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Therapeutic LASER, Class IV

Brad Farra - Monday, June 11, 2012

As a part of my continued commitment to providing cutting edge effective therapies, I am introducing class IV laser therapy into my practice.  Laser therapy will be an adjunct therapy to the services I already provide.  Laser therapy will fit in nicely with the other surgery free and medication free evidence based therapies I provide.  This blog will serve as a thorough description of how laser therapy works.  As always, if you have questions, please don't hesitate to ask.  You can post a question at the bottom of this blog or email me at:  drfarra@drbradfarra.com

There are thousands of published research studies supporting the efficacy of laser therapy for many different conditions.  Laser therapy has been used in Europe for over 40 years and extensively in the US for over 10 years (our FDA is a little slow!).  Laser therapy or 'photobiomodulation' is the use of specific wavelengths of light (red and infared) to create therapeutic effects.  Class IV therapeutic laser refers to a class of powerful lasers that provide penetration into deeper injured tissues.  Laser treatment times average between 3 and 9 minutes depending on the size of the area being treated.  This leaves plenty time for other needed treatments during the visit such as rehab. soft tissue therapies, and joint manipulation.  There are very few clinics in Portland that offer such an advanced and powerful laser. 

Some of the clinical effects include accelerated healing time, pain reduction, increased circulation, decreased swelling/inflammation, and decreased scar tissue formation.  Treatment with laser therapy is painless and can reduce muscle spasm and stiffness, which can lead to immediate pain relief.  The infrared light of laser therapy interacts with the tissues at the cellular level to increase cellular metabolic activity.  This increase is cell activity improves transport of nutrients across the cell membrane and increases production of ATP (an energy carrier).  This increase in ATP leads to a cascade of beneficial effects that improve cell function and health. 

Because of the wide ranging effects of laser therapy bio-stimulation it has the ability to help with a broad range of conditions.  Laser therapy can be used all over the body including conditions of the knee, foot, ankle, hip, back, neck, shoulder, wrist, hand, elbow, arm, leg, thigh, and head (not eyes!).  Examples of specific conditions that laser therapy is effective treating include:  ligament sprain, tendon or muscle strain, tennis/golf elbow (epicondylitis), carpal tunnel syndrome, myofascial trigger points, back pain, tendinopathies, repetitive stress injury, chondromalacia patellae, IT band syndrome, arthritis, plantar fascitis, shoulder injuries, traumatic/acute injuries, swelling/edema/inflammation, sports injuries, auto accident injuries, headaches, cervical or lumbar disc herniation, TMJ pain, ankle sprain, and achilles tendinopathy.

 That's the basics of laser therapy.  I will now go into some greater detail of the physics and physiology of laser therapy.  If you don't want to read the nerdy detail, just know that combined with the accurate diagnosis and other therapies I provide, laser therapy will help you get better faster with fewer treatments and less overall injury duration.  Of course, if you have any questions or are wondering if laser can help  you, please don't hesitate to email me.

LASER Therapy Physiology

Photobiomodulation is the accepted term for laser therapy.  Laser therapy is a form of light therapy.  Light (photons) is applied to the tissue.  The photons are absorbed by chromophores in the mitochondria and cell membranes.  These chromophores are special light absorbing molecules involved with the electron transport chain in the mitochondria and they allow for a photo-chemical reaction in which the cell converts this photon energy to ATP.  The additional ATP accelerates DNA & RNA synthesis, mitosis, and in some situations cell proliferation.  The end result is a myriad of cellular affects including accelerated tissue repair, resolution of inflammation, and pain reduction.  Compromised cells and tissues respond to laser therapy more readily than healthy cells and tissues.  As you can see laser therapy does not just treat symptoms, it actually promotes and enhances healing.

An important effect of laser therapy is vasodilation, which brings more nutrients and oxygen to injured tissue.  This increase in circulation also improves lymphatic drainage, which is in part responsible for the analgesic effect and improved tissue regeneration.

Inflammation is one of the first responses from the body after an injury.  Laser therapy can mediate the inflammatory response by stabilizing the cell membrane and decreasing levels of C reactive protein and neopterin.  Laser therapy also accelerates leukocyte activity, superoxide dismutatse, lymphocytic response, reduction of interleukin 1, increased angiogenesis, and of course vasodilation.  If inflammation is not kept in check healing will be slow.

Acceleration of leukocytic activity enhances removal of non-viable cellular and tissue components.  An increase in macrophage activity is also seen with laser therapy.  While scar tissue can sometimes be a necessary part of healing, it also can be a source of pain and dysfunction.  Laser therapy can limit the production of scar tissue formation after an injury.  Combined with the rehab and massage techniques I provide, this scar tissue will be remodeled and functional in no time!

Laser therapy can also enhance local immune system cellular components.  Increase of lymphocytic proliferation including helper T cells and suppressor T cells.  A modification of beta cells also occurs.

The pain reduction capability of laser therapy is done by way of local and systemic reactions.  This process includes ion channel normalization, an increase in beta endorphins, decreased bradykinin levels, increased levels of acetylcholine, axonal sprouting and nerve cell regeneration, a decrease in the firing of pain fibers and normalization of resting potentials.  Less pain while a condition heals means you don't have to take medications that are loaded with side effects.

Laser Therapy Physics

Therapeutic laser is all about physics!  Without the right combination of physics the above mentioned physiological effects would not be possible.  Laser is an acronym; Light Amplification by Stimulated Emission of Radiation, LASER.  The important characteristics of a therapeutic laser include:  Wavelength, power, frequency,  and wave emission characteristics.

Laser light is able to create coherent light at a very specific wavelength.  That is to say, laser light is monochromatic.  Coherency of laser light allows for a focus of light in a very specific area and is not easily dispersed.  This unique characteristic of laser light allows for a greater power density and a more favorable acceleration of the healing process when compared to non-coherent light.  Scientific research shows us that a range of wavelengths from 600 to 1000nm is able to promote healing of skin, muscle, nerve, tendon, ligament, cartilage, bone, and other tissues.  When tissues are injured they respond positively to specific doses of this light energy.  The closer the wavelength is to that 1000nm level, the deeper it will penetrate.  The problem is, the laser light is also absorbed by matter other than the injured tissue.  Many studies have been done to determine wavelength absorption characteristics.  An ideal wavelength for human tissue is 800nm, because it is minimally absorbed by water.  A deeper penetrating wavelength is 970nm.  Although 970nm is absorbed more by water, it's absorbed less by melanin.  This is an important wavelength to have for a dark skinned individual.  Combining the 800 and 970nm wavelengths is ideal.  The combination of these two wavelengths, and the ability to use just one or the other, allows for maximum absorption by injured tissue regardless of your skin color.


Another characteristic that determines the depth of penetration is power.  A laser can't just rely on wavelength to deliver appropriate dosage to deep tissues.  Without enough power the laser light will be absorbed before reaching deep target tissues.  Cases in the literature where laser therapy was found to be ineffective for treatment of a particular condition, the primary reason was not enough power and the dosage of laser light energy to the injured tissue was inadequate.  Not only does power allow for deeper penetration of the laser light, it also allows for shorter treatment times with a greater clinical effect.  Power is measured in watts, much like a light bulb.  A higher power laser is a brighter light and able to 'shine' to a greater depth.  Class IV lasers are the most powerful and thus the most effective therapeutic lasers available.

The frequency of laser light is another important characteristic.  Continuous wave has no interruption of output.  Pulsed light can be at any frequency and is measured in cycles per second or hertz.  Different problems respond differently to various frequencies.  For example, an acute condition might respond more favorably to a high frequency and chronic conditions to a low frequency.  The ability to transmit laser light of different frequencies is important to optimize treatment for many different types of conditions.

Congratulations on making to the end of this blog.  Please feel free to contact me if you have any questions.