Dr/ Shimaa A Essa
Ph.D , P.T, Laser applications in Physical therapy,
NILES, Cairo University, Egypt.
1. Traditional Chinese Medicine Concepts
2. Scientific explanation of acupuncture points
3. Physiological effects of needle acupuncture
4. Physiological effects of Low Level Laser therapy
5. What laser puncture means
6. Advantages of laser puncture over needle puncture
7. Characteristics of laser devices used for laser puncture
8. Technical considerations for laser puncture application
9. Precautions and contraindications for Laser puncture application
1. Traditional Chinese
Medicine (TCM)Concepts 
For every yin, there is a corresponding yang. For example, light is
yin and dark is yang. In the human body, the tendons and bones are
yin and the skin is yang.
Harmony and good health occur when the yin and the yang are
perfectly balanced, whereas unbalance results in dis-ease. All TCM
techniques aim to restore the balance of yin and yang.
Behind the theory of acupuncture ( Acu [Pronounced Ako]=
needle, Puncture= penetrate) are the basic underlying theories
involving yin, yang, and qi (pronounced “chee”). According to
TCM concepts, everything in nature can be classified as either
yin or yang.
2. Scientific explanation
of acupuncture points 
1- Skin resistance: (Not proved)
Acupuncture points can be identified by decreases in
electrical skin resistance
2- Correlation with motor points: (Not Proved)
3- Correlation with trigger points: (Not proved),
acupuncture is not limited to trigger points.
3. Physiological effects of
needle acupuncture 
1- Considerable evidence supports the claim that opioid
peptides are released during acupuncture and that the
analgesic effects of acupuncture are at least partially
explained by their actions.
2- Stimulation by acupuncture may also activate the
hypothalamus and the pituitary gland, resulting in a
broad spectrum of systemic effects.
3- Alteration in the secretion of neurotransmitters and
neurohormones and changes in the regulation of blood
flow, both centrally and peripherally, have been
3. Physiological effects of
needle acupuncture 
Brain single photon emission computed
tomography (SPECT) images demonstrating
cerebral blood flow changes in the
brain between the baseline state with
pain and post-acupuncture, when the
pain was relieved. Red indicates the highest
activity level, followed by yellow, blue, and
black (in descending order). With pain (ie,
baseline), thalamic activity is initially
asymmetric, with activity on the left side
greater than on the right. After
acupuncture, the thalamic activity has
shifted, with activity on the right side now
greater than on the left.
4. Physiological effects of
Low Level Laser therapy 
1. Stimulates cell growth: Increase ATP production 150 X
2. Increases cell metabolism
3. Improves cell regeneration
4. Invokes an anti-inflammatory response
5. Promotes edema reduction
6. Reduces fibrous tissue formation
7. Stimulates nerve function
8. Reduces the production of substance P
9. Stimulates long term production of nitric oxide
10. Decreases the formation of bradikynin, histamine, and
11. Stimulates the production of endorphins.
4. Physiological effects of
Low Level Laser therapy 
A pilot study (2000) on 15 adult subjects showed
specific changes in blood flow velocity in cerebral
arteries both during stimulation with light as well as
during acupuncture. These changes were more
pronounced with needle acupuncture than with laser
Also this study reported that laser puncture can elicit
reproducible and measurable bioelectrical effects in
the brain. These changes may have their origin in the
thalamus or hypothalamus.
5- What does laser
acupuncture mean? 
Low-level laser acupuncture involves
the application of photonic energy to
acupuncture points/tissues with the
objective of augmentation of the
normal healing process and/or pain
6- Benefits of Laser
acupuncture over traditional
needle technique? 
3) Consistently applied at any time (the results
1) Laser acupuncture is beneficial for patients
whom are apprehended by needle application
or in a very weak health condition.
2) Shorter treatment times (5-12 Sec/ point)
7. Characteristics of
laser devices used for
laser puncture 
4) Gallium-Arsenide Laser (904 nm)
Greatest depth of penetration, deeper than gallium-aluminum-arsenide.
This is due to a much longer wavelength and because they are pulsed,
forcing the laser light deep into the tissues. Useful for reaching deep
acupuncture points and for the treatment of pain. Continuous wave
lasers are now also available (Figure 2).
1) Helium-Neon Laser (632.8 nm)
Helium-neon gas mixture. Visible red light. Relatively shallow depth
of penetration. Very useful for laser acupuncture, superficial
applications, and wound healing. Absorbed by mitochondrial
cytochromes (Figure 2).
2) Indium-Gallium-Aluminum-Phosphorus Laser (633-635 nm)
Now replacing helium-neon lasers. Visible red light, smaller and
portable, inexpensive; higher power than the helium-neon, more
durable. Same applications as helium-neon (Figure 2).
3) Gallium-Aluminum-Arsenide Laser (780-890 nm)
Deeper penetration. Near infrared, invisible light. Many applications,
inexpensive, very useful for the treatment of pain, but also effective in
healing. Most popular therapeutic laser. Valuable to reach very deep
acupuncture points or deep Ah Shi points (Figure 2).
Figure 2. Relative depth of various
lasers commonly used in
8. Technical considerations
for laser puncture
Using cold lasers or electric stimulation
requires supervision or collaboration with
a physician acupuncturist or a licensed
acupuncturist knowledgeable in the use of
these modalities. 
The applied laser dosage is determined by the
manner of the intended effect, which is generally
characterized as to stimulate or to sedate
acupuncture points, Ashi Points, and Trigger Points.
According to the Arndt-Schultz Rule, it can be
understood that low dosages will stimulate and
that higher dosages will sedate. 
Dosages of 0.5 to 2.5 J/cm2 are reported to be
effective in the stimulation of superficial
With 2.5 to 5.0 J/cm2 being effective for deeper
points and myofascial trigger points.
Higher dosages (8 - 12 J/cm2) are effective for the
sedation of points. 
For optimal biostimulation, use lower dosages
per point with more treatment points and for
optimal bioinhibition, higher dosages per point
with less treatment points. 
Visible red wavelengths (~620-690 nanometers)
have shallow penetration and are used for superficial
treatment such as facial rejuvenation, acne, scars
and other skin blemishes. 
Infrared wavelengths (~760-1260 nanometers)
penetrate deeper for subdermal tissue treatment in
musculoskeletal injuries, sports therapy and wound
Laser therapy works on the principle of
inducing a biological response through
energy transfer, in that the photon
energy delivered into the tissue by the
laser will modulate the biological
processes within that tissue, and those
within the biological system of which
that tissue is a part. 
Laser energy at or near 800 nanometers is particularly
effective as this is close to the biophotonic emissions of
Infrared diodes of 810 nanometers and 150 milliwatts were the most
popular. Red diodes of 680 nanometers and 50 milliwatts ran a close
2 Hz Nerve regeneration, neurite outgrowth
7 Hz Bone growth
3-20 Hz Pain
700-2500 Hz Stimulatory effect
>2500 Hz Inflammation, edema
Most lasers may be used in all instances for which
moxibustion is indicated. There is no reducing or
tonifying technique when performing laser
Low-level lasers when used in pulsed mode have significant
effects that may correspond with central bioresonances. The
following frequencies are suggested from prior research studies.
Acute/chronic pain TMJ dysfunction
Paresthesias Cervical/lumbar spine syndromes
Allergic rhinitis/sinusitis Asthma
Frozen shoulder Phantom pain
Bursitis, tendonitis Nerve regeneration
Carpal tunnel syndrome Wound healing
The following is a partial list of conditions that have
shown promising results with laser acupuncture.
9. Precautions and
Laser therapy , 
1) Irradiation Of The Eyes
2) Pregnancy (over the pregnant uterus), cancers (over the tumor
3) Over the Thyroid gland
4) Over pediatric joint epiphysis.
5) Transplant patients, or other immuno-suppressed patients.
6) Hemorrhage, Laser is believed to increase blood flow and hence,
7) Patients using anticoagulants (susceptible for bruising due to over
pressure by the laser probe.
8) Steroid Injections Patients may suffer an exacerbation of symptoms
after laser therapy in conjunction with a recent steroid injection.
Precautions for Laser
therapy application , 
1) Photosensitivity, Patients who have a photosensitivity disease, using
photosensitizing drugs (Antibiotics, Antihistamines, Cancer chemotherapy
,Diuretics, Anti-depressants, Diabetic drugs, photodynamic therapy for skin
2) Anti-Inflammatories Patients taking anti-inflammatories (NASIDs) for acute
soft tissue injuries may not respond as quickly to laser therapy as those
who are not. Ideally, we would suggest a combination of ice and laser
therapy without the use of an anti-inflammatory.
3) Tattoos and Other Pigmented Tissues Dark pigments, such as tattoos and
melanin, may absorb light at the wavelengths used in laser therapy. Where
probes with high power densities are in use, the absorption of laser energy
by these pigments may cause localized heating, and subsequent discomfort
or injury, of the irradiated tissue.
Laser puncture 
The vast majority of contraindications for acupuncture
are relative rather than absolute contraindications
1- Sepsis and overwhelming infection.
2- Unexplained and/or unstable syncope or seizure.
4- Pregnancy (abortion risk)
3- Local contraindications of acupuncture include
active infection, skin lesions, or malignancy at the
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