5 Critical Factors of Laser Therapy

Lasers, lasers everywhere! It’s hard to know what’s important when choosing a therapy laser for your practice. There is so much misinformation circulating in the industry, and invariably when you start investigating lasers you will hear conflicting opinions. So, how do you decide which one to use? How can you choose the right laser for maximum results? Well, that depends on how you intend to use your laser in a clinical setting.  All therapy lasers have some benefit, but maximum success depends on the five critical factors listed below. These factors are based in physics, science, logic, common sense and results.

But first, let’s review the basics of how lasers work and the unique healing properties they provide.   Laser therapy aims to photo-biostimulate damaged cells. This therapy actually excites the kinetic energy within cells by transmitting healing energy known as photons. The skin absorbs these photons via a photo-chemical effect, not photo-thermal; therefore it does not cause heat damage to the tissues.  Once photons reach the cells of the body, they promote a cascade of cellular activities. It can ignite the production of enzymes, stimulate mitochondria, increase vasodilation and lymphatic drainage, ATP synthesis, and elevate collagen formation substances to prevent the formation of scar tissues. This is a critical step in reducing long term disabling chronic myofascial pain syndromes and joint hypermobility.  Clinicians will find joint manipulations even more effective when ligamentous laxity is reduced.

Now that you know some of what this special light can do. Let’s get started on our list.

1.    Optimal Wavelength

Light characteristics are determined by its placement along The Electromagnetic Spectrum.  Wavelength is calculated in nanometers (nm). The ideal range for therapeutic lasers is along the Invisible Red (IR) spectrum of 790-970 nm. IR beams penetrate deeper into the body for increased effects on cellular tissue.  Wavelengths in the Visible Red (VR) 600’s nm spectrum are ideal for superficial conditions and limited in deep penetration. Wavelengths above a 1000nm lose therapeutic value and crossover into surgical laser applications. Deep therapy applications such as spinal stenosis, disc herniations, trigger points of spinal intrinsic stabilizer muscles and neuralgia/radiculitis are inherently more responsive to the Invisible Red (IR) wavelength.

2.    Optimal Power

Power affects penetration, dosage, and treatment time. More power offers deeper penetration, higher therapeutic dosages, and decreased treatment times. Lasers are classified by power. Class 3 ‘cold lasers’ are at maximum power output of 500mw from a single laser source. Class 4 lasers are anything over 500mw. Currently, the FDA has cleared Class 4 laser power up to 10watts or 10,000mw. 

You cannot make up for insufficient power by increasing treatment time. Positive results require more than increasing time. By itself dosage cannot adequately describe laser treatment. One must ask several questions. What is the depth of the target tissue? Is the laser power strong enough to reach this target? If not, you get limited results!

65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption:

• Hemoglobin in blood

• Melanin in skin, hair, moles, etc.

• Water (present in all biological tissue)

In order to overcome those factors one most start with large quantities of energy.

Example:

Given enough time a 200mW laser could administer a dosage equal to that given by a 6 watt instrument. Yet results will be very different. The higher power density of the 6 watt laser will penetrate far more deeply and with greater effect.

3.    Optimal Dosage

Dosage is the single most important parameter for a successful outcome in laser therapy. Too little, or too much energy produces no effect. There is an ‘Optimum Window’ of therapeutic dosage. The primary factors in laser therapy that determine dosage is power and time.

DOSAGE = Power x Time

While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin and target tissue. Dosage may also be referred to as energy density or fluence. Its unit of measure is the Joule (J). Current industry dosage application requires 1- 4 J/cm2 for superficial, and 4-10J/cm2 for deeper conditions. 

4.    Optimal Frequencies (Pulsing/Modulation)

‘Simulated pulsing’ in most modern therapeutic lasers is simulated by mechanically or electronically interrupting the output of a continuous beam laser. The pulse rate may be adjusted up or down without significantly affecting treatment time. This is accomplished by modulating pulse duration and/or the space between pulses.

I wish to stress once again that delivering an effective dose to the target tissue is the key to a successful outcome in laser therapy. Unless a therapeutic dose is achieved, pulsing will be irrelevant.

From research we know that pulsing has significant positive effects on pain relief. The body’s sensitivity to any steady stimulus diminishes over time. Varying the pulse rate helps to ensure a better response. Changing the rate to keep the body interested is far more important than strict adherence to continuous laser stimulation. Commonly accepted frequencies include:

Indication                                           Recommended Pulse Rate

Pain                                                     3-20 Hz

Stimulation                                          700-2,500 Hz

Inflammation, Edema                           >2,500 Hz

Antimicrobial                                       >5,000 Hz

5.    Optimal Training and Diagnosis

Even the latest and greatest laser will not benefit your patient’s if you have an inaccurate diagnosis and poor training. Point that laser on the wrong spot and you get minimal results. Just like there is an art and science to chiropractic, there is an art and science to laser therapy. ‘Point and shoot’ simply won’t cut it. If you chase pain you will be forever lost in laser therapy. Your training should include intensive ‘hands on’ instruction, laser safety protocols, continuing education seminars/workshops, and a system for diagnosis. Don’t be afraid to ask what is included in training. Be wary of any laser company who simply drops off a laser at your clinic and says, ‘Just try it out to see if you like it!’ Alarm bells should go off. Ultimately, success in laser therapy comes down to how good YOU are.

Quality therapeutic lasers are expensive, but can be highly profitable. But only if you get one that delivers the results you advertise. Do your due diligence and investigate thoroughly before making your purchase decision. Lasers can help move your practice to a higher quality, volume and fee structure. It will be a new profit center for your office. Internal and external marketing will become much easier with the right laser therapy device. You can enhance this process by branding your practice as being cutting edge and state-of-the-art. Follow the Critical Five and you will be going in the right direction.

Perry Nickelston, DC is a 1997’ graduate of Palmer College of Chiropractic. He is Clinical Director of the Pain Laser Center, LLC in Ramsey, NJ and VP of Practice Development for K-LaserUSA. He may be reached for questions or clinical discussions at pnickelston@k-laserusa.com, www.k-laserusa.com or 1-866-595-7749 Ext. #102.

References:

1.     Tuner, J Hode L. The Laser Therapy Handbook. 2004 Gragensberg, Sweden: Prima Books

2.     Hode, L. Lasers That Heal. 2008 Gragensberg, Sweden: Prima Books

3.     Blahnick, J. Rindge, D. Laser Therapy, A Clinical Manual 2003 Melbourne, FL. Healing Light Seminars Inc.