Laser is a Light Amplification device that works by Light Stimulated Emission of Radiation (LASER). Low level laser therapy (LLLT), or cold laser, describes these medium powered lasers which are the best and most widely accepted type of laser used in rehabilitation. Historically, these devices have been classified as a non-thermal modality, meaning they do not generate heat within the tissue. Simply put, it’s a form of light energy that can be used to create physiological responses in the body, similar to electrotherapy or ultrasound.
There are many types of lasers which are used in a wide range of applications for laser technology. Lasers are classified based on their power outputs (measured in Watts or milliWatts) and the associated risk for causing biological damage. There are 5 classes of laser (1, 2, 3A, 3B and 4). As we ascend through the classes of laser from 1-4, the power output and the risk for biological damage increase. In cold laser, we typically are referring to class 3A or 3B lasers.
There are four basic components to any laser:
One of the key elements to laser operation is the process known as stimulated emission. Stimulated emission occurs as energy is inputted into the lasing chamber and energy is absorbed by atoms of the active laser medium, driving them to a higher energy level. As those atoms return to lower energy levels, photons are released, which can go on to stimulate other atoms, amplifying the process. As amplification continues and more photons are released, they are directed out of one end of the laser chamber in a concentrated beam. In therapeutic lasers, a laser applicator is used to direct the laser beam(s) to the targeted treatment area to stimulate a physiologic response.
Laser therapy uses a process called photobiomodulation to change the condition of damaged tissue by stimulating cellular metabolism, thereby accelerating the healing process (essentially energy in the form of ATP is juiced into the tissue). As light pores into the tissue, photons are scattered, reflected and absorbed. Lasers operating in the near infrared spectrum, from 650 to 1300 nanometers, can penetrate to deep tissue structures (our Lumix 250 can penetrate 3” deep!). Light that penetrates into the tissue can be absorbed by melanin, hemoglobin, oxyhemoglobin, and water. Energy from these absorption events will be dissipated as heat, generating a soothing warmth in the tissue. The primary target for photobiomodulation is the cytochrome c complex (think detox and antioxidant powerhouse of the cell), which is found in the inner membrane of the mitochondria that resides within the cell. Cytochrome c is a vital component of the electron transport chain that drives cellular metabolism. As light is absorbed, cytochrome c is stimulated, leading to increased production of ATP, the molecule that facilitates energy transfer within the cell. In addition to ATP, laser stimulation also produces free nitric oxide and reactive oxygen species. Nitric oxide is a powerful vasodilator (increases blood flow) and an important cellular signaling molecule involved in many physiological processes. Reactive oxygen species have been shown to affect many important physiological signaling pathways, including the inflammatory response. Together, the production of these signaling molecules have been shown to induce growth factor production, to increase cell proliferation and motility and to promote extracellular matrix deposition and pro-survival pathways.
Outside the cell, nitric oxide signaling drives vasodilation which improves microstimulation in the damaged tissue, delivering oxygen, vital sugars, proteins and salts while removing wastes. These mechanisms of action have been proved by over 40 years of laboratory experiments using lasers of minimal power. The recent development of higher-power, Class IV systems affords the device the ability to efficiently deliver adequate doses of light deep into tissue to reduce pain, reduce inflammation and accelerate healing. The advent of cold laser therapy has made it possible to not only apply the benefits of photobiomodulation superficially, but to also treat a greatly expanded range of conditions by delivering a clinically effective quantity of photos to cells deep within the tissue.
Application of cold laser therapy is very easy and similar to ultrasound, but there are a few key differences. In order to effectively use cold laser therapy, the skin should be cleaned with alcohol prior to treatment. No coupling media, lotions, gel or ointments should be used during the delivery of cold laser, the laser head applicator is applied directly to the skin above the treatment area. No movement is necessary during the duration of the treatment and maintaining firm, direct contact with the head of the laser onto the skin is important because pushing down on the treatment area will squeeze the blood out of the treatment area which prevents blood from absorbing the laser energy and preventing it from affecting the target tissue. Lastly, patients and clinicians must put on the provided protective eyewear and continue to wear them throughout the duration of the treatment. Even if the laser is not visible to the human eye, it can still cause damage if directed at the eye.
Although cold laser therapy is typically very safe, there are a few contraindications, typically associated with light sensitivity. Some of these include using the laser on cancer (tumors or cancerous areas), placing it directly on the eyes, for patients with photophobia or abnormally high sensitivity to light, when using photosensitizing medication, placing it directly over the fetus or the uterus during pregnancy, placing it on symptoms of unknown cause, over hemorrhaging lesions or near/on a pacemaker.
The benefits of using cold laser therapy are extensive. Some of the most pertinent benefits include the acceleration of tissue healing, increased localized circulation, pain and swelling reduction and decreased inflammation.
Cold laser is used to support; alzheimer’s angiogenesis, autoimmune diseases (all of them, including hashimoto’s hypothyroid, rheumatoid arthritis and lupus), Bell’s palsy, bone repair, brain injury/concussion, burns, cancer, cardiac disease, circulation improvement, collagen fiber growth, degenerative osteoarthritis, depression, diabetic ulcers, eczema, herniated discs, herpes, immune system, migraines, neonatal jaundice, neurological problems, nerve injuries, psoriasis, psychological problems, scar tissue and postsurgical adhesions, shingles, stroke, tinnitus, traumatic brain injury, wound healing and more!
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