1. 1 | P a g e
Laser Therapy, an Emerging Clinical Paradigm
The Genesis of Laser Therapy
Lightis one of the oldestforms of therapy; to live and function normally, all living creatures need light in some form.
1660-1903
Sir Isaac Newton was the first to separate light with a prism, and discovered the visible spectrum in the 1660's. Until
1903, sunlight was the only light available for therapeutic application.
1882
Danish medical Dr. Nils Finsen was awarded the Nobel Prize for successfullytreating tuberculosis, rickets, and lupus
vulgariswithultravioletlight.Thisisthe first evidence inhistorythatan artificial lightsource wasusedin a therapeutic
application.
1916
In1916, AlbertEinsteinpostulatedtheoryoflasersinanassumptionnecessarytosupportthe theoryof relativity.Einstein
correctlyproposedthatwhena photonof the correct energylevel collideswithanatomthat has beenenergizedunder
the right conditions, two photons of precisely the same energy would be emitted.
1923
The firstevidence thatinfraredlightcouldpossiblybe involvedinintracellularcommunicationwasreportedin 1923 by
a Russian researcher Alexander Gurswitsch, who observed that infraredlight could be transmitted from a test tube to
anotheradjacenttesttube withoutanyphysicalcontactbetweenthe twoof them.He usedthe termmitogenicradiation
to describe this process.
1960
It took almost 40 years before technology produced what Einstein predicted. On March 16, 1960, Theodore Maiman
producedthe firstRubylaseratthe HughesAircraftresearchlaboratoryinMalibu,California.InNovemberof 1960,Peter
SorokinandMirekStephensonatIBMlaboratoriesproducedthe firsturaniumlaser.In1961, Ali Javan,WilliamBennett,
and Donald Herriot invented the first helium neon laser at Bell Laboratories.
1967
In1967, Dr. Endre Mesterfromthe BudapestUniversityinHungaryundertookacomprehensive studytodiscoverif laser
irradiation caused cancer. His experiment was simple - he took two groups of mice and shavedtheir backs. One of the
groups was exposed to low-power laser energy and the other group was not. The laser-exposed group did not develop
cancer, and to his surprise, the hair on their shaved backs grew back much more quickly than the unexposed group.It
wasin thismannerthatphoto-bio-stimulationwasfirstdiscovered.Unfortunately,Dr.Mesterpublishedhisfindingsina
Hungarianmedical journal insteadof aninternational forum;therefore,the benefitsof lasertherapywereutilizedinthe
Eastern Bloc countries long before the West learned from them.
1970
Duringthe early1970s, laser therapywasemployedthroughoutEasternEurope,China,andthe SovietUnion.Nearlyall
of the earlyresearchand applied lasertherapyoriginatesfromthese areas.The first record of stimulatingacupuncture
pointsvialaserenergyoccurredinChina.Dr.YoChengZhoudiscoveredareductioninpainfollowingwhenlasertherapy
wasusedafterroutine dental extractions.Hisprotocolinvolvedthe applicationof 2- 6mW of a redbeamlasertoasingle
point for five minutes. The tooth was then removed. Laser therapy was then applied to Hegu, the distal acupuncture
point with recognized anesthetic properties.
1980
Throughoutthe remainderof the 1970s and early1980s, laser therapyspreadto WesternEuropean countries,utilizing
lasersinthe 5 - 10 mW range.Soonthereafter,the lasertherapyappearedinthe UnitedStates.In1981, available lasers
were in the 1mW range and were primarily manufactured in China.

2. 2 | P a g e
1993
By 1993, Margaret Naeser, PhD. had accomplished enough research through the Robert Wood Johnson foundation of
PrincetonNewJerseythatshewasabletoestablishthe firstindependentinstitutional reviewboardforlaseracupuncture
researchlocatedin BostonMassachusetts.Thiswas the beginningof an effortto compile andpresentall of the current
information and research to comply with FDA regulations.
1994
In May of 1994, the World Association for Laser Therapy was formed in Barcelona Spain. It was a unification of the
International Laser Therapy Association (ILTA) and the International Societyfor Laser Application in Medicine (ISLAM).
The purpose of these organizations was to pursue common goals of promoting research, education, and clinical
applications of laser photo stimulation internationally.
1998
The North American Association for Laser Therapy(NAALT) was established in 1998, and includes Mexico,Canada, and
the UnitedStates;itsmissionistoimprovetheunderstandingof photobiologicalmechanisms,treatmentparametersand
protocols,techniques,andregulatoryissues. NAALTincludesscientificandclinical laserspecialists,andprovide aforum
(Photomedicine and Laser Surgery), which publishes peer reviewed papers of importance within the medical laser
industry.
1999
In 1999, researchersfoundthat the applicationof higherpowerlasertherapy(upto 10,000mW, or 10Watts), produced
more efficient tissue response in laboratory studies. As the application of higher power laser therapy gained tentative
approval in the US.
2002
In 2002, therapy lasers utilizing 7.5Watts or more were commercially introduced. Unfortunately, during this period
proliferation of high power laser therapy was repressed through greedy opportunism by commercial therapy laser
suppliers, as 7.5Watt lasers were costing more than $40,000.
Present Day
Thanks to the determination of better-intentioned manufacturers and suppliers, high power laser therapy is now
available to all pain sufferers. With the preponderance of scientific evidence already established, and opportunistic
manufacturers and distributors held in check, thousands of practitioners are now providing effective laser therapy
treatments throughout the world.
The Science of Laser Therapy
Lasertherapy,alsoknownasphotobiostimulationorphotobiomodulation,isanemergingtherapeuticapproachinwhich
cellsortissue are exposedtonear-IRlightfromlasers throughadivergentbeamhandpiece,mosteffectivelyinthe 5Watt
to 30Watt range. Laserenergywill eitherstimulate or(lesslikely)inhibitcellularfunction,leadingtoreductionof cell and
tissue death,improvedwoundhealing,increasingrepairof damage tosofttissue,nerves,bone,andcartilage,andrelief
for both acute and chronic pain and inflammation.
By definition, the term photobiomodulation means the application of electromagnetic radiation within the red and
infraredspectrumintosickandinjuredtissue,usinglaserstostimulatehealingandpainrelief withinthose tissues.There
are currently several typesof lasersinvolvedinthe healthcare industry:surgical lasers,aestheticlasers, andtherapeutic
lasers. Surgical lasers cut tissue, aesthetic lasers modify tissue, and therapeutic lasers heal tissue.
Both light absorption and scattering in tissue are wavelength dependent, and the principal tissue chromophores
(hemoglobinandmelanin) have highabsorptionbandsatwavelengths inthe 810nmto 980nm range. A so-called'optical
window'atthese wavelengths,where the effective tissue penetration of light is optimal, will enhance tissue healing.
Benefits of Laser Therapy

3. 3 | P a g e
The benefitsof lasertherapytreatmentcaninclude rapidhealingof the joints,muscles,andnerve tissues,strengthening
of the treatedsofttissue,improvedbloodflowtothe affectedareas,painrelief,reducedinflammationandanimproved
immune response. These treatment benefits begin with initial therapeutic intervention, and improve with each
subsequenttreatment. Epithelial cells,asfoundin the dermal tissue layers,act as a barrierto laserenergypenetration,
requiring lasers capable of producing higher power (at least 4-5,000mW<) to penetrate deeply enough for a metabolic
change in the affected area. Class III and Class IIIB lasers, while sometimes able to block pain channels on the dermal
layers,are unabletostimulatefluctuationsindeep-tissuepathologyduetotheirintrinsicallylowpowerlevels(500mW>).
Rationale andApplications
The rationale behind LaserTherapy issupported bythe reportedefficacyof LaserTherapy at cellularandsubcellular
levels,particularlywavelengths between808nMand 980nM, and evidence forthisispresented below. Thisrange of
wavelengthsisalsoassociatedwith improvedbloodflowandneovascularization.A large varietyof cytokines,
chemokinesandmacromoleculescanbe inducedby lasertherapy.Amongthe clinical applications,non-healingwounds
can be healedthroughrestoringthe collagenases/collagenase imbalance insuchexamples; woundsheal fasterand
betterwitheffective lasertherapytreatments.Pain,includingpostoperative pain,postoperative edemaandmany
typesof inflammationcanbe significantlyreduced throughpropertreatments.
Laser Therapy,PrimaryGoals
The primarygoals of lasertherapy are tostimulate chronicallydormant/sick/injuredcellstoperformnatural functions
at an enhancedrate,creatinga more favorable environmentforrapidandlong-termhealingandpainrelief.The high
powertherapylaseracceleratescellularrespirationandtargetshemoglobinandcytochrome coxidase withinthe
mitochondrial portionof the cell.Insharpcontrastto ‘coldlasers’whichprovide no feelingorsensation,andare fartoo
weakto provoke abiological responseindeeptissue,highpowerlasertherapyprovidesawarm, healingsensation,and
floodsthe tissue withhealingenergy.
Unlike manypharmacological treatmentsthatmaskpainor onlyaddressthe symptomsof disease,LaserTherapytreats
the underlyingconditionorpathologytopromote painrelief andhealing.Thismeansthatthe treatmentsare effective
and the benefitsof LaserTherapyare longlasting.
Anti-Inflammation
Laser therapyhasan anti-edemiceffectasitcausesvasodilation,andenhancesperformance of the lymphaticdrainage
system(drainsswollenareas).Asaresult,there isareductioninswellingcausedbybruisingorinflammation.
Anti-Pain(Analgesic)
Laser therapyhasa highlybeneficial effectonnerve cells,blockingpainsignalstransmittedtothe brain,decreasing
nerve sensitivity,andgeneratingregrowthof surroundingmyelintissue.Inaddition,there islessedemaandpaindue
to decreasedlocal inflammation.
AcceleratedTissue RepairandCell Growth
A powerful flowof photoniclightenergyfromthe laserpenetratesdeeplyintotissue andacceleratescellular
reproductionandgrowth.Highpowerlaserenergyincreasesthe vitalityof the cell,sothatitcan absorbnutrients,and
dispose of cellularwaste productsfasterandmore effectively.
ImprovedVascularActivity
Laser energysignificantlyincreasesthe formationof new capillariesindamagedtissue,speedingupthe healing
process,closingwoundsmore quickly,andreducingscartissue inthe affectedarea.
IncreasedMetabolicActivity
Laser energyincreasescellularmetabolicratesbystimulatinghigheroutputsof specificenzymes,greateroxygen
exchange,andfoodparticle loadingestionforblood cells.
TriggerPoints/Acupuncture Points

4. 4 | P a g e
Laser therapystimulatesmuscle triggerpointsandacupuncture pointsnon-invasively,providingenhanced
musculoskeletal painrelief.
Making the case for Class IV (high power) vs. Class III (low power) Laser Therapy
A coldlaserutilizesveryweakenergyoutput inafocusedorcollimated beamto treataffectedtissue.Thisthinstreamof
energyreadilypenetratestissue (Imagineentering a darkroom with no light, turning on a laser pointer, and pressing it
into the palm of your hand. The laser pointer, which is only .03Watts, will light up the back of your hand, displaying
tendons, blood vessels, and so on). While impressive to observe, this process provides very little energy in order to
stimulate a metabolic change in tissue. Albert Einstein taught about the properties of light: Light energy consists of
photonicparticlesthatactas waveenergy thatcontainsacceleration butnotmass. Low powerclassIIIenergy(<500mW,
or ½ Watt and less) is far too weak to significantly stimulate living tissue below adipose tissue layers.
Class IV laser energy (over 1/2Watt, typically between 9 – 30Watts) is delivered in a divergent, rather than collimated
beam.This divergentenergybeamisthen intoproblematictissue, scatteringinto the tissue andinfusingitwithenergy.
A class IV therapy laser produces a high-energy beam that does not go on for a great distance like a laser pointer, but
penetrates,scatters,andisabsorbedby manytissuetypes.Thisactof energy transference causesametabolicchange by
stimulating the cells to produce up to 300% more energy in the affected tissue.
Primary Difference between Class III and Class IV Therapy Lasers
• POWER (Available energy)
• Class III is maximized at 500mW (milliwatts) from one laser beam
• Class IV is cleared by the FDA for up to 60W (Watts) or 60,000mW (milliwatts) of power from one laser beam
• Class IV Laser therapy reduces edema, increases vasodilation by up to 300%, and alleviates pain of the spine, joints,
muscles,andnervescausedbyvariouspathologies,actuallyresolving(orhealing) the conditioncausingthe pain.Thisis
achieved by stimulating rapid healing of the soft tissue through photobiostimulation (much like photosynthesis, or
chlorophyll production in plants).
• Class IV lasers penetrate the skin with photonic light energy (photobiostimulation), which reaches deep tissue to
activate enzymaticandmetabolicfunctionsof the tissue inthe treatedarea.Laserenergyprofoundlyenhancesoptimal
cellular function and healing processes, thereby reducing pain, edema, and morbidity.
Class IV laser therapy is often associated with heat; in fact, most low power class III laser supplierstypicallyattempt to
create an atmosphere of fear and aversionby portraying associatedheat as problematic.Anyone associated with laser
therapy should know that increases in tissue temperature is a POSITIVE byproduct of laser therapy, and is a sure
indication that the necessary energy for regenerative clinical outcomes is introduced through proper therapeutic laser
application.

5. 5 | P a g e
Laws of Thermodynamics
Heat exchange occurs whensignificantenergyistransferredfromaregionof highertemperaturetoanotherregionof
lowertemperature.Heattransferchangesthe internal energyof bothsystemsinvolvedinthe energytransfer.
Thermal equilibriumisreachedwhenall involvedbodiesandthe surroundingsreachthe same temperature.Thermal
expansionisthe tendencyof mattertochange volume inresponse toa change intemperature.
The enhancementof energyproductionandexchange stimulatesthe ATPSynthase Process.ClassIIIandIIIBdevicesdo
not produce andexchange significantenergy,asnoheatis generated.
Clinical studies and laser therapy trials have shown the following benefits on tissue and cells:
1, Pain Relief
Class IV Laser Therapy has a beneficial effect on nerve cells by blocking the pain transmitted by the cells to the brain,
whichdecreasesnervesensitivityandreducesthe perceptionof pain.Thisresultsindecreasedinflammationandreduced
level of edema. Pain is also decreased due to the production and release of endorphins and enkephalins,which are
natural pain-relieving chemicals released from the brain and adrenal gland.
2. Improved Nerve Function
Class IV Laser therapy speeds up the process of nerve reconnection, and stimulates the regeneration of surrounding
myelin tissue, reducing and often eliminating pain, tingling and burning.
3. Accelerated Nerve Growth and Cell Repair
Photoniclaserenergypenetratesdeepwithinthe tissuetoacceleratecell reproductionandgrowth.LaserLightincreases
energyto the cell,whichhelpsaidnutrientabsorptionandwaste removal.The resultis acceleratedhealingof muscles,
tendons, ligaments, and even bone.
4. Enhanced Immune System Function
Photonic packets of laser energy are driven into, and directly absorbed by chromophores (molecular enzymes within
cells) thatare embeddedwithinmostcellsof the body.Thislaserlightabsorptionactivatesaspecificenzymaticprocess
that triggers the production of ATP (adenosine tri-phosphate), through mitochondrial action. ATP is the single most
important form of energy that powers ALL chemical reactions within ALL cells of the body. Higher energy production
leads to better and more efficient metabolic function – especially immune-specific cells (especially Cytotoxic T
lymphocytes (CTLs)). This improved efficiency aids the immune system in fighting off undesirable microbes and
pathogens.
5. Reduced Edema and Inflammation
Laser therapy reduces edema, inflammation and congestion, by enhancing vasodilatation, which promotes proper
lymphatic drainage.
6. Faster Healing and Reduction of Scar Tissue Formation
Laser therapyincreasesbloodflowtoinjuries,whichincrease the rate of healingandreducesscar tissue.Lasertherapy
has proven effective in treating burns, wounds, and surgery sites.
7. Acupuncture/Acupressure Point Stimulation
LaserTherapyisaneffectivealternative totraditionalacupuncturetreatment.LaserTherapystimulatesacupunctureand
muscle triggerpointsprovidingmusculoskeletal painrelief andbetterflow of bloodflow (sometimesreferredto as CHI.
Noninvasive, Drug Free Solution to Pain
ClassIV Laser Therapyprovidesall of the benefitsof cryotherapy,ultrasoundtherapy,andE-stim(electronicstimulation
therapy) without the uncomfortable side effects. It also provides benefits associated with heat therapy without

6. 6 | P a g e
subsequentlyincreasinginflammationsometimescreatedbyheat, resultinginincreasedcomfortbothduringand after
the treatment.
What Additional Health Problems Have Researchers Found to be Effectively Resolved by Class IV Laser Therapy?
•Soft Tissue Injuries
•Bone Injuries
•Tedinopathies
• Back and Neck Pain
• Carpal Tunnel Syndrome
• Myofascial Trigger Points
• Epicondylitis (Tennis Elbow)
• Sprains, Strains
• Repetitive Stress Injuries
• Planter Fasciitis
• Neurogenic Pain
• Neuropathic Pain
• RSD/CRPS
• Post-traumatic Injury
• Fibromyalgia
• Trigeminal Neuralgia
• Degenerative Joint Conditions
• Rheumatoid Arthritis
• Osteoarthritis
• Chronic Sinusitis
• Symptoms of Tinnitus
• Symptoms of Lupus
• Symptoms of ALS (Amyotrophic Lateral Sclerosis)
• Symptoms of MS (Muscular Dystrophy)

7. 7 | P a g e
Laser Therapy Mechanism of Action
1. Biostimulation / Tissue Regeneration
2. Reduction of Inflammation
3. Analgesia
4. Enhanced Immune Function / Antimicrobial function
Function of Mitochondria
Lasertherapyaidsinenergyproduction,storage,andtransference,throughphotonicenergyabsorptionbymitochondria.
As you may alreadyknow,these tinyorganelles,whichare oftencalledthe ‘powerhouse’of the cell,are foundin most
plants and animals. Mitochondria are able to absorb laser energy,which thenactivatesa series of reactive cascade of
eventstoincrease, store,andshare increasedcellularenergyinthe formof adenosine triphosphate (ATP).Byincreasing
energyavailable inthisreadilyaccessiblefluid form, photoniclaserenergyisable tostimulate the metabolicfunctionof
cells,increasingoverall vitalenergytothe treatmentareaandthroughoutthe bodythroughcellularmigrationandblood
flow.
Laser therapyhas beenshowntostimulate the regenerationof bone,blood,the liningof bloodvessels,cartilage,nerve
tissue,myelintissue(the liningof nervoustissue) andsoftmuscletissue. Moreover,lasertherapyhasbeendocumented
to enhance the vigor and function of healthy tissue as well. Laser therapy is an ideal treatment modality; it is not only
effectiveintreatingawide varietyof medical conditionswithnonegative side effects,butalsoimproveshealthandwell-
being as evidenced by a host of biological markers.
Laser Therapy Profoundly Enhances Cellular Respiration
Cellular respiration is the process of metabolic reactions and procedures that take place in the cells of organisms, to
convert biochemical energy from nutrients into adenosine triphosphate (ATP), and then dispose of waste products
through the lymphatic system. The reactions involved in respiration are catabolic reactions that involve the redox
reaction(oxidationof one molecule andthe reductionof another).Respirationisone of the keyways a cell gainsuseful
energytofuel cellularfunction.Nutrientsthatare commonlyusedbyhuman,animal,andplantcellsinrespirationinclude
sugar, aminoacidsand fattyacids;a commonoxidizingagent(electronacceptor) ismolecularoxygen(O2).Bacteriaand
archaea (single-celled microorganisms) can also be lithotrophs (a subgroup of chemotrophic organisms involved in
cellularenergyconservation);theseorganismsmayrespireusingabroadrange of inorganicmoleculesaselectrondonors
and acceptors,such as sulfur,metal ions,methane orhydrogen.Organismsthatuse oxygenas a final electronacceptor
in respiration are described as aerobic, while those that do not are referred to as anaerobic. The energy released in
respirationisusedtosynthesize ATPtostore thisenergy.The energystoredinATP can thenbe usedto drive processes
requiring energy, including biosynthesis, and transportation of molecules across cell membranes. This process is
enhanced through the photobiostimulation process initiated and powered by laser therapy:

8. 8 | P a g e
Determining Photonic Energy Dosage (Laser Dosage)
Laser therapy dosage is a somewhat complicated issue and consists of wavelength, power density, type of tissue,
conditionof the tissue,chronicor acute problem, pigmentation,treatmenttechnique andsoon. Certainly,a maximum
effectivetherapeuticdose windowdoesexist.Anenergydensityof 20-40J/cm2 forsuperficial painand40-100 J/cm2 for
deep-lying painis generally considered acceptable; 100 cm2 is considered a typical treatment area (about the size of a
standardplayingcard).To calculate energydensity,simplydivide the energyinjoulesbythe areainsquare centimeters.
Rememberthe followingsimpleequations:Power=Energy/Time;Energy=Powerx Time;EnergyDensity=Energy/Area.
Once again, to determine the most effective laser therapy dosage, consider the following: laser wavelength, power
density, type of tissue,condition of the tissue, chronic or acute pathology, tissue pigmentation (melanin content), and
treatment technique.
Laser therapy seldom involved ‘absolutes’ in the final determination of treatment protocols. An infinite number of
treatment protocols are available (according to power, energy, and treatment duration); most of them function to
stimulate tissue,causingaphysiologicalchange inthe treatmentarea.Inaddition, withinacceptableranges, higherlaser
output leads to deeper the penetration of photonic energy into the tissue (assuming optimal wavelengths and other
importantvariables are taken intoaccount). This is due to the powerdensity(PD) formula,whichis calculatedas, PD =
mw/cm2 (PD = Power Output/surface area of the laser treatment beam).
Power Density
Power density is a major factor in laser penetration and deep tissue stimulation. In order to achieve optimal laser
stimulationof deep-seatedpathologies,powerdensitymustbe sufficient.A highlysustainedpowerdensityisnecessary
to achieve deep-tissue therapeutic stimulation.
Once powerdensityexceedsaspecificlevel,heatbuilduponsurface tissue becomesnoticeable.Atthispoint,the laser
handpiece mustbe putintomotionwithinthe treatmentareainorderto avoidtissue burns.Itisimportantto note that
many Class III lasers have a very limited ability to penetrate tissue, because the power density is not adequate to
overcome various tissue densities through which the laser energymust penetrate. Remember – epithelial tissue in the
skin covers the whole surface of the body. It is made up of cellsdensely packedand ranged in one or more layers, and
constitutes the opaquest tissue found in the body, making it difficult for laser energy to penetrate. This fact alone
supports the need for higher-powered Class IV lasers to penetrate through outer tissue layers to reach affected areas
below the adipose tissue layers.

9. 9 | P a g e
Before performing calculations of energy density, be sure that all quantitiesare expressed in their proper units; i.e.,
converttime in minutestotime inseconds.The powerof a therapylaserismeasuredinwatts,i.e.one milliwatt isone-
thousandthof awatt:1 mW = 0.001 W. Therapylasersrange inpowerfrom5mWup to30W, then convertthe milliwatts
to wattsbefore doinganycalculation(i.e.,5mW= 0.005 W).You can thinkof the powerof alaserjustlike the brightness
of a lightbulb:the higherthe wattage,the brighterthe laserlight. Dosageisthe total energydeliveredin Joules, Timeis
the rate of deliveryof energy, Energy isthe poweroutputof the laser.The followingequation appliesPower(Dosage)=
Energy/Time.
Calculate therapylaserdosage bymultiplyingoutputpowertimes treatmentduration.Forexample,energydeliveredby
a 100mW laserinthree minuteswouldbe (converting100mWto 0.1W and the three minutesto180 seconds):Energy=
Power x Time = 0.1W x 180s = 18 J. To calculate energy density, simply divide energy in joules by area in square
centimeters as follows: Energy Density = Energy/Area
For example,letussaythe 18J fromthe previouscalculationisdeliveredtothree differentareas:100cm2 (surface area
of a standard playingcard),5.5cm2 (the area of a postage stamp) and 0.4 cm2 (the area of a pencil eraser).Asyoucan
understand,18Jof energycanproduce widelyvaryingamountsof energydensity,dependingonthe sizeof theareabeing
treated.
If energydensityistoolow,itwill notbio-stimulate tissue;if itistoohighitwillinhibithealingorcouldevencause harm.
Consider this analogy: If you spread a gallon of water over an entire parched football field, you would have very few
blades of green grass, and if you dumped that entire gallon onto a very small spot, you would have mud. The key to
wateringgrassisobtainingthe requisiteamountof waterperunitarea,andthe keytoeffective lasertherapyisdelivering
the proper amount of laser energy per unit area.
Absorption Coefficient
Power(orWatts) equalsthe numberof photonsof radiationdeliveredoveraspecifictime.The energydeposited(Joules)
is the accumulation of these photons over time (1 Watt =1 Joule per second). A higher power setting will be able to
deliver optimal therapeutic doses to deeper tissue depths with equal treatment duration; lower power settings will
deliver the same amount of energy, or Joules, as the higher power settings but will require longer treatment times.

10. 10 | P a g e
Proper Dosages
Biostimulationhasbeenreportedto be effective atvaryingrates with doses from as low as 10J/cm2 all the way to 100
J/cm2 and more;however,a great deal of difference existsbetweenirradiatingnakedcellsina laboratoryand treating
an entrenched, debilitatingconditionwithinthe humanbody.Actual resultswillvaryaccordingtoa longlistof variables,
primarily:
• Overall health of the tissue
• Age of the patient
• Melanin concentration in the treatment area
• Wavelength
• Power setting
• Duration of treatment
• Tissue hydration
• Nervous system function
• Etc…
Inconclusion,basedonthe publisheddataandthe authors'ownexperience, highpowerlasertherapy isprovingtohave
more and more viable applicationsinmedicine.Inordertobe effective, lasertherapymustsatisfythe followingcriteria:
Optimal Wavelength
• Optimal wavelength isrequiredto targetproblematictissue.Atpresent,the publishedliterature stronglysuggests810
nm to 980nm for all aspectsof woundhealing,pain,anti-inflammatorytreatmentandvasodilation,withacombination
of 415 nm and 633 nm for light-only treatment of active inflammatory acne vulgaris and other skin conditions. If the
wavelength is incorrect, optimum absorption will not occur and as the first law of photobiology states, the Grotthus-
Draper law, without absorption there can be no reaction.
• Photonicwave intensity,i.e.,spectral irradiance orpowerdensity(W/cm2),mustbe adequate,oragainabsorptionof
the photons will not be sufficient to achieve the desired result.
• Laser therapy dosage, or fluence, must also be adequate (J/cm2). If power density is too low, prolonging irradiation
time toachieve the ideal energydensityordose will mostlikelynotgiveanadequate result,becausethe Bunsen-Roscoe
law of reciprocity, the 2nd law of photobiology, does not hold true for low incident power densities.
Summary
Provided these three criteria are met, laser therapy is indeed effective, and has many useful aspects in clinical practice
for practitioners of therapeutictreatments aswell as surgical procedures.The utilizationof lasertherapy as an adjunct
to other surgical or nonsurgical treatments will provide clinicians with better clinical results, less patient downtime,
reduced risk of infection, and excellent prophylaxis against obtrusive scar formation.