1. Benefits of cold laser on lymphoedema
The use of low-level or ‘cold laser’ by health professionals in treating lymphoedema
is growing, with Australia having led the way in the use of this therapy for this
distressing condition.
HealthSpeak spoke to physiotherapist Sharon Tilley from the Lymphoedema and
Laser Therapy Clinic in Adelaide to find out more.
Sharon has worked in hospitals and private clinics and lectured at university level.
She commenced at the clinic in 2001, initially as a staff physiotherapist, becoming a
principal in 2009. She has also completed postgraduate studies in lymphoedema
management; accredited through the Australasian Lymphology Association.
“My first experience with low-level laser was while working as a Hand Rehabilitation
Physiotherapist in Darwin - using it to assist in wound management. In the last five
years, as interest in the clinical use of laser has grown and more robust research and
meta-analysis has been published, I have been increasingly busy speaking for
various professional groups, most recently at the World Laser conference in
Washington DC,” Sharon said.
Australian research pivotal
She explained that Australia had led the way in the use of laser for lymphoedema. In
2009 she was invited to write a paper for the UK Journal of Lymphoedema outlining
the clinical methodology of laser use for the condition as their lymphoedema
community’s interest began to gain momentum.
She said that Professor Neil Piller, based at Flinders University, was a leading world
expert in lymphology and his prolific speaking engagements and research had placed
Adelaide in a prime position on the global lymphoedema map.

2. It turns out that Sharon’s predecessor at the clinic Ann Thelander ‘accidentally’
discovered the benefits of cold laser on lymphoedema while treating a
musculoskeletal issue.
“The patient returned with the unexpected news that her long standing lymphoedema
in the affected limb had also improved. Ann sought out the only research available at
the time involving the use of laser on medically induced oedema in rats in 1985 and
used some of those basic parameters to form her own protocols.
“To this day similar wavelengths and energy densities are used by clinicians around
the world with some ‘tweaking’ as new laser units are manufactured and clinical
responses documented.”
The first research using laser for breast cancer related lymphoedema was
undertaken by Ann Thelander in collaboration with Flinders University (Piller, et al,
1995). A scanning laser was used to treat the axilla and several 10 cm x 10 cm
segments of the affected limb. Plethysmography measurements showed a mean
decrease in volume of 19% following 16 treatments over 10 weeks.
A randomised controlled trial in Adelaide finally followed in 2004 (Carati et al) which
used the application of a handheld laser in the affected axilla alone. This showed no
immediate improvement compared to the control group, but interestingly, at three
months follow-up, 31% of subjects had at least a 200ml volume reduction compared
with only 2.8% in the placebo group.
These ongoing and longer term improvements following treatment sessions are
believed to be a result of reduction in tissue fibrosis through improved macrophage
activity (which allows better lymph drainage) as well as stimulating collateral vessel
regrowth. Bioimpedance Spectroscopy measurement is a sensitive and accurate
method of determining changes in extracellular volume (ECV). Of interest is the fact
that research has shown both immediate and sustained improvements in ECV
following laser; even in areas such as trunk segments that have not directly been
irradiated with laser!. This suggests there is a systemic affect in addition to the

3. local response as a result of a cascade of chemical and enzyme changes that
occurs through modulation of cellular activity when the light directly stimulates ATP
production – the cells’ energy fuel.
Significant benefits
Sharon told HealthSpeak that the first response that patients usually reported was a
reduction in symptoms such as limb heaviness, aching and tightness. This can be
significant and immediate. Changes in bioimpedance measurement can also be
immediate but circumferential change, using a tape measure for example, is a
cruder method of objective change and often not seen for several months.
At Sharon’s clinic laser is only one tool in the toolbox and it is usually combined with
other modalities such as lymphatic drainage massage, bandaging, compression
garments and exercise therapy.
Several patients have however elected to only have laser therapy as it’s been
discovered through trial and error that the laser gives them the best result for the
smallest financial outlay, an important factor in access to health care.
In support of this, a small trial of 46 participants undertaken in the USA in 2013
showed that 20 minutes of laser was as effective in reducing symptoms as 40
minutes of manual lymph drainage.
Further advantages
Other than its effectiveness in reducing limb discomfort, swelling and fibrosis, the
other advantages for the patient are that it poses no negative impact on day to day
lifestyle unlike other modalities such as thick multilayer bandaging which can
affect ability to work, walk, dress and even eat. Additionally, laser has no
carcinogenic effect on normal tissue and several initial studies have even shown
laser to have a ‘protective’ effect on normal tissue subjected to ionising radiation as
well as a pro-apoptotic affect on cancerous cells.

4. Sharon said this would be one of the ‘hot topics’ for future research.
(Breakout box)
Patient case study
A 63 year old gentleman presented who had who undergone extensive excision and
groin dissection for a pleomorphic sarcoma in the left adductor muscle. Due to a
large seroma in his upper thigh his surgeon did not want a compression garment
fitted initially. Massage was ineffective and painful because of the degree of hard
fibrotic tissue throughout his thigh. Laser was the modality of choice and in one week
with three laser treatments his L-Dex score had reduced from 69 to 52 ( normal
scores are between -10 to +10 ). As his tissues were then much softer and his
seroma drainage volume had reduced, a garment was then fitted six weeks after
initial assessment, massage also commenced and his L-Dex score after two months
of treatment (8 laser sessions and 2 manual lymphatic drainage sessions) had
reduced to 17. After the first two months of more intensive sessions he had monthly
sessions of laser and massage and the L-Dex score is now stable at 14 with
circumferential reductions of up to 7 cm at various leg segments.
An important and unexpected outcome given his lack of hip and knee flexion at initial
assessment was that he has been able to resume competitive cycling and recently
rode in the BUPA challenge event as part of the Tour Down Under – proudly wearing
his compression garment, of course!
Sharon told HealthSpeak that the future for laser therapy was exciting and that it
showed promise in ever expanding areas of medicine such as mucositis, macular
degeneration and even degenerative neurological disorders.
(ends)