Desirae Merrill

5/1/19
Link Internships

What is laser therapy?

Laser Therapy is a small infrared laser that penetrates through the tissue and inserts
photons into the mitochondria, improving the nutrients that are moving across the cell
membrane. Producing ATP cell production energy. Adenosine Triphosphate is a natural
chemical compound that exists in all living things, including your muscles. It is a chemical that
gives energy to drive multiple processes in living cells.

Effects:

Accelerated Tissue Repair and Cell Growth- the inferred light accelerated cell
reproduction and growth. The laser light increases accessible to the cell so that cell can collect
nutrients faster and throw out the waste products. Due to that cells, tendons, ligaments, bone,
nerves, and muscle are repaired faster.

Faster wound healing- the light therapy stimulates fibroblast development in damaged
tissue. A protein that is essential in order to replace old tissue or to repair tissue injuries, that is
called collagen. Laser therapy helps on open wounds, scars, and burns.

Reduced fibrous tissue formation- Through laser therapy it reduces the forming of scar
tissue from cuts, scratches, bruns, or even surgery this happens by inducing production of more
normal type 1 collagen.

Reducing inflammation- anti-emetic is the cause of vasodilation in laser light it starts the
lymphatic drainage system which basically means it drains the swollen areas. After the laser
treatment the swelling from inflammation will go down.

Analgesia-

Improved vascular activity

Increased metabolic activity

Improved nerve function

Immunoregulation

Trigger points and Acupressure points

Zoom tool: this is used to change the energy density, the spot size regulator helps you select
different treatment diameter. Which controls the energy density. It is not applied in a fixed point,
it is applied all around the area to be treated. If you need to treat a fixed point decrease the
applied continuous power CW or change to modulated mode Hz

Techniques:
Scanning and gridding technique-
This is a very common technique in laser therapy, basically you move the infrared light in
a grid like pattern across the injured area. Making sure it is at a constant speed, in a back and
forth and up and down movement so that the all the tissue in that area get the beneficial laser
treatment energy.

Pushing or Pressing:
This technique can be used as a pressure device that can help with trigger points. You
can do this by pausing and holding the want in one place for a few seconds, if needed clinically.
Most of the time the device is set to frequency modulates Hz mode.

Non-Contact:
With this technique you can use the zoom handpiece, you hover the wand over the
surface of the skin. Use the zoom handpiece and adjust the beam to the size it was when you
were in contact with the skin. This is best used when there is an open wound or sensitive skin.

Tips to Improve treatment results:

Range of Motion-
Through having patients go through active range of motion, like flexion, extension,
abduction, adduction, etc. during the laser treatment you can effectively stimulate
mechanoreceptors in the stabilizer muscles and joint structure. In some cases laser treatment
with active range of motion can break up adhesions in soft tissues.

Line of drive- Aim the laser at the place of target tissue. When doing this make sure the
wand is perpendicular to the skin and not at an angle. You hold it that way because there will be
less amount of reflection and increased the amount of energy that goes to the tissue. When
treating a patient you want the outcomes to be consistent so you can do that by holding the end
of the wand directly on the skin if the patient can tolerate it. If the patient has sensitive skin then
hover over the skin surface.

Pressure Technique- If you want to treat a individual point, you can use the laser therapy as an
acupressure device. When the laser is in frequency modulated Hz mode, not CW or ISP mode
because there is a risk of fur overheating. You can also when doing this push the wand in the
affected area and muscles, by doing that you are pushing away the vascular beds, giving a
deeper penetration. As well as using this tip for trigger points. When doing this don’t hold it for
too long in one spot.
Treat Nerve Roots- treat the nerve roots in the area that is needed. Through light therapy the
light will energize those nerve roots causing better pain management. Apply the laser in the
same area of laser treatment and the same dosage.

Treat from Proximal to Distal- Laser stimulates blood and lymphatic vessels to dilate. Dont treat
distally first because the fluids that are stimulated dont escape if the flow is blocked in the tissue
above. Doing that can cause pain. Treat proximal to distal from the center of the body to the
periphery.

Treatment Schedule- there is no really set schedule saying how many time you could do it. It's
said that acute injuries should be treated with a low dose more often. However the dosage is
already set on this program. Chronic doses are more successful with higher dosages about
twice a week.

Metal Implants- you can give laser treatment directly over metal implants no matter where they
are placed. There is no heating of the metal implant. Only the tissue is absorbing, patients with
joint replacement are in chronic pain due the the pain fibers being altered.

Nutrition- the laser improves the circulation in that targeted section by drawing nutrition. If the
patient has poor nutrition they might not feel the difference in the treatment. A nutrient that has
to exists for the production of ATP is COenzyme Q10. They might not get the benefits because
they are taking a medication that strips that nutrients away. If that happens you should possibly
give the patient a diet with 100mg CoQ10.

Geriatric Patients- like some patients you will run across geriatric patients, they will be extra
sensitive to k laser more than people who are just sensitive to the laser. Since they are sensitive
you can give them a lower dose if the machine allows you to change the dosage.

Contraindications of laser therapy:

Pacemakers- the metal can not be affected by the photons during laser therapy, however any
light therapy device or electrical stimulation can affect that. Similar to ultrasounds you can do it
anywhere else

Pregnancy- avoid large doses over the pregnant uterus, Do not treat on gravid uterus.

Epileptic seizures- with red light therapy between 5-10 Hz range can cause epileptic seizures
use extreme caution when using laser therapy. There are no studies on infrared light on people
with epilepsy sense it is a invisible light. However use with caution.
Thyroid Gland- The thyroid gland is a very delicate structure. To be safe avoid using the laser
over the gland. Some animal studies show that with large doses of laser therapy can cause
thyroid disorders.

Children- like ultrasounds where you can’t do on children due to the fact it will mess with the
growth plate. There are some concerns about growth plates in children and laser therapy. There
are not many studies on laser and growth plates and since its unknown. Avoiding doing laser
treatment on children is encouraged.

Do not treat over area recently injected with steroid or NSAID

Treat fix points, keeping a distance of two centimeters from the skin of the patient. Especially if
you are doing continuous emissions, in order to check the sensibility of the patient

Do not treat directly over cancer or tumor, cancer should not be treated unless with the
specialists. It is said the laser can contraindicated in patients going through radiation treatments.

Use the laser glasses that are given. If patient is face down on the table they do not need
glasses, however if not both patient and PT have to wear glasses. Direct exposure or if the laser
light reflects off the skin can cause damage to the retina and resulting in scotoma.

Case study- Comparison of laser therapy, phonophoresis, iontophoresis in lateral epicondylosis

(tennis elbow)
Tested grip strength, pain, and function
In the end of this clinical trial they found not a big difference. However they found that laser
therapy provides benefit only for pain, iontophoresis in beneficial for both pain function. LLLT is
more influential than iontophoresis for decreasing pain. When they compared phonophoresis
and iontophoresis in terms of effectiveness, iontophoresis is better in terms of pain,function, and
grip strength.

Frequency
Bone, Cartilage- CW; 2-100
Connective Tissue- 500-700
Soft Tissue- 2500-5000
Open Wounds- 10,000

Surgery- Could possibly to laser treatment after surgery, or starting early to help pain and
decrease scar tissue.