. After the application of any physical agent, such as
heat, ice, or ultrasound, which may alter skin
For sensory stimulation place the electrodes so as to permeability
surround the area to be stimulated. 6. Care should be taken to avoid producing muscle
contractions with electrical stimulation in all
circumstances where muscle contraction may disturb
the healing process e.g. recent surgical procedures,
repetitive strain injury, fresh fractures.
26 27

Recommended electrical stimulation Recommended parameters for electrical
treatment sites and/or parameters stimulation
Muscle contractions
Electrical stimulation produces muscle contractions Waveform Pulsed biphasic Russian
by applying a current with sufficient amplitude and Pulse duration 125 – 200 µs for The duration for
duration to depolarize the motor nerve innervating a small muscles Russian cannot
muscle or group of muscles. This type of stimulation be set.
only produces contractions in innervated muscles. 200 – 350 µs for
Electrically stimulated muscle contractions may be large muscles
used for muscle strengthening, muscle endurance Frequency 35 – 80 pps 50 Hz
training, maintaining or increasing joint range of On/off times 6 – 10 sec. on/50 – 120 sec. off
motion, as a substitute for an orthotic, for functional Ramp times At least 1 sec.
re–education, reduction of muscle spasm, enhancement Amplitude To contraction
of local circulation or prevention of deep venous
Treatment time Sufficient to produce the desired
thrombosis formation after surgery. number of muscle contractions to
achieve the goals of treatment.
28 29

Muscle strengthening: Quadriceps Muscle strengthening: Triceps
Waveform Pulsed biphasic Russian Waveform Pulsed biphasic Russian

Pulse duration 200 – 350 µs The duration for Pulse duration 200 – 350 µs The duration for
Russian cannot Russian cannot
be set. be set.
Frequency 35 – 80 pps 50 Hz Frequency 35 – 80 pps 50 Hz
On/off times 6 – 10 sec. on On/off times 6 – 10 sec. on
50 – 120 sec. off 50 – 120 sec. off
Ramp times At least 2 secs. Ramp times At least 2 secs.

Amplitude To > 10% of MVIC in injured Amplitude To > 10% of MVIC in injured
> 50% of MVIC in uninjured > 50% of MVIC in uninjured
Treatment time 10 – 20 min to produce 10 – 20 reps Treatment time 10 – 20 min to produce 10 – 20 reps
30 31

Muscle re-education: Wrist extension Muscle re-education: Ankle dorsiflexion

be set. be set.
On/off times Depends on functional activity On/off times Depends on functional activity
Ramp times At least 2 secs. Ramp times At least 2 secs.
Amplitude Sufficient for functional activity Amplitude Sufficient for functional activity
Treatment time Depends on functional activity Treatment time Depends on functional activity
32 33

Muscle spasm reduction: Low back Muscle spasm reduction: Upper trapezius

be set. be set.
On/off times 2 – 5 sec. on On/off times 2 – 5 sec. on
2 – 5 sec. off 2 – 5 sec. off
Ramp times At least 1 sec. Ramp times At least 1 sec.
Amplitude To visible contraction Amplitude To visible contraction
Treatment time 10 – 30 min Treatment time 10 – 30 min
34 35

Pain modulation (TENS) Acupuncture-like (low-rate): Typically used
Electrical stimulation for pain management for chronic pain
Two mechanisms are thought to underlie the efficacy
Waveform Pulsed biphasic Interferential
of electrical stimulation for pain management: gate Pulse duration 150 – 300 µs The duration for
control and opiate-mediated control. Conventional intereferential
(high-rate) TENS is thought to modulate pain via gate cannot be set
control. Acupuncture-like (low-rate) TENS is thought to independently. It
modulate pain via opiate mediated control. is related to the
inverse of the
carrier frequency.
Conventional (high-rate) mode: Generally used
Frequency 2 – 10 pps 2 – 10 Hz
for acute pain
Waveform Pulsed biphasic Interferential Treatment 20 – 30 min
duration
Pulse duration 50 – 80 µs The duration for
intereferential Modulation None
cannot be set Amplitude To visible contraction
independently. It
is related to the
inverse of the
carrier frequency.
Frequency 100 – 150 pps 100 – 150 Hz
Treatment Throughout the duration of pain.
duration May be used 24 hrs/day if necessary.
Modulation Use if available
Amplitude To produce tingling
36 37

Low back pain: Acute Low back pain: Chronic
Waveform Pulsed biphasic Interferential Waveform Pulsed biphasic Interferential

intereferential intereferential
cannot be set cannot be set
independently. It independently. It
is related to the is related to the
inverse of the inverse of the
carrier frequency. carrier frequency.
Frequency 100 – 150 pps 100 – 150 Hz Frequency 2 – 10 pps 2 – 10 Hz
Treatment Throughout the duration of pain. Treatment 20 – 30 minutes
duration May be used 24hrs/day if necessary. duration
Modulation Use if available Modulation None
Amplitude To produce tingling Amplitude To visible contraction
38 39

Sciatica: Acute Sciatica: Chronic

40 41

Cervical radicular pain: Acute Cervical radicular pain: Chronic

42 43

Knee pain: Acute Knee pain: Chronic

Treatment Throughout the duration of pain. Treatment 20 – 30 min
44 45

Tissue healing and edema control Sacral pressure ulcer: Inflammatory phase
Tissue healing
Electrical stimulation can accelerate the healing of
chronic wounds including pressure ulcers, vascular
ulcers and neuropathic ulcers. The proposed mecha-
nisms for this effect include attraction of appropriate
cell types to the area, activation of these cells by
alteration of cell membrane function, modification of
the endogenous electrical potential of the tissue in
concert with healing potentials, reduction of edema,
enhancement of antimicrobial activity and promotion of
circulation. Negative polarity high-voltage pulsed
current (HVPC) is most effective during the inflamma-
tion phase of healing and positive polarity HVPC is
most effective during the proliferation phase of healing.
Recommended parameters for tissue healing

Waveform HVPC
Pulse duration Fixed at 40 – 100 µs
Frequency 100- 105 pps
Polarity Negative during inflammatory phase.
Positive during proliferation phase
Amplitude To produce comfortable tingling
Treatment time 45 – 60 min
Waveform HVPC
Frequency 100- 105 pps
Polarity Negative
46 47

Sacral pressure ulcer: Proliferation phase Acute edema due to inflammation
When there is acute edema due to inflammation,
indicated by swelling, warm and red skin, and local
pain, treatment is directed at repelling negatively
charged blood cells and plasma proteins. This, in turn,
results in flow of fluid away from the swollen and
inflamed area. Electrical stimulation can produce this
effect by use of a high voltage pulsed current (HVPC),
with sufficient pulse duration and amplitude to produce
sensation but not a muscle contraction, with the
negative polarity electrode placed over the swollen and
inflamed area.
Recommended parameters for controlling acute

edema due to inflammation
Waveform HVPC
Frequency 120 pps Polarity
Negative
Treatment time 30 min
Waveform HVPC
Frequency 100 - 105 pps
Polarity Positive
48 49

Acute edema due to inflammation: Knee Acute edema due to inflammation: Ankle
Waveform HVPC Waveform HVPC

Pulse duration Fixed at 40 – 100 µs Pulse duration Fixed at 40 – 100 µs
Frequency 120 pps Frequency 120 pps
Polarity Negative Polarity Negative
Amplitude To produce comfortable tingling Amplitude To produce comfortable tingling
Treatment time 30 min Treatment time 30 min
50 51

Chronic edema due to lack of motion Chronic edema due to lack of motion:
Electrical stimulation is generally used to increase Foot and ankle
local circulation when edema is present. When there is
chronic edema due to lack of motion present, indicated
by swelling and cool and pale skin, treatment is directed
at increasing the activity of the muscles around the
venous system. Intermittent contraction of these
muscles can help pump fluid through the veins from the
periphery to reduce peripheral swelling. Intermittent
electrical stimulation of the motor nerves can be used to
produce such intermittent muscle contractions.
Recommended parameters for controlling chronic

edema due to lack of motion
Waveform Pulsed biphasic Russian
Russian cannot
be set.
Frequency 35 – 50 pps 50 Hz
On/off times 2 – 5 sec. on
2 – 5 sec. off
Ramp times At least 1 sec. Waveform Pulsed biphasic Russian
Amplitude To visible contraction Pulse duration 200 – 300 µs The duration for
Russian cannot
be set.
Frequency 35 – 50 pps 50 Hz
2 – 5 sec. off
Ramp times At least 1 sec.
Amplitude To visible contraction
52 53

Chronic edema due to lack of motion: Laser and Light
Hand and wrist Introduction to laser light therapy
What is laser light therapy?
Light is electromagnetic energy in the visible or near
visible part of the electromagnetic spectrum.
Electromagnetic spectrum
Light of a specific or narrow range of frequencies can
be produced by a laser, a supraluminous diode (SLD) or
a light-emitting diode (LED).
Supraluminous diode/light-emitting diode/laser

Lasers produce light that is of one frequency only
(monochromatic), coherent (all the waves are in sync)
and, directional (non-divergent). SLDs and LEDs
produce light with a narrow range of frequencies that is
not coherent and that is slightly divergent.
Coherent and directional light

Laser light therapy is the application of light from a
laser, an SLD or an LED to the body for therapeutic
Waveform Pulsed biphasic Russian
benefit.
Russian cannot
be set.
Frequency 35 – 50 pps 50 Hz Laser
2 – 5 sec. off
Ramp times At least 1 sec.
Regular light
Amplitude To visible contraction source
54 55

How laser light works Laser light parameters explained
Laser light therapy works by photobiomodulation. Wavelength: The length of each cycle of the electro-
The light is absorbed by chromophores in cells. This can magnetic wave. The wavelength of the light affects its
increase the production of adenosine triphosphate (ATP) color and depth of penetration, the longer the
by mitochondria, increase the production of ribonucleic wavelength the greater the depth of penetration.
acid (RNA) specific for collagen synthesis, alter Wavelength is generally measured in nanometers (nm,
prostaglandin synthesis, alter serotonin and endorphin 10-9) and, for most therapeutic lasers, ranges from
metabolism and reduce nociceptor activity. Together, around 600 nm to around 1,000 nm to produce red or
these effects help to control pain and inflammation and infra-red light.
promote tissue healing.
Coherent vs. non-coherent light

Coherent Non-coherent
56 57

Power: The amount of electromagnetic energy per Contraindications for the application of laser
unit time, usually measured in mW (milliWatts). The light therapy
power of a laser light device is preset on each applicator 1. Irradiation of the eyes: the patient and the clinician
and generally ranges from 5 to 500 mW. Some applica- should always wear protective eyewear when treating
tors produce a higher total power by containing a cluster with a laser device.
of multiple lower powered diodes. Some devices can 2. Malignancy
produce a lower total power from an applicator by 3. Within 4 to 6 months after radiotherapy
pulsing the output. 4. Areas of hemorrhage
5. Irradiation of endocrine glands
Energy: The total amount of electromagnetic energy
delivered over the entire treatment time. Energy is Precautions for the application of laser light
generally measured in J (Joules). Energy is power therapy
multiplied by time. 1. Low back or abdomen during pregnancy
2. Epiphyseal plates in children
1 J = 1 W × 1 sec 3. Impaired sensation
4. Impaired mentation
Therefore, the higher the power of the applicator the 5. Photophobia or abnormally high sensitivity to light
shorter the treatment time to deliver the same amount of 6. Pretreatment with one or more photosensitizers
energy.
Energy density: The total amount of electromagnetic

energy delivered to an area over the entire treatment
time. Energy density is generally measured in J/cm2
(Joules per centimeter squared). Most authors agree that
this should be the standard measure of treatment dose.
Most treatments use 2 – 30 J/cm2.
58 59

Suggested laser light treatment sites and Arthritis: Knee
parameters
Lateral epicondylitis
Wavelength 620 – 690 nm Wavelength 700 – 1,000 nm

Color Red Color Infrared
Energy density 5-24 J/cm2 Energy 0.5 – 2700 J
60 61

Arthritis: Wrist Sciatica: Acute
Wavelength 700 – 1000 nm Wavelength 700 – 1000 nm

Color Infrared Color Infrared
Energy 0.5 - 7000 J Energy density 2 – 8 J/cm2
62 63

Sciatica: Chronic Cervical radicular pain: Acute
Wavelength 700 – 1000 nm Wavelength 700 – 1000 nm

Color Infrared Color Infrared
Energy density 10 – 20 J/cm2 Energy density 2 – 8 J/cm2
64 65

Cervical radicular pain: Chronic Thigh hematoma
Wavelength 700 – 1,000 nm Wavelength 620 – 690 nm

Color Infrared Color Red
66 67

Sacral pressure ulcer: Superficial Sacral pressure ulcer: Deep
Wavelength 620 – 690 nm Wavelength 700 – 1,000 nm

Color Red Color Infrared
68 69

Electrical Stimulation, Ultrasound, and Laser Light Handbook

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Electrical Stimulation, Ultrasound, and Laser Light Handbook

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The outline format of the handbook is meant to make the

Copyright © 2018, Elsevier Inc. All rights reserved.

Copyright © 2018, Elsevier Inc. All rights reserved.

Effective Radiating Area (ERA): The area of the

Power: The amount of acoustic energy per unit time,

Frequency: Number of cycles per unit time. Ultrasound

Copyright © 2018, Elsevier Inc. All rights reserved.

Pulsed: Ultrasound can be delivered either continuously

Copyright © 2018, Elsevier Inc. All rights reserved.

The speed of transducer movement should be

Copyright © 2018, Elsevier Inc. All rights reserved.

NOTE: It has been shown that ultrasound does not

Copyright © 2018, Elsevier Inc. All rights reserved.

Duty cycle Continuous Duty cycle Continuous

Copyright © 2018, Elsevier Inc. All rights reserved.

Duty cycle Continuous Duty cycle 20%

Copyright © 2018, Elsevier Inc. All rights reserved.

Copyright © 2018, Elsevier Inc. All rights reserved.

Alternating current (AC) : A continuous bidirec-

Copyright © 2018, Elsevier Inc. All rights reserved.

Copyright © 2018, Elsevier Inc. All rights reserved.

pulse. Phase duration is generally expressed in micro-

second. Pulse frequency is expressed in pulses per

+ polarity + polarity + polarity

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General guidelines for electrode placement

Skin Electrodes closer together Electrodes farther apart

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Precautions for the use of electrical stimulation

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Waveform Pulsed biphasic Russian Waveform Pulsed biphasic Russian

Ramp times At least 2 secs. Ramp times At least 2 secs.

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Waveform Pulsed biphasic Russian Waveform Pulsed biphasic Russian

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Waveform Pulsed biphasic Russian Waveform Pulsed biphasic Russian

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Waveform Pulsed biphasic Interferential Waveform Pulsed biphasic Interferential

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Waveform Pulsed biphasic Interferential Waveform Pulsed biphasic Interferential

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Waveform Pulsed biphasic Interferential Waveform Pulsed biphasic Interferential

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Waveform Pulsed biphasic Interferential Waveform Pulsed biphasic Interferential

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Recommended parameters for tissue healing

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Recommended parameters for controlling acute

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Waveform HVPC Waveform HVPC

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Recommended parameters for controlling chronic

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Supraluminous diode/light-emitting diode/laser

Coherent and directional light

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Coherent vs. non-coherent light

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Energy density: The total amount of electromagnetic

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