[LASER THERAPY] The Light Answer decreased treatment times. Lasers are clas- siﬁed by power. Class III “cold lasers” are at maximum power output of 500mw from a single-laser source. Class IV lasers are any- eﬁcial inventions used in mod- thing over 500mw. ern society. In 1967, Dr. Endre You cannot make up for insufﬁcient power Mester, a professor of surgery by increasing treatment time. Depth of tis- in Hungary, performed a revo- sue penetration will not increase with more lutionary series of experiments application time if you have insufficient that ﬁrst documented the heal- power. Positive results require more than ing effect of lasers. Therapy increasing time. Sixty-ﬁve percent of laser lasers have been used and energy is absorbed in the skin and subcuta- researched in Europe for more neous tissue layers with the following having than 30 years. The U.S. Food a high afﬁnity for absorption: hemoglobin in and Drug Administration (FDA) blood; melanin in skin, hair, moles, and oth- approved the first low-level ers; and water (present in all biological tis- Class III laser (LLLT) in 2002 and sue). In order to overcome these factors, start the ﬁrst Class IV therapy laser in with large quantities of energy to reach the 2003. The most signiﬁcant clini- deeper target cells and myofascial structures cal and therapeutic difference with a required dose. between Class IV lasers and Class III is the Class IV can pro- Optimal Dosage duce a primary biostimulative Dosage is the single most important param- effect on deeper tissues while eter for a successful outcome in laser ther- also producing substantial sec- apy. Too little or too much energy produces ondary and tertiary effects.1 no effect. There is an “optimum window” Laser therapy aims to photo- of therapeutic dosage. The matter of correct biostimulate chemically dam- dosage is very complicated, since a number aged cells. This therapy actually of factors must be taken into account, includ- excites the kinetic energy within ing laser wavelength, power density, type cells by transmitting healing of tissue, condition of tissue, acuteness or energy known as photons. The chronicity of the problem, skin pigmentation, skin absorbs these photons via treatment technique and depth of target tis- a photo-chemical effect, not photo-thermal; sue. Deep-tissue laser therapy therefore, it does not cause heat damage to The primary factors in laser therapy that for low-back pain gets the tissues. determine dosage are power and time. While Once photons reach the cells of the body, power is the amount of energy measured at results By Perry Nickelston, DC they promote a cascade of cellular activities. It the source of the beam, dosage is the amount can ignite the production of enzymes, stimu- of energy delivered to the skin and target tis- M ore than 80 percent of the US late mitochondria, increase vasodilation and sue. Dosage may also be referred to as energy population will experience lymphatic drainage, synthesize ATP, and ele- density or ﬂuence. Its unit of measure is the some form of back pain over vate collagen formation substances to prevent Joule (J). Current industry dosage applica- the course of their lifetime. the formation of scar tissues. This is a critical tion requires 1- 4 J/cm2 for superﬁcial, and These people want pain relief and are des- step in reducing long-term disabling chronic 4-10J/cm2 for deeper conditions.3 Therefore, perate to improve their quality of life. A myofascial pain syndromes and joint hyper- a 50cm2 deep-tissue area may require up to growing number of progressive health care mobility. Other formative cells are also posi- 750J for maximum effect. providers are giving them relief by using tively inﬂuenced. One of laser therapy’s many Class IV high-power deep-tissue laser ther- immune-enhancing effects is an increase in the Optimal Wavelength apy. Unfortunately, there is a plethora of mis- number of macrophages.2 When determining Light characteristics are determined by its information regarding laser therapy, such as how to apply laser therapy for back pain, there placement along the electromagnetic spec- which type is best, how much to use (dos- are a few key factors to consider. trum. Wavelength is calculated in nanome- age), treatment frequency and even proper ters (nm). The ideal range for therapeutic diagnostic procedures. Laser Power lasers is along the invisible red (IR) spectrum KYLE KIELINSKI First theorized by Albert Einstein in 1916, Power affects penetration, dosage and treat- of 790-970 nm. IR beams penetrate deeper and invented by Theodore Maiman in 1960, ment time. More power offers deeper pen- into the body for increased effects on cellular the laser has become one of the most ben- etration, higher therapeutic dosages and tissue. Wavelengths in the visible red (VR)ADVANCE for Physical Therapy & Rehab Medicine ❘ December 28, 2009 ❘ www.advanceweb.com/pt
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