Class IV Laser Therapy

Treatment Guide

Technological Medical Advancements, LLC

1209 North Flagler Drive • West Palm Beach, FL 33401
866-862-6606 • tmainternational.com
 TABLE OF CONTENTS

Indications for Laser Therapy.............................................................................................. 2

Contraindications.................................................................................................................. 3

Laser Safety............................................................................................................................. 4

Treatment Protocol Guidelines............................................................................................ 7

Calculating Laser and Treatment Parameters.................................................................. 11

Treatment Protocols – Diowave 10 and 15 watt Laser Systems.................................... 13

LASER THERAPY TREAMENT GUIDE 1

Indications for Laser Therapy
Inflammatory Conditions Muscle Injury / Disorders
Bursitis Edema
Carpal Tunnel Syndrome Inflammation
Edema Muscle Bruises, Contusions
Effusion Muscle Contractures
Epicondylitis Muscle Ruptures
Inflammation Muscle Spasms
Muscle Spasms Myofasciitis
Myofasciitis Myositis
Paresthesia Primary Diagnosis Pain In Joint
Plantar Fasciitis Restricted ROM / Stiffness
Primary Diagnosis Pain
Radicular Pain Joint Injuries / Disorders
Restricted Rom / Stiffness Dislocations
Rheumatoid Arthritis Edema
Effusion Of Joint
Inflammation
Pain Management Ligament Injury
Bursitis Osteoarthritis
Cervical/Neck Pain Primary Diagnosis Pain In Joint
Edema Restricted Rom / Stiffness
Effusion TM Disorders
Fasciitis
Fibromyalgia Neurological Injury / Disorders
Inflammation Crush Injuries
Low Back Pain Decreased Rom / Stiffness
Muscle Spasms Edema
Myofascial Pain Effusion
Myofasciitis Inflammation
Primary Diagnosis Pain Muscle Spasms
Restricted ROM / Stiffness Myofasciitis
Neuritis
Paresthesia
Connective Tissue Injury / Disorders Primary Diagnosis
Edema Prolapsed Disk
Effusion Radicular Pain
Inflammation Ruptured Disk
Muscle Spasms
Myofasciitis Skin Injuries / Conditions
Primary Diagnosis Pain Burns
Radicular Pain Edema
Restricted Rom / Stiffness Inflammation
Sprains Primary Diagnosis Pain In Joint
Strains Restricted Rom / Stiffness
Tendon Ruptures Skin Grafts
Tendonitis Skin Ulcers
Surgical Incisions

2 LASER THERAPY TREAMENT GUIDE

Contraindications FOR LASER THERAPY
In general, contraindications are based on prudence more than hard experimental or clinical data and are
presented as precautions for overall safe and effective treatment and care.

Precautions to use are also important to consider where patients may develop side effects from laser therapy
because of specific disorders or conditions.

Contraindications to laser therapy may be:

1. Absolute
2. Relative
3. Anecdotal/Unproven
4. Precautions

1. Absolute Contraindications for Laser 3. Unproven Contraindications for Laser

Therapy include: Therapy include:
• Eye exposure • Epilepsy (mild)
• Over cancer or tumor • Multiple Sclerosis
• Over gravid uterus • Patients with Pacemaker
• Over thyroid • Systemic infections
• Un-united Epiphyseal Plate
2. Relative Contraindications for Laser • Un-united Fontanelles
Therapy include:
• Autoimmune disorders 4. Precautions for Laser Therapy include:
• Encephalopathy • Dark skin
• Hypersensitivity to laser • Hairline sensitivity
• Lupus (severe) • Iodine treated wounds
• Meningitis • Patients using anticoagulants
• Neuropathy • Steroid therapy
• Over tattoos • Through dark clothing
• Patients using IR photosensitizing medications
• Patients using steroids
• Renal failure (severe)

Summary
Contraindications are presented as precautions for overall safe and effective treatment and care
An adequate history should be taken from the patient to determine if any contraindications to treatment are
present
Following treatment protocols for laser dosage will prevent some, if not all of the potential adverse
responses to treatment
Mild adverse reactions with normal treatment protocols may occur.
Some patients may report increased pain after the initial treatment or within 24 hours
Mild bruising also may occur from pressure of the laser wand into cutaneous tissues using the laser tip in
conjunction with deep tissue myofascial techniques
Mild temporary dizziness may rarely occur, most likely from the peripheral vasodilatory effect and a
possible drop in blood pressure

LASER THERAPY TREAMENT GUIDE 3

Laser Safety
Overview
Safety Program
Eye Protection
Laser Safety Officer
Safety Goggles
Using Safety Goggles Correctly
Laser Safety Warning Signs
Laser Safety Checklist

Safety Program
Laser therapy is extremely safe when basic protocols are followed by the laser operator and support staff.

As with all therapeutic procedures, some element of risk is present through negligence or accident. These
hazards are easily prevented or reduced with safety protocols for each application.

Laser Safety Officer

Every clinic using a laser should have an individual trained in safe operation of laser therapy and regularly
use a safety checklist. This individual (often the doctor), is the Laser Safety Officer (LSO).

Eye Protection
Class IV Therapy Lasers emit both visible and invisible radiation. Protective eyewear is necessary for both
Class III and Class IV lasers where irradiation of the eye is possible.

Required Users of Safety Goggles::

1 Administrator of the laser therapy treatment
2 Patient
3 Any other individuals in the room

Importance of Wearing Safety Goggles

Laser beam focused by the lens on the retina or fovea

An incident laser beam striking directly inline with the lens is very
dangerous. The beam is magnified over 100,000 times by the lens of
the eye. The more divergence of the beam the less light strikes the eye.
The more the mean is focused or collimated the greater the fluence of
the beam and potential for injury.

4 LASER THERAPY TREAMENT GUIDE

Safety Goggles
Not all Safety Goggles are the same. The protective eyewear that came with your laser is manufactured
specifically for the wavelengths emitted by the laser. Do not use protective eyewear from other
manufacturers as they may not provide the appropriate level of protection.

Technical Specifications for proper usage include:

Wavelength Specific
Blocks 980nm (and also 810nm)
Meets ANSI Safety Standards

Using Safety Goggles Correctly

Laser Safety Goggles are vital for eye protection in the presence of laser radiation. Since accidental laser
radiation exposure can cause irreversible damage to the human eye, protective measures must not be taken
lightly.

Ensure that the eyewear has appropriate optical density for the wavelength of operation.

Remove all reflective objects (such as rings, metal watchbands, and jewelry) prior to treatment with the
laser. Indirect or direct eye contact with the laser beam or with scattered laser light from any reflective
surfaces will cause serious damage, irreparable corneal and/or retinal damage, and possible blindness to one
or both eyes

Do not allow any reflective object to fall into, or obstruct the path of the laser beam

Always wear protective eyewear. Any person present during the laser operation must wear protective
eyewear.

Never look directly into the end of any therapy hand piece

Never direct the laser light directly into the eyes, or direct the laser beam at anything other than the area to
be treated with or without the correct Safety Goggles

Do not remove the Safety Goggles until the administrator of the laser has turned off the laser or notified the
patient that it is safe to remove them

LASER THERAPY TREAMENT GUIDE 5

Laser Safety Warning Signs
Lasers require the use of specific Warning signs for the safe operations of each laser system

Warning signs must be in view outside and inside the room where the laser treatment is being performed

Warning signs must meet ANSI recommendations

Laser Safety Checklist

Check List for the Laser Operator and Laser Safety Officer

✔ Appropriate warning signs posted

✔ Access to laser and treatment area is secure and controlled
✔ Visually inspect and clean all optical connectors for dirt, debris, etc.
✔ Inspect laser for proper function
✔ Visually inspect and clean all safety goggles
✔ Goggles available for all persons in Nominal Hazard Zone
✔ Extra goggles placed outside treatment room if necessary
✔ Sources of potential laser beam reflection and scatter controlled
✔ Treatment protocol established for patient
✔ Laser injury management protocol in place for accidental injury
✔ Document laser treatment and post-treatment outcomes

6 LASER THERAPY TREAMENT GUIDE

Treatment Protocol Guidelines
Introduction
The guidelines listed here are very general guidelines. Many factors affect the selection of the appropriate
dosage and treatment frequency for each condition and patient.

The healthcare practitioner must take into account the body mass of the patient, their age and general health,
the depth of the injury, the tissue type, skin color, etc.

Approaches to Treatment
1. Treat the site of the injury and / or pain
2. Treat using an Anatomical perspective
3. Treat using an Acupuncture perspective

Additional Treatment Approaches

1. Treat the pathway of the involved nerves
2. Treat the involved spinal level; often the Cervical spine area from C1 to C4
3. Treat the auricular point(s) related to the condition.

General Treatment Guidelines

Follow all Safety guidelines
Treatment must be administered directly to exposed skin.
IMPORTANT: Do not treat through clothing or bandages (the treatment will not be effective)
Patient feedback is important to avoid any discomfort or pain.
Patients may report a number of sensations, such as localized feelings of “soothing warmth”, tingling,
or an increase or decrease in symptoms during the laser therapy treatment or within a 24 hour period
immediately following the treatment.
Ask the patient to immediately report any discomfort or pain (“feels too warm or hot”) during the laser
therapy treatment.

Treatment Method Two Options

Option One: NON – CONTACT METHOD: the Handpiece or Probe is held ½” away from the skin
Option Two: CONTACT METHOD: the Handpiece or Probe is held directly on the skin

Position of the Handpiece or Probe

Position the handpiece perpendicular to the skin
Do not angle the handpiece to the skin, but follow the contour of the body and skin treatment area

LASER THERAPY TREAMENT GUIDE 7

Treatment Techniques for Using the Handpiece
The area to be treated should be performed in a “painting” manner, with a constant slow movement of
approximately 1-2 inches per second. 50% of the treatment should be delivered along a vertical plane and
50% in a horizontal plane.
When performing treatment with the Diowave Class IV Therapeutic Laser, different techniques can be
used. Most healthcare providers use variations of a scanning technique, requiring the wand to be moved
at a consistent speed over a specified pattern. The pattern that the operator follows is not as important as
maintaining a consistent speed while delivering the therapeutic laser treatment.

Note: overlapping patterns do result in increased thermal perception by the patient. Variances in probe
to skin distance alter power density and consequently dosage delivered to the injured tissue.

Using the Handpiece Spacer

The wand should be placed directly on the skin for most musculoskeletal conditions. If you are treating a
deep injury (i.e: to the back or hip joint), and at higher power the wand spacer can be used and should be
placed on the skin to achieve maximum power density and penetration.
For treatment over skin lesions, small peripheral joints, or bony prominences, the wand can be held as far
as 1-2 inches off the body. This will effectively increase the treatment surface area and decrease the power
density.

Size of Treatment Area

A single treatment area is the size of the palm of your hand. We recommend treating a wide area that
includes at least 1-2 inches of healthy tissue outside of the targeted area. This helps to establish proper
circulation to the affected tissues. The majority of energy should be delivered over the area of pathology.

Thermal Discomfort
If the patient experiences thermal sensitivity, make the following adjustments:
First try increasing the rate of wand movement (greater than 1 inch per second) without changing the
treatment probe to skin distance or decreasing the output power of the laser. (This method will not affect
energy density of the treatment beam). Increase the distance between the treatment probe and the skin.
(This method will affect energy density of the treatment beam). Decrease the power (wattage). (This
method will affect energy density and dosage of the treatment beam.)

Skin Type and Skin Color Considerations

Use the Fitzpatrick Classification Scale; match the patient’s skin to this chart.
In general, darker skin and skin pigmentations such as moles, tattoos; and dark hair areas will absorb a
greater amount of laser energy. (Skin Types IV, V, VI)
Ask the patient to provide feedback regarding their comfort level, so there is no discomfort or pain.
The following are recommendations if the patient indicates discomfort
• Move the handpiece or probe more quickly across the skin
• Increase the distance between the handpiece or probe and the skin; however this will decrease the
overall power density
• Lower or decrease the treatment power level setting
• Change the treatment from Continuous Wave (CW) to Pulsing (frequency level)

8 LASER THERAPY TREAMENT GUIDE

Fitzpatrick Classification Scale
The Fitzpatrick Classification Scale was developed in 1975 by Harvard Medical School dermatologist,
Thomas Fitzpatrick, MD, PhD. This scale classifies a person’s complexion and their tolerance of sunlight. It
is used by many practitioners to determine how someone will respond or react to facial treatments, and

Skin Type Skin Color Characteristics

I White; very fair; red or blond hair; blue eyes; freckles Always burns, never tans

II White; fair; red or blond hair; blue, hazel, or green eyes Usually burns, tans with difficulty

III Cream white; fair with any eye or hair color; very common Sometimes mild burn, gradually tans

IV Brown; typical Mediterranean caucasian skin Rarely burns, tans with ease

V Dark Brown; mid-eastern skin types Very rarely burns, tans very easily

VI Black Never burns, tans very easily

Treating Over Tattoos

The following are recommendations if the patient indicates discomfort
• Move the handpiece or probe more quickly across the skin
• Increase the distance between the handpiece or probe and the skin; however this will decrease the
overall power density
• Lower or decrease the treatment power level setting
• Change the treatment from Continuous Wave (CW) to Pulsing (frequency level)

Treatment Expectations
A majority of patients will indicate a level of improvement, even from the initial treatment.
This will often consist of a decrease in pain, or inflammation and / or improved range of motion.
There are different levels of results between acute and chronic pain and injury. In general, acute conditions
will respond quicker than chronic conditions.
Treatment reactions, if they occur, are often reported after initial laser treatments, however, they generally
diminish after the second or third treatment.

Treatment Frequencies
Treating toward the higher duration of the suggested treatment times will accelerate recovery. The frequency
of treatments can vary depending on the phase of injury (acute, sub-acute, chronic) and the patient’s
response to therapy. Generally speaking, treatments range from once every 24 hours to once every 48 hours.
Acute Conditions: 1- 5 treatments spaced one day apart during the first week; or every other day
When treating acute musculoskeletal injuries, the initial desired outcome of laser therapy is the reduction
of pain and inflammation. It can be very effective when used in conjunction with cryotherapy, rest and
elevation of the injury site. Ideally treatment will begin as soon as possible after the injury occurs, with
relatively high dosage being used to attenuate the pain and reduce the initial inflammatory response.
Chronic Conditions: 6-12 treatments spaced one day apart; or every other day
If the patient is not responding, the number of treatment may need to be accomplished; or the power level
may need to be increased (or treatment time).
Additional diagnosis of the condition may be needed.
LASER THERAPY TREAMENT GUIDE 9
Treatment Times and Power Levels (Dosage of joules)
The dosage of joules is a factor of power over the treatment time. In general, the lower the power level, the
longer the treatment time. Increasing the power will provide a shorter treatment time.

Treatment Plans
The goal of a laser therapy treatment is to deliver joules of light energy to a damaged or painful area that
will stimulate the healing processes in the body.
Laser devices may feature “built in” or “pre-set” treatment plans or protocols. If the laser device does
contain this feature, the operational use will be easy to follow or administer.
Custom treatment plans are available separately or can be developed based on the needs of the clinician’s
practice and patients.

Laser Acupuncture (Needleless Acupuncture)

Laser Acupuncture relies upon similar dosage principles as needling, and knowledge of acupuncture theory
and practice is required. There are two approaches; first the Precise Approach; and second the General Approach.
1. The Precise Approach uses the laser with great finesse to effect stimulation of the precise acupuncture
points. Some believe that lower dosages will “tonify” the acupuncture points, while higher dosages will
“sedate” the acupuncture points.
2. The General Approach uses the laser to stimulate the acupuncture points and the surrounding area of
the acupuncture point.
Active acupuncture points are typically painful upon palpation. The application of laser therapy has proven
to be effective at “releasing” the acupuncture point, and reducing pain.

Importance of Cleaning the Lense

If the wand spacer is not used then the lens must be cleaned meticulously with either 91% isopropyl or
methyl alcohol after each treatment for aseptic purposes and to assure proper laser transmission. A dirty
lens will cause the laser light to be scattered into the hand piece and overheating will occur. Otherwise just
the spacer need be cleaned after each treatment.

Summary of Treatment Techniques

Wand Position: Perpendicular to treatment area, usually directly on the skin.
Treatment Area: Area that includes at least 1-2 inches of healthy tissue outside the targeted area.
Treatment Rate: Move wand at a rate of 1” per second. You may increase rate if patient experiences
thermal sensitivity.
Treatment Frequency: Acute: daily. Chronic: every other day: 3 times/week.
Treatment Duration: Refer to treatment protocol chart.
Dosage: Refer to treatment protocol chart.
Areas Requiring Deeper Penetration
Wand Position: Perpendicular to treatment area, place wand on the skin.
Areas Requiring Superficial Penetration
Wand Position: Perpendicular to treatment area, 1 -2 inches from the skin.
Regions: Fingers, Toes and over open wounds.
Pulsed application is used to custom tailor beam quality to fit the patient’s condition, (acute/chronic),
comfort level, as well as technique of application. Cryo-therapy is strongly advised for continuous laser
applications above 35 watts and for all pulsed applications over 25 watts.

10 LASER THERAPY TREAMENT GUIDE

Calculating Laser Treatment Parameters
Power
Power and energy are closely related. Power is the rate at which energy is delivered, not an amount of
energy itself.

Formula:
Power = Energy / Time 1 Watt = 1 Joule / Second
Therapeutic Energy = Power (Watts) or Joules/sec x Time (sec).

Power Density
Power density or Irradiance refers to the amount of power delivered per unit area.
Power density indicates the degree of concentration of the laser output.
It is expressed in Watts per square centimeter (W/cm2), or miliWatts per square centimeter (mW/cm2)
Some studies have concluded that the power density may be of even greater significance than the dose.
Example: A laser’s output is 4 Watts, and it is illuminating a circle of 3 centimeter diameter.
First find the area of the circle, 3.14 x 1.5 x 1.5 = 7 cm2.
Then divide the power by the area, 4W / 7cm2 = 0.6 W/cm2.
Formula:
Irradiance (PD) = W/cm2

Energy Density(ED) / (Fluence)

The energy density expresses the total amount of energy delivered per unit area, in Joules per square
centimeter (J/cm2).
The energy is measured in Joules, and is calculated by multiplying the power output of the laser times the
amount of time elapsed during the laser treatment.
Example: A 4 Watt continuous wave laser would deliver 240 Joules in one minute.
(4 Watts x 60 seconds = 240 Joules)
Then simply divide the total energy by the area to arrive at the energy density in Joules per
centimeter squared.
Formula:
Fluence (ED) = Power x Exposure Time, measured in Joules/cm2 (Watts x Seconds)

Key
The amount of energy delivered, determines the magnitude of the laser interaction within the tissues and
the individual cells.

LASER THERAPY TREAMENT GUIDE 11

Effect of Laser Spot Size on Tissue Distribution of Light Energy
A beam of light incident on tissue may be:
• Reflected
• Absorbed
• Scattered
Scattering in tissue broadens the incident beam, decreasing the effective fluence in the intended target area.
For effective penetration, light needs to avoid scattering and surface absorption.
Doubling the spot size will increase the effective volume by a factor of eight.
A larger spot size usually enables faster and more effective treatment in dermatologic applications such as
treatment of vascular lesions, laser hair removal, etc.
However, more photons must be supplied by more complex and expensive power supplies, components,
and delivery devices. As a general rule, doubling the spot size and halving the fluence will yield an
equivalent effective fluence at a given depth. This effect becomes more pronounced with increasing depth.

12 LASER THERAPY TREAMENT GUIDE

Treatment Protocols – Diowave 10 & 15 watt Laser Systems

HEAD & NECK

Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Cervical Disc Herniation 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Cervical Radiculopathy 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Cervical Soft Tissue Strain 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Cervical Spondylosis 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Cervical Stenosis 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Headaches, Cervogenic 15 watts 10 mins. 9,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Headaches, Migraine 7.5 watts 10 mins. 4,500 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Headaches, Tension 7.5 watts 10 mins. 4,500 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Sinusitis 5 watts 7 mins. 2,100 J 7.5 watts 10 mins. 4,500 J 10 watts 10 mins. 6,000 J
TMJ Syndrome 7.5 watts 7 mins. 3,000 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Trigeminal Neuralgia 1.0 watts 10 mins. 600 J 2 watts 10 mins. 1200 J 4 watts 10 mins. 2,400 J

BACK & SHOULDER

Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Back, Lower 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Back, Upper 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Lumbar, Disc Pathologies 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Lumbar, Facet Joints 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Lumbar, Spondylosis 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Lumbar, Stenosis 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Sacroiliac Joint 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Tailbone 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Lumbar Radiculopathy 7.5 watts 10 mins. 4,200 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Sciatica 7.5 watts 10 mins. 4,200 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Rotator Cuff 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Shoulder, Frozen 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Shoulder Sprain 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Shoulder Strain 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J

ELBOW & HAND

Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Biceps, Tendonitis 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Carpal Tunnel Syndrome 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Epicondylitis, Lateral 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Epicondylitis, Medial 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Fractures 10 watts 10 mins. 6,000 J 12 watts 15 mins. 10,800 J 15 watts 15 mins. 13,500 J
Joint, Wrist 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Olecranon Bursitis 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Triceps, Tendonitis 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Ulnar Nerve Pathologies 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Joint, Finger 5 watts 5 mins. 1,500 J 7.5 watts 5 mins. 2,250 J 10 watts 5 mins. 3,000 J
Soft Tissue Injury 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
LASER THERAPY TREAMENT GUIDE 13
 HIP & KNEE
Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Abductor, Ilio-Psoas 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Abductor, Illiotibial Band 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Bone Leg, Fracture 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Hamstrings 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Hip, Joint, DJD 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Hip, Joint, RA 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Hip, Periarticular 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Knee Strain, Sprain 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Knee, Bursitis 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Knee, DJD 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Knee, RA 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Knee, Sprain Deep 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Ligament, Cruciate Anterior 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Ligament, Cruciate Posterior 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Ligament, Meniscus Injury 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Ligament, Meniscus Sprain 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Tendonitis, Infra-patellar 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Tendonitis, Patellar 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J

FOOT & ANKLE

Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Ankle Sprain, I - III 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Bone Facture 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Bone Stress Fracture 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Hallux Valgus 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Heal Pain 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Plantar Fasciitis 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Shin Splints 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Metatarsalgia 7.5 watts 10 mins. 4,200 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Morton’s Neuroma 7.5 watts 10 mins. 4,200 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Turf Toe 7.5 watts 10 mins. 4,200 J 10 watts 10 mins. 6,000 J 15 watts 10 mins. 9,000 J
Peripheral Neuropathy (Burning) 12 mins. 1,080 J 3.0 watts 15 mins. 2,700 J 3.0 watts 15 mins. 2,700 J
1.5 watts T on/off 10 ms T on/off 10 ms T on/off 10 ms
Peripheral Neuropathy (Numbness) 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Achilles Tendonitis 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Plantaris Strain 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Tarsal Tunnel Syndrome 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J
Tendonitis Tibialis 10 watts 10 mins. 6,000 J 12 watts 10 mins. 7,200 J 15 watts 15 mins. 13,500 J

GENERAL PATHOLOGIES
Conservative Aggressive Chronic Aggressive
Power Time Joules Power Time Joules Power Time Joules
Arthritis, Neck 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Arthritis, Shoulder 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Arthritis, Back 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Arthritis, Hip 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Arthritis, Knee 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Arthritis, Ankle 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Artritis, Wrist 5 watts 5 mins. 1,500 J 7.5 watts 5 mins. 2,250 J 10 watts 5 mins. 3,000 J
Arthritis, Digits 5 watts 5 mins. 1,500 J 7.5 watts 5 mins. 2,250 J 10 watts 5 mins. 3,000 J
Arthritis, Elbow 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Fibromyalgia 10 watts 10 mins. 6,000 J 15 watts 15 mins. 13,500 J 15 watts 20 mins. 18,000 J
Wound Pain 5 watts 5 watts 1,500 J 7.5 watts 5 mins. 2,250 J 10 watts 5 mins. 3,000 J

14 LASER THERAPY TREAMENT GUIDE