Back Pain: Advance PT Magazine Article


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Copy of my article published in Advance Physical Therapy Magazine on Laser Therapy for Back pain.

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Back Pain: Advance PT Magazine Article

  1. 1. [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 ❘
  2. 2. After a collision, back spasms and lingering lower back pain limited my performance, my doctor suggested I complement my treatment regimen with the LiteCure Therapy Laser; afterward, I quickly regained mobility, range of motion and pain decreased. Karen Bardsley Goalkeeper - Sky Blue FC 2009 Women’s Professional Soccer ChampionsUse what the Pros are Using.Try the most advanced laser therapyavailable, the Class IV, LCT-1000 DeepTissue Therapy Laser®. The LCT-1000 Proven results in treating pain associated with:allows for Drug-Free, Surgery-Free, Pain- • Plantar Fasciitis • Repetitive Motion InjuriesFree Relief with no known side effects. • Tendonosis • Myofascial Trigger PointsSchedule a FREE demo today! • Epicondylitis • Knee Pain ❘ December 28, 2009 ❘ ADVANCE for Physical Therapy & Rehab Medicine 5 Visit or call us at 302.709.0408 to learn more.
  3. 3. [LASER THERAPY]600s nm spectrum are ideal for superficial or restricted in some way demonstrating a Treatment guidelines and laser dosage wasconditions and limited in deep penetration.4 lack of mobility, or symmetry within a given administered over a large square area andWavelengths above 1000nm lose therapeutic movement pattern. Painful denotes a situa- multiple regions, thus preventing overstimu-value and cross over into surgical laser appli- tion where the selective functional movement lation and cellular inhibition.7cations. Deep-therapy applications such as reproduces symptoms, increases symptoms, The patient was put on a care plan of threespinal stenosis, disc herniations, hip derange- or brings about secondary symptoms that visits the first week and two visits per weekments, trigger points of spinal intrinsic stabi- need to be noted.6 for a total of 10 sessions. The patient returnedlizer muscles and neuropathic conditions are Selective Functional Movement Assessment after one session with an approximatelyinherently more responsive to the IR wave- (SFMA™) revealed the following: 50-percent reduction in symptoms. After thelength. • Multi-Segmental Flexion—Dysfunctional full 10 sessions, the patient was pain free, was Painful (DP); prescribed corrective exercises for restoringProper Diagnostic Procedures • Multi-Segmental Extension—Functional faulty movement patterns, and was instructedSimply treating the symptomatic area will and Painful (FP); in active isolated stretching combined withnot give you maximum results with laser. It • Multi-Segmental Rotation—Dysfunctional self-myofascial release techniques using foamis vitally important to treat the underlying and Non-Painful (DN) with a breakout pat- rollers, tennis balls and a stick.kinetic chain referral and compensation pat- tern of right standing rotation lateral single Lasers are a hot buzzword now. For the next ©2009, Reprinted with permission from Merion Publications Inc., Publishers of ADVANCE Newsmagazines. ADVANCE Reprints 1-800-355-5627, ext 1446.terns. High-power, deep-tissue laser allows leg; few years, laser therapy will appear high-techyou to treat many of these contributing areas • Single Leg Stance (Right)—Functional and to patients. They will be seeking this treatmentwith proper dosage during a single therapy Painful (FP); (Left)—Dysfunctional and option and you can enhance this process bysession. The key is to address dysfunctional Non-Painful (DN); branding your practice as cutting edge andpainful (DP) patterns in combination with the • Squatting Pattern—Dysfunctional and state-of-the-art. Lasers help move your prac-dysfunctional non-painful (DN). Painful (DP); tice to a higher quality, volume and fee struc- By utilizing special evaluation procedures • Upper Extremity Movement Patterns ture.from the SFMA™ (Selective Functional Move- (Right)—Functional and Painful (FP); When incorporating laser therapy into yourment Assessment), created by Gray Cook, (Left)—Dysfunctional and Non-Painful office, research a quality product manufac-MSPT, OCS, CSCS, and Kyle Kiesel, PT, PhD, (DN); turer that offers extensive training in Class IVATC, CSCS, you can implement an integrated • Cervical Movement Patterns—Functional application. Class IV laser therapy can be themodel to address regional interdependence to and Non-Painful (FN). answer your patients have been searching forlocate the dysfunctional non-painful areas.5 We already know the key to the SFMA and in regaining their quality of life. ■What you will typically find with chronic back deep-tissue laser therapy application is to treatpain sufferers is involvement with ankle, hip the dysfunctional non-painful in conjunction Referencesand thoracic spine hypomobility combined with the symptomatic complaint. Based on the 1. Vickers, J., & Harrington, P. (2009). Class IV Lasers:with knee, pelvic and lumbar instability. above (DN) results, I performed a more in- Maximizing the Primary Effects of Laser Therapy. depth evaluation of bilateral hips, ankles and 2. Blahnick, J., & Rindge, D. (2003). The Laser TherapyOne Case Study thoraco-lumbar junction for mobility issues Handbook. Melbourne, FL: Healing Light Semi-This is an actual case study that presented and inter-related myofascial trigger points. my office by patient referral for Class 3. Tuner, J., & Hode, L. (2004). The Laser TherapyIV deep-tissue laser therapy. The patient Application Handbook. Grangesberg, Sweden: Prima Books.entered with a complaint of chronic central- Laser therapy application consisted of the fol- 4. Turchin, C. (2008). Light and Laser Therapy: Clinicalized lower-back pain with periodic radiation lowing protocols. Class IV deep-tissue laser Procedures.into the right gluteus region and outer thigh. treatment at 10 watts of power on continuous 5. Cook, G., & Kiesel, K. (2009). Impaired Patterns ofThere was an insidious onset of symptoms, wave (CW) output with 600J of energy deliv- Posture and Function.with no known mechanism of injury. The ered per minute. 6. Cook, G., Kiesel, K., & Plisky, P. (2008). The Selec-patient is currently taking prescription pain Fiber was held one quarter inch from skin tive Functional Movement Assessment: An Integratedmedication and anti-inflammatories. Pain is and applied with a sweeping motion at half Model to Address Regional Interdependence.a 6/7 on a scale of 10. MRI confirmed a right the speed of ultrasound. Based on Joules per 7. Riegel, R., & Pryor, B. (2008). Clinical Overview andpostero-lateral disc herniation at L4/5. cm2 for deep-tissue application, I applied the Applications of Class IV Therapy Lasers. Prior courses of treatments included following dosages to these regions per singlephysical therapy (i.e., electric muscle stim- session.ulation, ultrasound, exercise), chiropractic • Lumbar spine T12-L5 (including bilateral Perry Nickelston is clinical director of the Painmanipulation and one epidural injection. quadratus lumborum) 4000J; Laser Center, LLC in Ramsey, NJ. He has beenAll therapies provided only temporary relief • Bilateral hip and gluteus 2000J per hip; using Class IV lasers since 2004 and lecturesof symptoms. • Bilateral plantar fascia 1000J per foot; extensively on laser therapy and clinical applica- The term functional describes any unlim- • Bilateral iliopsoas/iliacus 2000J per side; tions. He is FMS and SFMS Certified, specializingited or unrestricted movement. Dysfunc- • Total Joules of laser energy for session: in therapeutic outcomes with Class IV laser. He maytional describes movements that are limited 14,000J. be contacted at www.stopchasingpain.comADVANCE for Physical Therapy & Rehab Medicine ❘ December 28, 2009 ❘