All posts in Laser Therapy

Laser Therapy

The goal of laser therapy is to deliver light energy units from infrared laser radiation, called photons, to damaged cells. The consensus of experts is that photons absorbed by the cells through laser therapy stimuate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state.

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Laser Therapy for Pain

Laser Therapy continues to be a large part of my treatment program. Laser is highly effective in the treatment of soft tissue and sports injuries, wound healing, dermatological conditions, musculoskeletal problems, as well as a number of conditions you might not even think  about going to a chiropractor for. 

Many practitioners and lay people are unaware of the extensive applications of Laser Therapy. I will definitely continue to use laser on my  patients.

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Chronic Pain News

Thinking of events as a catastrophe, fear, and being depressed appear to be major predictors of whether acute pain from surgery or injury will morph into chronic pain, researchers reported at the annual meeting of the American Academy of Pain Medicine. For patients with low back pain, “castastrophizing has been found to be seven times more powerful than any other predictor in predicting the transition from acute to chronic pain,” said Sean Mackey, MD, PhD, chief of the pain management division at Stanford University.

Fear also appears to play a role, Mackey commented. “Those who had more fear during an acute low back pain episode were much more likely to ultimately over-predict the amount of pain they had, which ultimately led to significant increase in fear-avoidance behaviors, with subsequent worsening of symptoms, increase in duration of pain, and increase in disability,” he said.

Depression and anxiety also had similar effects. “About 30% to 65% of patients who have chronic pain also have comorbid depression,” Mackey added. 

Being optimistic was linked to better recovery and higher quality of life (Annals of Surgery 2007; 245: 487-494). 

As part of my chronic pain management strategy, I use therapeutic lifestyle changes including diet, nutrition, attitudinal discussions and gentle exercise. The laser modality is still very, very new to most clients and definitely needs to be tried by chronic pain patients.

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Erectile dysfunction & laser therapy

You heard it here first… it’s not the news about the fact that there is an epidemic of erectile dysfunction in men. Let’s connect some of the dots… 76% of men reporting erectile dysfunction are obese. Men in America are steadily becoming more obese and steadily becoming sterile – there is a direct connection between men accumulating too much estrogen in there body through diet and chemical toxicity exposure, and obesity and sterility: manufactured foods cause obesity. You have to clean up your diet and go on a cleanse. The adipose tissue in your body sets in motion estrogen production; excess estrogen promotes more obesity – round and round it goes…but the part I want to tell you about is that laser has been shown to help ED. Figure out the treatment…diet, exercise and laser on the shaft of the penis to increase blood flow!

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Plantar fascitis & foot pronation

Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who excessively pronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.

Symptoms: A chronic mild ankle sprain could have symptoms related to stretching of the ankle ligaments; mild pain; mild swelling on the outside of the ankle; some joint stiffness or difficulty walking or running.

Plantar fascitis can be heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia. Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet. Pain is usually worse first thing in the morning. After a few minutes it eases as the foot gets warmed up, but can get worse again during the day especially if walking a lot. 

How to best treat and prevent this from happening again: Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation. However a good plantar fascitis taping technique can help the foot get the rest it needs by supporting the plantar fascia.

Cold therapy can be applied regularly until symptoms have resolved.

Stretching the calfs and plantar fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to becoming inflamed. Tightening of the plantar fascia happens in particular over night which is why pain is often worse in the morning. A plantar fascia night splint is an excellent product which is worn over night and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Arch supports or custom made orthotics are often required.

In office treatment includes using the warm laser, the Deep Muscle Stimulator (DMS), or the ‘scrapping’ tools called Graston or SASTM. I like to use K-tape as well.

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Corticosteroid injections

Corticosteroid injections ease the pain of tennis elbow short term but may worsen it long term, according to a meta-analysis.

The injections significantly cut pain scores over the first four weeks with a standardized mean difference of 1.44 compared with no intervention (*P*<0.0001), Bill Vicenzino, PhD, of the University of Queensland in St. Lucia, Australia, and colleagues reported online in *The Lancet*.

But by six months, the effect had reversed to significantly favor no treatment (standardized mean difference -0.40, *P*<0.003). And at 12 months, no treatment still looked better than the injections (standardized mean difference -0.31, *P*=0.05).

Action Points
– corticosteroid injections ease the pain of tennis elbow short term but may worsen it long term.
– this study concluded that there is insufficient evidence for the efficacy of corticosteroid injections for treatment of tendinopathies of the Achilles and kneecap.
– other tendinopathies showed mixed results.

There is insufficient evidence for the efficacy of corticosteroid injection in tendinopathies of the Achilles and kneecap, and the rarity of acute tendon rupture with corticosteroid injections — less than 1% in the meta-analysis — was reassuring, the editorialists noted.

Other injections, such as such as plasma-rich protein, prolotherapy, or sodium hyaluronate injections, should still be considered experimental with no evidence that any are a magic bullet for tendinopathy, they cautioned.

Of the 2,672 patients in these trials, 1,171 had tennis elbow. For them, corticosteroid injections were consistently better in the primary outcome of protocol-defined pain score at one month with large effect sizes compared with no intervention, nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and orthotic devices.

At six months, though, tennis elbow showed significantly poorer reductions in pain compared with no intervention, NSAIDs, physiotherapy, and platelet-rich plasma injections. The same pattern was seen at 12 months with the exception of no difference between NSAIDS and corticosteroids.

Notably, repeated corticosteroid injections — ranging from three to six over 18 months — actually yielded poorer long-term pain results than just one injection.

For rotator cuff tendinopathy, the 10 trials showed conflicting short-term results for corticosteroid injections ranging from a medium effect compared with placebo to no difference compared with NSAIDs or physiotherapy. Intermediate and long-term results showed no differences among the treatments.

For medial epicondylalgia (also known as golfer’s elbow), the one study available showed no benefit of corticosteroid injection even in the short term.

For tendinopathies of the leg, the one trial evaluable indicated a large short-term pain reduction with corticosteroid injection, but more for patellar than Achilles tendons.

Given these findings, the researchers cautioned in the paper that “response to injection should not be generalized because of variation in effect between sites of tendinopathy.”

Adverse events seen with corticosteroid injection included atrophy (9%), pain (8%), depigmentation (less than 1%), and one case of tendon rupture of the Achilles tendon (less than 1%).

Among the other types of injections, the researchers found:

– The sclerosing agent polidocanol (Asclera, also known as lauromacrogol) improved patellar tendinopathy but not Achilles tendinopathy or tennis elbow.
– Platelet-rich plasma yielded mixed results with no short- or intermediate-term pain reductions in one study for Achilles tendinopathy but a large effect at intermediate and long term in a second study.
– The collagen-building substance sodium hyaluronate substantially improved tennis elbow at all time points compared with placebo in one study but was no better than electrotherapy for rotator cuff tendinopathy in another.
– Injections of an irritant to stimulate the body’s repair mechanisms (prolotherapy) held no reduction in pain short term but a big effect at six months for tennis elbow in one study and no difference at any time point for Achilles tendinopathy compared with the combination with eccentric exercise in a second study.
– Botulinum toxin (Botox) showed a big pain reduction short term for chronic tennis elbow compared with placebo in one trial.

The study received partial support from the National Health and Medical Research Council of Australia.

*Primary source: *The Lancet
Source reference:
Coombes BK, et al “Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials” *Lancet* 2010

 

Dr. Tucker recommends a trial course of warm laser and/or Deep Muscle Stimulation (DMS) for such injuries prior to cortisone injections. A reasonable trial course may include 6-7 sessions. If the pain improves the warm laser and/or DMS can be continued. If the trial course did not help, it is reasonable to try another course of treatment.

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Laser Treatments

Laser therapy has been around for a long time but it is considered cutting edge treatment for musculoskeletal injuries and pain.
Laser therapy stimulates cellular activity, expediting the healing processes to reduce inflammation and repair damaged tissue. 

You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.

Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:

Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.

Treats acute and chronic conditions as well as post surgical pain.

Pain relief is often felt immediately.

Most laser treatments take only 10-20 minutes.

Are you a potential candidate?

  • If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
    This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
  • If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
  • If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
  • If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
  • If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
  • Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.

Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442

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Tennis elbow – injections vs therapy

BMJ, doi:10.1136/bmj.38961.584653.AE (published 29 September 2006)

Mobilisation with movement and exercise, corticosteroid injection, or
wait and see for tennis elbow: randomised trial Leanne Bisset et al
Abstract
Objective: To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.

Participants: 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks’ duration, who had not received any other active treatment by a health practitioner in the previous six months.
nterventions: Eight sessions of physiotherapy; corticosteroid  injections; or wait and see.

Results: Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most
participants in both groups reported a successful outcome.

Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.

Conclusion: Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term.

The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.

I have found the warm laser to be very effective for tennis elbow.

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What is High Power Deep Tissue Laser Therapy?

Laser Therapy is a non-invasive, safe, and effective treatment modality where light is used to relieve pain, reduce inflammation, and promote wound healing and soft tissue repair. Most therapy lasers on the market today have a power range from 5mw to 500mw, making them a cold laser. Our laser will emit a power range from 1000mw to 10,000mw, making this a high-power heat deep tissue laser that can put an end to your pain fast!

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Laser treatment

I use High Power Laser Therapy (7.5 watts). Laser stimulation has been shown to increase blood flow and lymphatic drainage while, at the same time, stimulating endorphin and enkephalin release for pain management. Stimulation with laser reduces inflammation, and promotes nerve regeneration.

High Power Laser Therapy has the ability to reach deep within the body when compared to Low Level Laser Therapy. Laser energy apperas to also biostimulate collagen and fibroblast growth.

I usually use the laser in combination with hands-on therapy and I often use the Deep Muscle Stimulator (DMS) as well. Exercises are taught based on the Functional Movement Screen (FMS) and squat evaluation.

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