Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A.
Breast-cancer-related lymphedema (BCRL) is a chronic disease, and currently there is no definitive treatment for it. Low-level laser therapy (LLLT) has been used in the treatment of post-mastectomy lymphedema since 2007 in the US.
Seventeen BCRL patients referred to our lymphedema program between 2007 and 2009 were enrolled in this study. All patients had experienced at least one conventional treatment modality such as complex physical therapy, manual lymphatic drainage, and/or pneumatic pump therapy. LLLT was added to patients’ ongoing therapeutic regimen. All patients completed the full course of LLLT consisting of two cycles. The difference between sums of the circumferences of both affected and unaffected arms (DeltaC), pain score, scar mobility, and range of motion were measured before and after first and second cycles of LLLT sequentially.
RESULTS: All patients were female with a median age of 51.8 (44-64) years. DeltaC decreased 54% (15-85%) and 73% (33-100%), after the first and second cycles of LLLT, respectively. Fourteen out of seventeen experienced decreased pain with motion by an average of 40% (0-85%) and 62.7% (0-100%) after the first and second cycle of LLLT, respectively. Three patients had no improvement in pain after LLLT. Scar mobility increased in 13 (76.4%) and shoulder range of motion improved in 14 (82.3%) patients after LLLT. One patient developed cellulitis during LLLT.
CONCLUSION: Patients with BCRL received additional benefits from LLLT when used in conjunction with standard lymphedema treatment. These benefits include reduction in limb circumference, pain, increase in range of motion and scar mobility. Additionally, two cycles of LLLT were found to be superior to one in this study.
Photomed Laser Surg. 2009 Oct;27(5):763-9.
Double Blind Placebo Control Randomized Study.
Ahmed Omar MT, El Morsy AM, Abd-El-Gayed Ebid A.
BACKGROUND: In post-mastectomy patients, lymphedema has the potential to become a permanent progressive condition and become extremely resistant to treatment. The aim of this study was to evaluate the effect of low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand grip strength.
Fifty women with breast cancer-related lymphedema were enrolled in a double-blind, placebo controlled trial.
Laser treatment wavelength of 904 nm, power of 5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a week for 12 wk. Total energy applied at each point was 300 mjoules over seven points, giving a dosage of 1.5 joules/cm(2) in the active group.
CONCLUSION: Laser treatment was found to be effective in reducing the limb volume, increase shoulder mobility, and hand grip strength in approximately 93% of patients with postmastectomy lymphedema
Photomed Laser Surg. 2010 Feb;28(1):115-23
Scar tissue (adhesions) may cause pain, weakness, and limitation in motion. Characteristics of scar formation in muscles, fascial tissue, and joints is that:
It is weaker than normal surrounding tissue
It’s less elastic than normal tissue
It’s vulnerable to re-injury
It can be a cause of chronic muscle and joint pain.
Normal tissue is meant to slide and glide over one another and when it doesn’t you might feel stiffness. Worse, all nerves (which are sensitive) were meant to slide and glide as well, and when nerves become entrapped in scar tissue it can create painful and irritating symptoms.
I am a scar tissue expert. Most doctors use hands-on manual therapy and maybe have an old ultrasound machine or some type of electrical stimulation with pads. These work OK, but if you need real therapy and have chronic issues related to scar formation you need more help. I have more tools to break up scar tissue formation than any other doctor I know of. Scar tissue removal starts with warmth to the tissues. I have two different laser machines (Theralase & LightForce) which provide deep, deep, heat; I have two shockwave machine (a Piezowave & a Zimmer) to break up difficult and deep layers of scar tissue; I have the Deep Muscle Stimulator (DMS) for increased blood flow; I have the Rapid Release Technology for superficial fascia restrictions; I have a state of the art Lymphatic drainage machine and multiple hand held tools called ‘instrument assisted soft tissue’ devices.
My scar tissue methods are helping people to decrease symptoms and increase range of motion. Call 310-444-9393 for an evaluation appointment.
Regarding laser therapy – I have a TheraLase 2000 and a Light Cure laser in my office. I don’t know any other Doctor who has this combo. To create ATP to heal tissues, you need to trigger the protein pump.
The work on the Arndt-Schulz law was done only on open wounds (Turner, Laser Phoyotherapy Clinical Practice and Scientific Background 2014). “Inhibition” is cited by some laser manufacturers as the reason why higher energy or certain wavelength lasers should not be used. The specific narrow finding has been extrapolated to all conditions that lasers treat. Low power density is recommended for open wounds because layers of the skin are missing. Typically, the layers of the dermis and epidermis absorb about 66 percent of laser energy.
Tiina Karu, PhD (Ten Lectures On Basic Science of Laser Phototherapy book) disproved the notion that once the point of inhibition is reached, more energy density (does) is harmful. She found at certain levels of dose that there was inhibition, but as the dose is increased the inhibition goes away and cells thrive more. Her findings are that the Arndt-Schultz law needed to be updated because there were a number of peaks and valleys.
That is way I have two lasers – ‘the ability to go low and go high dose’. It all depends on the patient I am with.
Patients with chronic and debilitating elbow pain find relief from my poly-modiality treatment strategy. This includes hands-on myofascial release, Laser, Rapid Release Therapy, Deep Muscle Stimulation, instrument assisted soft tissue techniques (IASTM), PhysioTouch lymph drainage and eccentric exercises.
The key exercise is simple and involves grasping a FlexBar in the injured side hand, with maximum wrist extension. The other hand grips the top of the bar and twists, all the while keeping the involved wrist in extension. Both arms are brought in front of the body, elbows fully extended. The twist in the bar is maintained by holding the non-involved wrist in full flexion and the involved wrist in full extension. The bar untwists by allowing the involved wrist to move into flexion. This movement is repeated 10-15 times, up to three times a day.
To schedule an appointment call 310-444-9393.
By Jeffrey Tucker, DC, DACRB
Therapeutic lasers are used for three primary indications: eliminating pain, reducing inflammation and accelerating tissue healing. There are different types of light forces such as LED’s, low powered lasers and high powered lasers or “super-pulsed” lasers.
I have more than five years of experience using a Class IV laser and, more recently, decided to add the Class IIIB in my practice. My choice to add a Class IIIB laser had to do with the depth of penetration and the ability to use laser without having to move the handle around on the patient’s dermis without fear of it getting too hot and burning the patient.
We are all familiar with going to the market, buying a light bulb, usually anywhere from 25 to 100 Watts. We’ve placed that bulb in the socket and felt the heat it generates. I’m sure your fingers have experienced the burn by that heat. Laser light is a type and source of energy that can generate heat. The light must be absorbed in order for a photo chemical reaction to take place. For my practice, I need a device that can penetrate this light source deep into the hips, shoulders, knees, low back, etc. The Class IIIB is able to penetrate four inches of tissue, whereas other light products with the low powered LED do not have the power in order to penetrate sufficient depth of tissue. If you are dealing with more acute injuries or superficial injuries, these systems would be fine, but if you are dealing with deeper tissues or more chronic conditions, you are going to need more powerful systems.
There are two methodologies used to increase power. One is the Watts. There are lasers that use a “super-pulsed” technology with a very high impulse function of 50 Watts across the laser diode. Remember what a 50 Watt light bulb would feel like on your fingers once it’s in the socket! So, for a fraction of a second there is 50 Watts of power at that tissue surface. This “super-pulsed” function is what allows the practitioner to hold the handle of the laser in one place without a hot burning sensation and for the light to penetrate up to four inches into tissues. We cannot leave 50 Watts of continuous power on the same spot of tissue because it would burn a hole through the patient. The “super-pulsed” delivery method provides an average power of 100 mWatts. The maximum permissible tissue exposure is 500 mW depending on the wavelength.
The second important method to increase power is getting light of the right color. Photochemists typically work in only a few sections of the electromagnetic spectrum. Some of the most widely used sections, and their wavelengths, are the following: Ultraviolet: 100–400nm; Visible Light: 400–700nm; Near infrared: 700–2500nm.
The class IV laser companies try to increase the power because they feel that more power is better. They are right up to a certain extent, once they go above 500 mWatt (half of watt), they now exceed the maximum tissue exposure and the Class IV lasers will deliver heat to tissues which is why they have to defocus the beams or use the roller tract ball at the end of the laser handle. The advantage of a roller ball or tract ball is that you can perform fascial release during the laser treatment. Again, the disadvantage to the class IV laser is that the practitioner has to keep the light moving otherwise if they hold it in one place it will burn the patient. The important thing about how lasers work is to get the right light wavelength down into the tissues.
All lasers (class I, class III, class IV), are tools that emit light and work on the ATP pathway. It is the emitted light from the laser that produces photochemistry and therefore photobiology. For the basic functions of the body (metabolism), we need food and we have to have oxygen, water and glucose. The glucose or the sugar molecule goes into the cell and gets transported into the mitochondria. Between the inner and outer membrane of the cell, the glucose molecule is transformed through a process called phosphorylation, which is known as Adenosine tri-phosphate which gets converted to the basic energy source of cells called ATP. The last source of the Krebs cycle or the citric acid cycle forms ADP to ATP and involves a Cytochrome which is a light sensitive protein. Our eyes see from 400 to 700 nanometers of light. At four hundred nanometers (400nm), we see violet, then blue, green, orange and yellow. Red is the widest bandwidth, the peak is at 660nm.
Lasers also use two other pathways to help the healing process. One is the nitric oxide pathway. Nitric oxide is a very powerful molecule but it has a very short term life. It causes endothelial cells to relax or become flaccid which causes temporary vasodilation in capillaries. Vasodilation causes more blood, more oxygen and more fuel molecules to the tissues and kicks off the lymphatic system to drain off more interstitial fluids. Some molecules are too big to go through the circulatory system and need to go through the lymphatic system. The nitric oxide causes the lymphatic system to become more leaky and allow more absorption of interstitial fluids. You can take a person with osteoarthritic knees or an inflamed knee and measure the circumference of the knee with a cloth tape measure. After you laser them for 10 to 15 minutes, including the lateral and medial joint lines, you will see a reduction in the measurement of the knee circumference. The lymphatic system is a very important system for the body. It drains fluid, swelling and facilitates the natural fluid flow in order to be healthy. By activating both the cardiovascular system and the lymphatic system you can affect healing at a much faster rate.
The most common reason patients seek our professional help is because of pain. No matter how hard I try to create a practice with patients coming in for diet, nutrition and exercise therapy, I am still known for helping people get out of pain, especially chronic pain. I have a lot of first hand experience using laser to help many people go on their happy way after seeking help and not getting full satisfaction from acupuncture, physical therapy, drug therapy,and surgery. Pain is a biochemical process and laser helps relieve pain.
A nerve cell receives a stimulus of pain, trauma, heat, cold or whatever type. The receptors force sodium outside of the cell wall and create a potential difference of 80 milli-Volt. When the sodium is outside, its very hard for it reintegrate back into the nerve cells. It has to go through a sodium- potassium pump. The peak absorption of lipids is 900 nanometers, so if you look at the lipid membrane of a cell it’s a bi-lipid membrane. By using 905nm light with the “super-pulse” technology we can make the lipid membrane more porous and allow faster integration into nearby channels. This promotes removal of noxious pain chemicals when patients are treated. After a laser treatment the patient will say my injury “feels different,” “my pain is less,” “it dropped from an 8 to a 4 out of 10,” “it feels like I have greater range of motion.” Why? Because we have rebalanced the sodium potassium, we produce a lot of nitric oxide and we took away the inflammation and accelerated the tissue healing by ATP.
I have been impressed with the many conditions that laser can affect: TMJ, traumatic brain injuries, neck pain, shoulder pain, low back pain, knee osteoarthritis, rheumatoid arthritis, epicondylitis, iliotibial band, chondromalacia patella, plantar fasciitis, achilles tendinitis and muscle stiffness. There are hundreds if not thousands of conditions to treat but only a few contraindications of laser light.
Because laser light is so powerful, on a square inch basis, it is 100 times more powerful than the sun. This light would be damaging to the eyes. We make sure we wear special glasses and don’t point laser into the eyes. If the light goes into the optical path, the cornea of the lens focuses 30,000 times onto the retina and you would cause permanent damage to the retina if it was a sustained dose. Luckily, we have a blink reflex, but having laser into the eye is one of the main contraindications. If you are working around the periphery of the face, you have to wear glasses. If they are face down on a table and I am working on the back, I ask them to close there eyes, and in this case they don’t need to have laser glasses. Another contraindication is cancer. We do not treat somebody who has cancer if they have not been clear for five years. We are also cautious not to treat the abdomen of a pregnant woman.
Laser is effective for nerve action growth, wound healing, damage to nerves either through surgery or trauma, diabetic ulcers, diabetic polyneuropathy, venous stasis, improving oxygenation and myofascial pain. Laser is noninvasive, has little known side-effects and is safe. In conjunction with exercise therapy, nutrition and our hands-on skills, it is a highly effective treatment. Compared to drugs like NSAIDs and Cox 2 inhibitors, there are no contraindications.
When I looked to purchase a new Laser for my practice, I really did my research. I picked a Laser that I could use while performing deep tissue massage. The Laser plus massage provides pain relief faster than Laser alone.
Here is what I am seeing after using the laser in my day-to-day practice…
Patients like the soothing warm feeling of the Laser with deep tissue massage better than hands-on only.
Laser is best known for healing and anti-inflammatory effects. I am not disappointed by the results.
For an acute injury, the sooner you get in for the Laser treatment the quicker the healing process.
Patients like when I apply the Rock Tape after the Laser.
For long term chronic pain problems, combining the Deep Muscle Stimulator, Radial Pulse Therapy, exercise, and nutrition are getting the best results.
The Laser is useful for treating large painful areas like the low back, and in a short time obtains pain relief.
The laser is solving difficult knee, shoulder, ankle and foot pain.
Typical Laser sessions can last from 5 – 15 minutes.
The current price of a laser session in my office is approximately $40. Other Doctors are charging $60-90 for Laser treatments and they are using less quality devices.
Laser treatments are safe, they last, they are effective for analgesia of painful conditions, they penetrate deeply.
Call the office at 310-444-9393 to try the Laser with massage.
I stopped using the Biolase and am now testing out a new Laser device/system. Class IV Laser Therapy for pain relief are becoming more and more mainstream. I started using laser more than 5 years ago. I have more experience with warm laser than most practitioners. Laser therapy reduce pain associated with inflammation and swelling.
Sometimes I use the laser as a stand alone treatment and with other clients they require laser in conjuction with Radial Shock Wave Therapy, the Deep Muscle Stimulator (DMS), SCENAR or hands-on therapy. I continue to recommend stretching, corrective exercise and diet recommendations.
I also look at clients shoe wear and arch supports(or lack of support) – sometimes wearing better or different shoes with inserts helps make a big difference in low back pain. I discuss sitting and standing posture. Prolonged sitting without taking a break is a major contributor of back and neck pain. The new recommendation for taking a break from sitting is stand-up every 20 minutes for at least two minutes– don’t let your muscles tighten up in the first place. Reduce the time spent sitting!
Please come in and feel the new Laser. Call 310-444-9393
Staying innovative as always! Best, Jeff
When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going to cells, it can lead to diabetes complications.
Diabetes is a major cause of heart disease and stroke. Diabetes is also the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults in the U.S.
In this study, extracts from turmeric (curcumin) help manage blood sugar levels in people with type 2 diabetes. Daily supplements of curcuminoids for three months was associated with improved glycemic control in 50 type 2 diabetics, compared to placebo, according to findings published in Molecular Nutrition & Food Research 2012.
Ccurcuminoids may have an anti-diabetic effect by decreasing serum fatty acid possibly through the promotion of fatty acid oxidation and utilization. Curcumin, the natural pigment that gives the spice turmeric its yellow color, has become one of my favorite supplements for patients with inflammation, arthritis, and those with stenosis. Curcumin has been linked to a range of health benefits, including potential protection against Alzheimer’s disease and protection against heart failure, diabetes and arthritis.
In this study the recommendation was 300 mg of curcuminoids per day for three months. I use much higher amounts for my stenotic patients in conjunction with laser therapy.
Results showed that the curcuminoids group displayed a significant decrease in blood glucose levels, hemoglobin A1C (a marker of the long-term presence of excess glucose in the blood), and insulin resistance, compared to placebo. There was also a significant reduction in free fatty acids in the curcuminoids group, the researchers said.
I feel that it is important to take curcuminoids as a supplement and I recommend Xymogens Curcuplex tablets.
Molecular Nutrition & Food Research.
2007-2009. For men and women, the prevalence of age-adjusted arthritis increased significantly with increasing BMI (P <.001 for trend). The age-adjusted prevalence of OA among people who were obese (25.2% for men and 33.8% for women) was nearly double that of people who are underweight/normal weight (13.8% for men and 18.9% for women). Source: CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2007-2009. MMWR. 2010;59(39):1261-1265.
Treatment options for OA
In patients with knee OA, my approach tends include shoe inserts. These are good adjuncts to supplements, laser, Deep Muscle Stimulation (DMS), injectables, taping, and exercise therapy. I recommend swimming, recumbent bicycles, rowing machines and elliptical trainers. I teacgh my clients a lot of low load, easy to do stretches and strenghtening exercises. Weight loss is really important here.
On laser therapy for treating patients with knee OA: It depends on the patient and the severity of his or her OA. For example, if the patient is older and has a severely arthritic knee, a total knee replacement will probably be necessary. If a patient has OA and joint effusion, I might recommend laser, aspiration and corticosteroid injection.
If I have a patient with symptoms of OA who may have incurred an injury such as an ACL tear, I will use warm laser and DMS.
If you have undergone an arthroscopic procedure, but not yet fully out of pain, I will use laser.
I often use glucosamine and chondroitin sulfate with high dose omega 3’s.
I like topical menthol products such as BioFreeze. These have evidence of efficacy.
There are dangers of using cortisone, which has been administered for years as an injection in the joints. If any of my patients ask for cortisone because it worked when administered to them 10 years ago, I would educate them on safer long-term options. The most common recommendation I have for most of my patients is to eat less carbs and exercise more. I love the anti-inflammatory diet coupled with UltraInflamX by Metyagenics and high dose omega 3 fish oils. Through weight reduction and a low-impact exercise program, many patients will achieve dramatic improvements in their arthritis pain.
My goal for patients is to decrease pain and inflammation, maintain or improve function and retard disease progression if possible. In this regard, preventing damage to subchondral bone, cartilage, joint space narrowing and osteophyte formation is the goal.
The contraindications for NSAIDs include gastrointestinal (GI) bleeding or adverse effects to the kidneys or liver. Some patients worry about taking a glucosamine product because they have diabetes, but I inform them no data support this concern.
I might recommend UltraInflamX by Metagenics alot. I like garlic, ginseng and gingko — but these affect bleeding time. If used in conjunction with NSAIDs, the risk of GI problems increases.