LASER THERAPY

INTRODUCTION
LASER is an acronym for Light Amplification by Stimulated Emission of Radiation

Laser light directs biostimulative light energy to the bodys cells which is converted into chemical energy to promote natural healing & pain relief.
Optimizes the immune responses of blood & has anti-inflammatory & immunosuppressive effects.

HISTORY
ALBERT EINSTEIN outlined the principles of laser in the beginning of 19 th century But, the first laser was produced by THEODORE MAIMAN in 1960
By the end of the 60s, ENDRE MESTER (Hungary) was reporting on wound healing through laser therapy

ALBERT EINSTEIN

THEODORE MAIMAN

WHAT IS 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

PRODUCTION OF LASER
Laser light is produced when an electron of an active medium undergoes a stimulated quantum jump from a higher to lower energy state, causing emission of photons The emitted photons collide with other excited electrons causing more photon emission This causes a chain reaction and the frequency of the laser light produced is with a frequency characteristic of the active medium

PROPERTIES OF LASER
MONOCHROMATIC light is all of same frequency (if it is within visible range, it is of all one colour) COHERENT is all waves are in phase with each other DIRECTIONAL means that laser beam exhibits minimal divergence

TYPES OF LASERS
Based on the intensity the laser is divided into 2 types - Hot Lasers (High intensity) It generates heat and destroys the selected tissue and used for making surgical incisions and cauterize during surgical procedures - Cold Lasers (Low intensity , PD =50mW/cm,ED<35J/cm , P<500mW) used for rehabilitation purposes and it is bio stimulative and facilitate healing

PHYSIOLOGICAL EFFECTS OF LASER

Biostimulation improved metabolism, increase of cell metabolism
Increases speed, quality & tensile strength of tissue repair

Vasodilation
Increases blood supply

Increases ATP production Analgesic effect

Relieves acute/chronic pain

Anti-inflammatory & anti-edematous effects

Reduces inflammation

Conts
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

CELLULAR & TISSUE RESPONSE

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

PARAMETERS-PATIENT
Patient
Need medical history & proper diagnosis
Diabetes may alter clinical efficacy

Medications
Photosensitivity (antibiotics)

Pigmentation
Dark skin absorbs light energy better

PARAMETERS-LASER
Laser
Wavelength Output power Average power Intensity Dosage

WAVE LENGTH
Nanometers (nm) Laser light with wave lengths of between 600 and 1300nm penetrates 1 to 4mm Laser light with longer wavelength and lower frequency penetrates deeper (Ga-As laser) Laser light with shorter wavelength and higher frequency penetrates less deeply (He-Ne laser) Type of the tissue also affects the penetration

POWER
Output Power
Watts or milliwatts (W or
mW)

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

Important in categorizing laser for safety Not adjustable

Power Density (intensity)

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

DOSAGE
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

RECOMMENDED DOSAGE
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 6J /cm2

INDICATIONS
Soft tissue injuries Fractures Osteoarthritis, Rheumatoid Arthritis Pain Wounds & Ulcers Acupuncture

CONTRAINDICATIONS
Direct irradiation to the eyes Within 4 to 6 months after radiotherapy Hemorrhaging regions Locally to the endocrine glands

PRECAUTIONS

Epilepsy Fever Malignancy To the lower back of abdomen during pregnancy or mensuration Embryo or fetus Confused or disoriented patients Areas of decreased sensation Epiphyseal lines of children Infected tissue Sympathetic ganglia, vagus nerves or cardiac region in patients with heart disease

CONSIDERATIONS
Better to underexpose than to overexpose 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

Wandering 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)

DURING THE TREATMENT..,

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 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

DOCUMENTATION
Type of laser used Treatment technique Treatment area Duration Intensity Dosage

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