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 60s, Endre Mester (Hungary) was reporting on wound healing through laser therapy

In early 1960s, 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

Whats in a Name?
Therapeutic Laser Low Level Laser Therapy Low Power Laser Therapy Low Level Laser Low Power Laser Low-energy Laser Soft Laser Low-reactive-level Laser Low-intensity-level Laser Photobiostimulation Laser Photobiomodulation Laser Mid-Laser Medical Laser Biostimulating Laser Bioregulating 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 bodys cells which convert into chemical energy to promote natural healing & pain relief.
Optimizes the immune responses of blood & has antiinflammatory & 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

Cytochromes function to couple the release of energy from cellular metabolites to the formation of high energy phosphate bonds in adenosine triphosphate (ATP)
ATP is used to drive cell metabolism (maintain membrane potentials, synthesize proteins & power cell motility & replication).

Assuming cytochromes also can absorb energy directly from illumination, it is possible that during LLLT light energy can be transferred to cell metabolism via the synthesis of ATP.

Mitochondria

Tissue & Cellular Response

Magnitude of tissues 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 FDAs 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 & 100s 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
Surgical Lasers Hard Lasers Thermal Energy 3000-10000 mW

Low
Medical Lasers Soft Lasers Subthermal Energy 1-500 mW Therapeutic (Cold) lasers produce maximum output of 90 mW or less 600-1000 nm light

Infrared Light Therapy

SLD Super Luminous Diode
Brighter

LED Light Emitting Diode

Laser Light Properties

Monochromaticity
1 color 1 wavelength <400 nm Ultraviolet spectrum

Coherence
Waves same length & traveling in same phase relationship 400-700 nm Visible

Collimation
Degree to which beam remains parallel with distance 700-10,000 nm Infrared

Parameters
Patient
Need medical history & proper diagnosis
Diabetes may alter clinical efficacy

Laser
Wavelength Output power Average power Intensity Dosage

Medications
Photosensitivity (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 Power
Output Power
Watts or milliwatts (W or mW) Important in categorizing laser for safety Not adjustable

Average Power
Continuous or pulse-train (burst) frequency mode Knowing average power is important in determining dosage with pulsed laser If laser is continuous avg. power = peak output power If laser is pulsed (burst) then avg. power is = to peak output power X duty cycle

Power Density (intensity)

W or mW/cm2 Takes into consideration actual beam diameter If light spread over lager area lower power density Beam diameter determines power density

Parameters Energy Density

Dosage (D) Amount of energy applied per unit area Measured in Joules/square cm (J/cm2)
Joule unit of energy 1 Joule = 1 W/sec

Dosage is dependent on:

Output of laser in mW Time of exposure in seconds Beam surface area of laser in cm2

Various dosage ranges 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

Indium-Gallium-Aluminum-Phosphide
InGaAip Replacing HeNe lasers Semiconductor Wavelength: 630-700 nm Power output: same as HeNe Energy depth: superficial wound care

Gallium Arsenide
Semiconductor - produces an infrared (invisible) laser Wavelength: 904910 nm Power output: may produce up to 100 mW Energy depth: 30-50 mm Short pulse-train (burst) duration (100-200 ns)

Gallium Aluminum Arsenide

GaAIAs Semiconductor Wavelength: 780-890 nm Power Output: 30-100 mW (up to 1000 mW) Energy Depth:

What Does it Look Like?

http://www.laserhealthsystems.com/omegao fferings.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 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

 Dynatrons 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