Laser & Light Therapy

What is Laser Therapy?

• Light Amplification by the Stimulated
Emission of Radiation

• Compressed light of a wavelength from the

cold, red part of the spectrum of
electromagnetic radiation
• Monochromatic - single wavelength, single color
• Coherent - travels in straight line
• Polarized - concentrates its beam in a defined
location/spot
 History
• Albert Einstein – 1st described this theory that was transformed in
to laser therapy

• By the end of the 60’s, Endre Mester (Hungary) -

– was reporting on wound healing through laser therapy

• In early 1960’s, the 1st low level laser was developed.

• In Feb. 2002, the MicroLight 830 (ML830) received FDA

approval for Carpal Tunnel Syndrome Treatment (research
treatment)

• Laser therapy – has been studied in Europe for past 25-30 years;
US 15-20 years
 What’s in a Name?
• Therapeutic Laser • Low-intensity-level
• Low Level Laser Laser
Therapy • Photobiostimulation
• Low Power Laser Laser
Therapy • Photobiomodulation
• Low Level Laser Laser
• Low Power Laser • Mid-Laser
• Low-energy Laser • Medical Laser
• Soft Laser • Biostimulating Laser
• Low-reactive-level • Bioregulating Laser
Laser
 What Does It Do?
• Laser light waves penetrate the skin with no heating
effect, no damage to skin & no side effects.

• **Laser light directs biostimulative light energy to

the body’s cells which convert into chemical energy
to promote natural healing & pain relief.

• Optimizes the immune responses of blood & has anti-

inflammatory & immunosuppressive effects.
 Physiological Effects
• Biostimulation – improved metabolism, increase
of cell metabolism
– Increases speed, quality & tensile strength of tissue
repair
• Improved blood circulation & vasodilation
– Increases blood supply
• Increases ATP production
• Analgesic effect
– Relieves acute/chronic pain
• Anti-inflammatory & anti-edematous effects
– Reduces inflammation
 Physiological Effects
• Stimulation of wound healing
– Promotes faster wound healing/clot formation
– Helps generate new & healthy cells & tissue
• Increase collagen production
– Develops collagen & muscle tissue
• Increase macrophage activity
– Stimulates immune system
• Alter nerve conduction velocity
– Stimulates nerve function
 Tissue & Cellular Response
• Red light affects all cell types
– Absorbed by the mitochondrial present in all cells
– Cytochromes (respiratory chain enzymes) within the
mitochondria have been identified as the primary
biostimulation chromophores (primary light-absorbing
molecules).
– Since enzymes are catalysts with the capability of
processing thousands of substrate molecules, they
provide amplification of initiation of a biological
response with light.

• Infrared light is more selective absorbed by

specific proteins in the cell membrane & affects
permeability directly
 Tissue & Cellular Response
• Magnitude of tissue’s reaction are based on physical
characteristics of:
– Output wavelength/frequency
– Density of power
– Duration of treatment
– Vascularity of target tissues

• Direct effect - occurs from absorption of photons

• Indirect effect – produced by chemical events caused
by interaction of photons emitted from laser & the
tissues
 LASER Regulation
• LASERs - classified by the FDA’s Center for Devices
& Radiological Health based on the Accessible
Emission Limit (AEL).
• Class Levels 1-4
• 1 = incapable of producing damaging radiation levels (laser printers
& CD players)
• 2 = low-power visible lasers (400-700 nm wavelength, 1 mW)
• 3 = medium-power lasers - needs eye protection
• 3a – up to 5 mW
• 3b** – 5 mw-500 mW
• 4 = high-power lasers– presents fire hazard (exceeds 500 mW)
 Laser Generators
• Components of a generator:
• Power supply – electrical power supply that can deliver
up to 10,000 volts & 100’s amps
• Lasing medium – gas, solid, liquid
• Pumping device –
– high voltage, photoflash lamps, radio-frequency oscillators or
other lasers (pumping is used to describe the process of
elevating an orbiting electron to a higher, excited energy level)
• Optical resonant cavity – contains lasing medium
 Types of Lasers
• 4 categories of lasers
– Crystal & Glass (solid - rod)
• Synthetic ruby & others (synthetic ensures purity)

– Gas (chamber) – 1961

• HeNe, argon, CO2, & others (HeNe under investigation)

– Semiconductor (diode - channel) - 1962

• Gallium Arsenide (GaAs under investigation)

– Liquid (Dye) - Organic dyes as lasing medium

– Chemical – extremely high powered, frequently used for military purposes

 High vs. Low Level Lasers
• High • Low
– Surgical Lasers – Medical Lasers
– Hard Lasers – Soft Lasers
– Thermal – Subthermal
– Energy – 3000-10000 mW – Energy – 1-500 mW
– Therapeutic (Cold) lasers
produce maximum
output of 90 mW or less
– 600-1000 nm light
 Parameters
• Patient • Laser
– Need medical history – Wavelength
& proper diagnosis – Output power
• Diabetes – may alter
– Average power
clinical efficacy
– Intensity
– Medications
• Photosensitivity – Dosage
(antibiotics)
– Pigmentation
• Dark skin absorbs light
energy better
 Parameters - Wavelength

• Nanometers (nm)
• Longer wavelength (lower frequency) =
greater penetration
• Not fully determined
• Wavelength is affected by power
 Parameters – Energy Density
• Dosage (D) • Dosage is dependent
• Amount of energy on:
applied per unit area – Output of laser in mW
• Measured in – Time of exposure in
seconds
Joules/square cm
– Beam surface area of
(J/cm2)
laser in cm2
– Joule – unit of energy
• Various dosage ranges
– 1 Joule = 1 W/sec
per site (1-9 J/cm2)
 Parameters – Energy Density

• Recommended Dosage Range

– Therapeutic response = 0.001-10 J/cm2
– Minimal window threshold to elicit response
– Too much – suppressive effect
– Open wounds – 0.5-1.0 J/cm2
– Intact skin – 2.0-4.0 J/cm2
– Average treatment – 6 /cm2
 Helium Neon Lasers
• Uses a gas mixture in a pressurized tube
• Now available in semiconductor laser
• Emits red light
• Wavelength: 632.8 nm
• Power output: 1.0-25.0 mW
• Energy depth: 6-10 mm

• The higher the output lasers (even though they

are still low power) allow reduced delivery time
 What Does it Look Like?

• http://www.laserhealthsystems.com/
omegaofferings.htm

• http://www.thorlaser.com/products/
 Indications
• Indications
– Soft tissue injuries
– Fractures
– Osteoarthritis, Rheumatoid Arthritis
– Pain
– Wounds & Ulcers
– Acupuncture
 Contraindications
• Contraindications
– Application over eyes
– Possibly can damage cellular structure or DNA
– Cancerous growths
– Pregnancy – over & around uterus
– Over cardiac region & Vagus nerve
– Growth plates in children
– Over & around thyroid gland & endocrine glands
– Patients who have been pre-treated with one or more
photosensitizers
 Treatment Precautions
• Better to underexpose than to overexpose
• Avoid direct exposure into eyes (If lasing for extended
periods of time, safety glasses are recommended)
• May experience a syncope (loss of consciousness)
episode during treatment during chronic pain, but
very rare
• If icing – use BEFORE phototherapy
– Enhances light penetration
• If using heat therapy – use AFTER phototherapy
– Decreases light penetration
 Treatment Techniques
• Gridding Technique
• Divide treatment areas into grids of square
centimeters
• Scanning Technique
• No contact between laser tip in skin; tip is held 5-10
mm from wound
• Wanding Technique
• A grid area is bathed with the laser in an oscillating
fashion; distance should be no farther than 1 cm
from skin
• Point Application (Acupuncture point)
 Treatment Techniques
• Simple
• For general application, only
treatment time & pulse rate
vary
• Dosage
• Most important variable in
laser therapy & may be
difficult to determine because
of the above conditions
• Handheld applicator
• Tip should be in light contact
with skin while laser is engaged
for calculated time
• Maintain laser perpendicular to
treatment surface
• Firm contact unless open
wound
• Clean area prior to treatment
• Begin with minimal treatment
and gradually increase
• Check for pre/post-treatment
changes
• Ask the patient how they are
doing prior to next treatment
– May have to adjust dosage
• Dynatron’s Solaris D880 Infrared Therapy
– 880 nm wavelength – SLD (32 ) (deep)
– 660 nm – LED (4) (superficial)
– 10 minute max. treatment or 60 Joules
– Place probe on treatment area. Maintain constant
contact with the skin.
• Do not bathe the area with the probe.
– FDA cleared to “provide topical heating for temporary
increase in blood circulation, temporary relief of minor
muscle & joint aches, pain & stiffness & relaxation of
muscles; for muscle spasms & minor pain & stiffness
associated with arthritis.”
• Dynatron Solaris 709
 MedX Laser & Light Therapy

• Laser probe
• SLD (2)
 Miscellaneous
• www.geocities.com/altmedd/laser.htm

• http://laserhealing.net/lowlevel.html

• Journal of Laser Therapy

– www.walt.nu/journal.htm