The Truth About Laser Therapy Presented by “Avicenna Laser Technology, Inc. ”Inventors of “Class IV” Laser TherapyPHYSICIAN WEBINAR
Today’s Moderators: Bruce R. Coren, DVM, MS Cofounder, Chairman & CEO Avicenna Laser Technology Joseph Costello, DC. DABCO Chief of Clinical Services Avicenna Laser Technology(Please hold all questions till after the presentation is over)
Today’s Format• Please hold all questions till after the presentation is over as wewill answer all of your questions• You can raise your hand by clicking the icon when you have aquestion or• You can also type in a question and submit it
HPLT – High Power Laser Therapy• HPLT (Class IV) was first introduced to the medical field in 2002 by Avicenna Laser Technology, Inc. Avicenna invented and developed the first High Power Therapeutic Laser to receive FDA clearance, in 2003.• Up until that time only low power therapeutic or cold lasers where available.• The first therapeutic laser system we developed was capable of delivering healing laser energy to depth’s never before achieved in the field of laser therapy.• It was developed to allow physicians of all medical disciplines the capability to heal injuries previously refractive to traditional medical care.
The Design of the Avicenna Laser• The Avicenna laser was designed from the ground up to be a therapeutic medical laser.• It was developed using research by our own biomedical engineers , specifically James Ohneck, the other Cofounder of Avicenna, physicians, and most recently collaboration with the medical school and optics department at the University of Toledo.• We investigated important criteria such as wavelength, power output and power density, optics and beam delivery, in order to safely produce the greatest penetration and delivery of a therapeutic dose of laser energy capable of stimulating tissue healing in deep seated pathologies.
The Design of the Avicenna Laser• All of our lasers have there own research to support our claims as well as being tested in our patient treatment and R&D center.• No other laser manufacturer that we are aware of can make this statement.• They typically use studies done with other lasers and then make a great leap of faith to make the claims they do without any of their own research.• The world of laser therapy is unfortunately buyer beware! We frequently receive calls from physicians who wish they were better educated before they made their laser purchase.
Review of the Biological Effects of Therapeutic Lasers• Therapeutic lasers are designed to bio-stimulateinjured and dysfunctional tissues.• Clinical studies and trials of Class III & IV lasertechnology indicate the following beneficial effectsof light therapy on tissues and cells.• For those of you who are new to laser therapy weare going to briefly present these benefits, as thistopic could constitute a webinar all by itself.
Summary of LT Biological Effects •Accelerated Tissue Repair and Cell Growth •Faster wound Healing •Reduced Fibrous (Scar) Tissue Formation •Anti-Inflammation •Anti-Pain (Analgesia) •Improved Vascular Activity •Increased Metabolic Activity •Improved Nerve Function •Immunoregulation •Trigger Point Resolution and Acupuncture Pt. Stimulation
All Lasers are Not Created Equally• Although all therapeutic lasers bio-stimulate tissue, that is where the similarities end.• Laser Therapy is all about Physics!
Therapeutic Laser Classifications• Therapy lasers are classified based on their power output•Class IIIa = lasers 1 to 5mw of power (laser pointers)• Class = lasers 6 to 500mw in power (typical cold laser or Low Level Laser)• Class IV = lasers above 500mw of power
Therapeutic Laser Physics• Laser therapy is a positive form of energy medicine• When you treat a patient with a therapeutic laser there is a measurable dosage delivered during every treatment.• The dosage delivered is based on the power output of the laser, how long the patient is treated for, and how often the laser is on during the treatment time• There are no shortcuts to clinical success.
Therapeutic Laser Physics• The therapeutic dosage of laser energy is measured in Joules• 1 Watt = 1 Joule / Second - For every one watt of laser power output, one joule of energy is delivered per second of time, for a continuous laser. - For a pulsed laser the energy delivery depends on the duty cycle, which tells us what percentage of time the laser is on or actively firing. If the duty cycle is 50% then the laser at 1 watt only delivers 0.5 Joules / Second. - For any given time period a continuous wave laser delivers twice as much energy that a pulsed laser with a 50% duty cycle.• From this we can see that high power lasers can deliver considerably more energy than low power or their cold laser predecessors.
How Light Penetrates Tissue• As light energy hits the surface of the skin and subsequent deeper layers, some of it is scattered and reflected and some of it is absorbed• At each tissue interface less energy is available to pass further through to the next layer because of the effects of absorption, reflectance and transmission. This is a very important concept to be aware of.
Irradiance Map• Light coming out of a fiber optic cable, the typical high power laser delivery system, is bell shaped. For that reason the energy delivery is not uniform andmore energy is concentrated in the center of the beam. This creates hot spots thatcause more superficial vasodilatation, and as you will soon learn, more laserenergy to be absorbed at the skin level.
Overcoming the Weaknesses of Fiber Optics• Our research efforts revolved around finding a transmission medium that would produce a more uniform beam distribution and less superficial heat build up than with a fiber optic delivery system• We accomplished this by transmitting the laser light thru a proprietary liquid light medium, called a light guide• Translation: more uniform energy delivery, less superficial tissue heating, and thus greater penetration for any given power output when compared to traditional fiber optic delivery systems
Depth Penetration Factors• Instrumentation – Total Power – Spot size – Time – Power density ( Measures the concentration of the laser energy, measured in mw / cm2) – Wavelength – Method of delivery Pulsed or Continuous
More Depth Penetration Factors • Patient – Skin pigmentation – Hair – Thickness of each tissue layer – Vascular content of treatment area – Cleanliness of treatment area – Method of laser applicationOne thing to note when you apply the wand to the skin and push back and forth you areActually pressing blood out of the area and by doing so you actually INCREASE depthPenetration. Having a laser delivery system that can contact the skin is a good designFeature.
Physiological Effects Light – Tissue Interactions• It is widely agreed upon that almost 65% of laser energy isabsorbed in the skin and subcutaneous tissue layers with thefollowing 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 largequantities of energy on the skin as well as choose a wavelengthwhich helps to increase penetration
Therapeutic Laser PenetrationThe Prime Determinants of Laser Penetration andConcomitant Tissue Stimulation are: • Power – measured in Watts or milliwatts • Wavelength – measured in nanometers. It is important to use a wavelength that provides both tissue stimulation and depth of penetration. Our research led us to the 980 nm wavelength • Power Density – measured in mw / cm2 • Frequency – continuous wave versus pulsing
Importance of Power Density• Becausethat almost 65% of the energy delivered is lost in the epidermis• If you don’t start with enough energy on the skin surface, there will not be enough to stimulate cell healing, especially in deeper pathologies• Also if you do not have a sustained power density over a long enough period of time, treatments may be ineffective• Too much power density can also be detrimental (surgical lasers that have been converted to therapy lasers.)• Collimated beam vs. Divergent Beam
How Much is Enough • 49-73 mw/cm2 for cell stimulation1 EFFECTS OF INFRARED LASER EXPOSURE IN A CELLULAR MODEL OF WOUND HEALING Mark D. Skopin and Scott C. Molitor, Department of Bioengineering, University of Toledo, Toledo OH• This independent study showed us that the 980 nm wavelength waseffective for tissue stimulation as well as the power density range thatwas optimal for tissue stimulation and wound healing.
Laser & Tissue Powers Tissue Layer Max Power (mw/cm2) Epidermis 206 Dermis Layer 182 Dermis Plexus Super. 135 2nd Dermis Layer 115 Dermis Plexus Prof. 93 Muscle Tissue 9.7(Power Setting 5 Watts, 3.0cm spot size, 980nm)The above chart, calculated using sophisticated computermodels by U of Toledo shows us how the concentration ofenergy diminishes as the laser energy passes thru thedifferent tissue interfaces.
Translation of Previous Two Slides• It is important to understand that as laser energypenetrates through the body more and more energyis absorbed at each tissue interface, so by the timeyou start reaching deeper structures there is notenough therapeutic energy to cause adequatetissue stimulation. This is the reason why low powerlasers as well as pulsing lasers fail to deliver whentreating deep seated pathologies.
Multiple Wavelength Lasers vs.Avicenna Single Wavelength & Continuous Wave Laser • Companies that use a dual wavelength platform typically have no research to prove their efficacy and in fact are actually inhibiting penetration as • A laser with two or more wavelengths only has the ability to penetrate as deep as each individual wavelengths allows. • Lasers that pulse or have a high duty cycle coupled with multiple wavelengths of energy emission will not penetrate as deep as CW lasers of a single wavelength • Continuous wave lasers = 100% duty cycle, laser is always delivering energy which is needed to overcome absorption in the superficial layers
In Laser Medicine 1 + 1 Does not = 2• Dual wavelength lasers only penetrate as deep as eachwavelength will go individually. The penetration is not additive sothere is no real benefit to this scenario.• It is more advantageous to have one wavelength of greaterpower that stimulates cell metabolism and tissue regeneration atall tissues in its pathway. We knew this going into the formation ofour laser system unlike our competitors, who relied on other lasermanufacturers incorrect theories of wavelength and tissuebiostimulation.
Other Factors Affecting Lasers Penetration • Duty Cycle – 100% • Laser is firing continuously • Duty Cycle – 50% • Laser is firing 50% of the time. This will not only cut energy delivery but it will also affect ability to penetrate. • Pulsing – Lasers that pulse also do not emit continuous energy • Avicenna is 100% continuous wave energy
Why Therapeutic Lasers Fail• Under dosage – The typical low level or cold laser does not deliver enough energy to adequately stimulate deep seated inflammatory conditions• Under penetration - The typical low level or cold laser does not concentrate the laser energy sufficiently to allow for adequate penetration• What is the correct dosage? Avicenna protocols typically call for thousands of joules and may approach as high as 10,000 joules for deeper seated pathologies• There are no short cuts to clinical success
High Power Therapeutic Laser Medicine (HPTLM) presented by Joseph Costello, DC, DABCOA New Medical Discipline that Allows Physicians to Successfully Treat Medical Failures
The Success of HPTLM Revolves Around Creating the Best Environment for Tissue Healing• High Power Therapeutic Laser Medicine is a new discipline in Neuromusculoskeletal Medicine created by Avicenna Laser Technology’s Team of Physicians• It revolves around using the Avicenna High Power Laser in conjunction with numerous areas of medicine such as:
• High Power Laser Therapy• Non-surgical orthopedics• Neurology• Foot pathology• Biomechanics, gait and kinetic chain dysfunction• Orthotic intervention• All of the above are critical components in achieving a successful outcome.
“The Key to Better Outcomes”• Higher the power output of laser energy•The Greater The Penetration•The Faster the Therapeutic Outcome•The Quicker the Patient Returns to Normal•This is one of the reasons we developed our new technology the AVI HPLL-12
Goal of Pain Management Using Laser Therapy• Relieve Pain and Reduce Inflammation • Promote Tissue Healing • Minimize Side Effects • Restore Active Range of motion
Lasers vs. Standard Modalities Currently Used to Treat Neuromusculoskeletal Pathologies
Applications of Laser Therapy•Disc Pathologies, Spinal Stenosis, Radicular Pain,spondylolesthesis, and sacroiliac dysfunction•Failed surgical back syndrome• Accelerated Post Surgical, Soft and hard Tissue healing•Arthritis (Degenerative Joint Disease)•Foot Pain and Neuropathies•Muscle, Ligament and Tendon Injuries•Ulcerations and Open Wounds
Clinical Translation of the Previous Slide as it Pertains to the Spine • Decreased inflammation of disc, nerve roots and the cauda equine • Increase microcirculation of spinal structures • Accelerate healing of annular defects • Decreased formation of abnormal/non functional scar tissue • Decreased scar tissue and non-osseous hypertrophic changes • Reduce pain associated with prolotherapy injection • Decrease or even eliminate need for epidurals
Clinical Translation of the Previous Slide as it Pertains to the Lower Extremities• Decreased inflammation of nerve tissue• Accelerated Reinervation of nerve fibers• Increase blood flow and microcirculation of tissue structures• Accelerate healing of open wounds• Decreased formation of abnormal/non-functional scar tissue
Clinical Translation as it Pertains tothe Lower Extremities Continued…• Increase synovial fluid and cartilage production• Increase collagen and fibroblast production• Increase osteoblastic activity and fracture healing• Decreased bony edema – osteochondral bone bruise• Decrease in pain associated with epidural, prolotherapy or other invasive injections
Evidence Based Medicine•Avicenna clinicians all subscribe to the theory of EBM•Clinicians measures results with outcome assessment tools: • Pressure Algometer • Inclinometer , Goniometer • Thermal Imaging and Doppler Studies • VAS, PDQ – Pain Disability Questionnaire•These tools are vital to document outcomes whichultimately lead to adequate reimbursement
Avicenna Laser Therapy Protocols• Developed by Clinicians for Clinicians• Proprietary to AVI HP –7.5 and AVI HPLL-12•Utilizes Texas Back Institute Protocols in conjunction with laser• Will not work for LLLT or other Low Power Lasers as they cannot create significant power (energy density) to over come tissue saturation to reach deep structures in the disc, joint or areas of deep seated inflammation
Avicenna’s Clinical Advantage• Avicennas training incorporates the teachings of multiple disciplines including non-surgical orthopedics, physical medicine and rehab, neurology, podiatry, bio-mechanics and kinetic chain dysfunction.• Regardless of your medical discipline or level of experience we will train you to outperform anything in medicine when it comes to treating neuromusculoskeletal pain.• The training you will receive will be second to none, you will receive it along with unlimited phone consultation services!• As good as our laser is, without proper training you may fail when treating difficult conditions• With our training, when it comes to pain management you will now be able to outperform anything in medicine, safely and without the potential for side-effects.
Clinical Importance of Proper Therapeutic Laser Dosage• Treating pathologies in large joints and/or the spine, requires large dosages, typically greater that 10,000 Joules.• This is the dosage we have researched necessary to get a long term if not permanent result.• Anything short of this and especially the typical LLLT dosage recommendation of 10-20 joules or other class iv laser companies who claim you can treat for 5-10 minutes with a pulsed laser, should raise a red flag.• There is a great difference between feeling better and getting better.• The latter should always be the clinicians goal.
Introducing the AVI HPLL-12• A technological advancement in energy output and delivery, that delivers a therapeutic dosage of laser energy necessary to treat deep seated pathologies• The AVI HPLL-12 is the world’s most powerful and advanced therapeutic laser system• But: As good as this technology is, without the appropriate training when it comes to treating medical failures your results will be marginal at best• As a physician based company we have treated or will know how to treat any condition you are confronted with the ultimate result being a better outcome• With the superior training and clinical support we provide physicians the above goal will readily be achieved
Changing the WayPhysician’s Manages Pain Thank You For Attending Feel Free to Ask Questions www.AvicennaLaser.com 561-882-1430