LASER

From : Samrth Pareta

What is laser therapy ?
• Light amplification by the stimulated emission of radiation.
• The principle behind the laser is the quantum theory.
• It is one of the most recent treatment modality available to
physiotherapist.

History of laser
• Albert Einstein firstly described this theory that was transformed into
laser therapy .
• In early 90’s first low power laser was developed.
• As we have studied its principle is based on quantum theory, so
quantum theory is given by Einstein in 1997.
• The laser for medical used is develop between 1960 to 1970.

Properties of Lasers
1. Monochromaticity - Laser light is concentrated in a narrow range of
wavelength. (Same wave length and same color)
2. Coherence - All photons emitted in one phase( same time and
distance )
3. Collimation(Directionality) - In one direction and non spread
(focusing on beam of light on certain point)

Production of Lasers
• The laser production is depend on - 1. Spontaneous emission 2.
Absorption 3. Stimulated emission.
• Laser light is produced when an electron of an active medium
undergoes an stimulated quantum jump from a higher to a lower
energy state, causing the emission of photons (spontaneous emission).
• The incident photon is absorbed by resting electron, which moves to
higher energy level. (Absorption)
• The emitted photons collide with other excited electrons causing more
photons emission. (Stimulated emission)

Classification of laser
1. According to nature of material placed between two
reflecting surface.
2. According to intensity.
3. According to hazard.

Classification of laser (cont.)

1. According to nature of material..…
(a). Crystal laser (solid state laser)
- Ruby crystal (aluminium oxide and chromium)
(b). Gas Lasers include
- Helium Neon (HeNe)
- Argon
- Carbon Di Oxide (Co2) Laser
(c) Liquid Laser
- Oxazine
(d)Semiconductor or Diode Laser
- Gallium Arsenide Laser(GaAs)

Classification of laser (cont.)

2. According to Intensity
• a) High Power Laser - Known as “hot” Laser because of the thermal
response they generate. These are used in surgical cuttings,
dermatologic, vascular specialities.

• b) Low Power - It is used for wound healing and pain management.

They doesn’t give thermal effect rather than that they cause
photochemical effect. No tissue warning occurs.
• *Generally Low power lasers are used in physiotherapy.

Classification of laser (cont.)

3. According to hazards.
• Class 1 :- These are the low power (<0.5mW) . Eg. BlackBoard pointer,
supermarket barcode reader, etc.
• Class 2:- These are lasers with a power output upto 1 mW placed in
the visible region of electromagnetic spectrum. These are safe for skin.
• Class 3:- These are the mid power lasers and are further divided into 3
A( Low medium lasers with power output upto 5 mW). 3 B (Medium
Laser with power output upto 500 mW). These are safe for skin but
harmful for eyes.

Classification of laser (cont.)

3. According to hazards(cont.).
• Class 4 and 5:- These are the high power lasers with power
output of > 500 mW. These lasers are unsafe for both skin and
eyes. However, these are used for surgical applications.
Ruby Laser
• Emission of red light at a wavelength of 694.3 nm emitted by ruby rod.
• Ruby rod is made up of aluminium oxide.
• It has a Xenon flash tube which is wound around the ruby rod. It is
subjected to white light for a brief time i.e. 0.5 ms cause the ruby
molecule to be excited and raise the electrons to the higher energy
level. Electrons stay in higher level for short time(Before falling to the
meta stable level where they stay for a long time). Now the stage
comes when there are more electrons in the meta stable level than
the ground level which is called population inversion.

Helium-Neon Laser (HeNe)

• This device emit red light at a wavelength of 633 nm and
frequency higher than IR laser. This laser is mixture of helium
and neon gases at low pressure. Have a depth of penetration
shorter than IR radiations.
Physiological effects of laser
1. Reducing pain
A. There is an increase in serotonin levels [inhibit pain transmission to
brain and from nocicepetors ].
B. Increase realease of acetylcholine ;acetylcholine helps normalise
nerve signal transmission in the autonomic and somatic pathways.

Physiological effects of laser(Cont.)

• 2. Reducing inflammation
A. Enhancement of atp by stimulation of mitochondria.
B. Stabilization of the cellular membrane.
C. Acceleration of leucocytes activity

Physiological effects of laser(Cont.)

• 3 . Promoting tissue healing
A. Increased macrophages activity.
B. Increased fibroblast proliferation.
C. Keratinocyte proliferation. [keratinocyte the outermost layer of skin ]
D. At last , growth factor increases.

Physiological effects of laser(Cont.)

• 4 . Recovery from nerve injury
A. Accelerate nerve regeneration [by stimulation of nerve growth
factor ]
B. Increased frequency of action potential.
C. Increased rate of nerve conduction.

Therapeutic effects of laser

1. Arthritic conditions
2. Effect on muscoskeleton conditions
3. Tendinitis
4. Bursitis
5. Tennis elbow
6. Golfers elbow

Contraindication of laser
1. In patients with active or suspected carcinoma : it is possible that
therapeutic laser application could accelerate carcinogenesis in
patients where carcinoma is present.
2. Within 4 to 6 months of radiotherapy : because it may increase tissue
susceptibility to malignancy and burns
3. Areas of haemorrhage: it can exacerbate the condition.
4. Direct over pregnant uterus.

Dangers of Laser
1.Damage to eye.
2.Electric shock.

Principles of application
1. Probe : a hand held applicator about a size of a large marker pen .
Direct application to the skin ensures max. Transfer of laser energy
and the light pressure by squeezing blood from superficial vessels can
increase the penetration further.
2. Cluster probe : a collection of individual laser diodes emitting at
different wavelength. The advantages of using cluster probe is that, it
can be used to treat a larger area of approx. 25cm.
3. Scanner applicator : the laser applicator is attached to a stand up to
30cm away from the skin.

Preparation of patient
1. Need to wear a goggles to the patient [wavelength specific ]
throughout the treatment to restrict any risk of accidental application
of laser beam into eyes.
2. Explain the nature of treatment to the patient.
3. The surface of skin which is treated is being cleaned with alcohol
wipe to remove any material that absorb or scatter the radiation and
the part is supported in such a way that it not cause movement
discomfort.

Preparation of apparatus
1. The laser probe is selected depending upon the nature and size of
legion.
2. Localised legion probe,
• larger area cluster probe,
• Open wound laser scanner applicator is used.

Application of treatment
1. The probe is applied over a wound at specified distance before
machine is switched on.
2. Wear the protective glasses entire the therapy.
3. Then activate the machine.
4. It is important to maintain the laser applicator in contact to the tissue
so, that it applied at right angle and achieve the max. penetration .

Dosage and parameters

• Calculation of laser dose is dependent on :
1. The output power of the laser in mw.
2. The time of exposure in seconds
3. The beam surface area of the laser in cm^2.

THANK YOU :-)